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ABSTRACT Objective: To investigate the primary reasons for smoking relapse and examine how they vary according to the time elapsed between abstinence and relapse. Methods: This was a cross-sectional study analyzing 1,305 adult smokers who sought treatment at a smoking cessation center in Brazil between January of 2018 and December of 2020. All participants had previously attempted to quit smoking. On the basis of the longest duration of abstinence achieved, participants were divided into two groups: early relapse (within six months) and late relapse (after six months). The main reasons for relapse were assessed for the overall population and compared between the two groups. Results: The most frequently reported reasons for relapse were chemical dependence, anxiety, stress due to everyday problems, and irritability/anger. In comparison with individuals with late relapse, those with early relapse more commonly cited chemical dependence (45.0% vs. 20.5%; p < 0.001), anxiety (39.2% vs. 27.3%; p < 0.001), and irritability (20.5% vs. 13.4%; p = 0.001). In contrast, late relapse was more often associated with stress due to everyday problems (35.5% vs. 23.1%; p < 0.001), exposure to high-risk situations (19.6% vs. 9.2%; p < 0.001), and interacting with smokers outside the home (10.7% vs. 5.6%; p = 0.001). Conclusions: Reasons for smoking relapse vary over time. Early relapse is more frequently associated with chemical dependence, anxiety, and irritability, whereas late relapse is more commonly associated with stress, exposure to high-risk situations, and social exposure to smokers. These findings may guide tailored interventions based on the timing of relapse.

Resumo em Inglês:

ABSTRACT Objective: To determine the prevalence of electronic cigarette use among physicians, residents, and medical students at a university hospital in northern Brazil. Methods: We conducted a cross-sectional observational study using a semi-structured questionnaire to collect data on participants’ knowledge and use of electronic cigarettes. Results: A total of 36 participants were included, most of whom were young female medical students (58.3%) in the 21- to 30-year age bracket. Although 91.7% were aware of electronic cigarettes and their associated health risks, 16 participants reported recreational use of such devices. Conclusions: Despite high awareness of the potential harms of electronic cigarettes, a considerable proportion of participants-primarily young female medical students-continue to use electronic cigarettes recreationally, highlighting the need for targeted educational and preventive strategies among future health care professionals.

Resumo em Inglês:

ABSTRACT Introduction: Post-bronchodilator (BD) spirometry testing is required for a diagnosis of airflow obstruction (AO) and COPD. We compared the impact of pre- and post-BD AO, as well as that of pre-BD and post-BD reference values, on survival, exacerbations, and FEV1 decline. Methods: We analyzed data derived from the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) study, involving individuals residing in three Latin American cities and evaluated 5-9 years after baseline examination. Categories were formed by pre-and post-BD FEV1/FVC < the 5th percentile (lower limit of normal) by PLATINO reference values (pre-BD and post-BD). Results: At baseline, 2,942 participants completed pre- and post-BD spirometry; 2,262 were normal (controls); 139 had pre-BD AO (FEV1/FVC below the lower limit of normal; reversible AO); 230 had pre-BD and post-BD AO (persistent AO); 43 had only post-BD AO; and 148 had a preserved ratio impaired spirometry (PRISm) pattern. Additionally, 105 individuals had post-BD AO by post-BD reference values. When compared with controls, the reversible AO group (hazard ratio [HR] = 1.9; 95% CI, 1.1-3.1), the persistent AO group (HR = 2.99; 95% CI, 2.1-4.3), the PRISm group (HR = 1.6; 95% CI, 0.9-2.7), and the group of patients with AO by post-BD reference values (HR = 1.9; 95% CI, 1.1-3.4) had a higher mortality; those with a PRISm pattern and those with persistent AO had more exacerbations, and the latter group had an additional FEV1 decline in adjusted models (−13.4 mL/year; 95% CI, −6 to −21). The reversible AO group had a higher risk of developing COPD (post-BD AO) during follow-up (OR = 4.1; 95% CI, 2.0-8.5). Conclusions: Individuals with post-BD AO identified only with post-BD reference values had an increased risk of death. Those with pre-BD AO had higher mortality and an increased risk of developing COPD, therefore requiring close follow-up monitoring and being classified as pre-COPD patients.

Resumo em Inglês:

ABSTRACT Objective: Cystic fibrosis (CF) lung disease begins in early childhood, despite close follow-up and monitoring. Although imaging methods such as chest CT may detect structural changes before significant clinical manifestations, their role in preschool children remains debated. Evidence from low- and middle-income countries is limited. We sought to investigate the age at first chest CT, as well as imaging findings and their impact on treatment decisions. Methods: We conducted a retrospective cross-sectional study including children with CF attending a referral center in the city of São Paulo, Brazil, between 2009 and 2019. Clinical data were obtained from patient medical records and the Brazilian CF Registry database. Results: A total of 90 children were included, of whom 56.7% were male and 71.1% carried at least one F508del variant. The median age at CF diagnosis was 2.4 months (IQR, 1.5-4.5). The first chest CT was performed at a median age of 36.7 months (IQR, 28.1-47.8). Structural lung abnormalities were common, including air trapping (in 86.6% of the children), mucoid impaction (in 75.5%), bronchiectasis (in 45.5%), and atelectasis (in 35.5%), with only 4.4% of the scans being considered normal. Prescription of dornase alfa was based on CT findings in 74% of the cases, with initiation at a median age of 36.9 months (IQR, 28.9-57.6). A strong correlation was observed between age at first chest CT and age at initiation of dornase alfa therapy (r = 0.658; p < 0.001). Conclusions: Early chest CT revealed a high prevalence of structural lung disease in Brazilian infants and preschool children with CF and strongly influenced the initiation of dornase alfa.

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ABSTRACT Objective: Donor-derived disease is an inherent risk in solid organ transplantation, especially lung transplantation (LTx), because of direct contact between the organ and the external environment, and the consequences of lung denervation after LTx. We sought to demonstrate the burden of pneumonia after LTx in a large center in Brazil, characterizing the main source of infection and its associated mortality. Methods: We performed a retrospective analysis of all LTx procedures occurring between 2017 and 2023 at a public center in Brazil. All microorganisms isolated from the donor BAL fluid and the recipient bronchial secretions at organ harvest were compared with those found by postoperative day 14 and classified as donor-derived, recipient colonization-related, or hospital-acquired pneumonia. We analyzed the characteristics of donors and recipients, as well as the associated mortality. Results: Donor-derived pneumonia was found in 8/149 patients (5.36%) who received lungs from infected donors. In all cases, donor-derived pneumonia was due to gram-negative bacilli, all of which showed drug resistance, causing a 50% mortality rate. Recipient colonization-related pneumonia occurred in 14/107 patients (13%), being mostly due to Pseudomonas aeruginosa (in 58.8%), with a 28.6% risk of death. Hospital-acquired pneumonia occurred in 17 of 217 recipients (7.83%), being mainly due to Acinetobacter baumannii (in 20%), P. aeruginosa (in 15%), Klebsiella pneumoniae (in 10%), Stenotrophomonas maltophilia (in 10%), or Burkholderia cepacia (in 10%), with a mortality rate of 50%. Conclusions: Although infrequent, donor-derived pneumonia appears to be associated with high early mortality, comparable to that for hospital-acquired pneumonia. Recipient colonization-related and hospital-acquired pneumonia are linked to an increased chance of death, especially in patients colonized with P. aeruginosa and those with extensively drug-resistant bacteria, respectively.

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ABSTRACT Objective: To analyze cases of foreign body (FB) aspiration in the last 50 years, describing clinical presentations, radiological characteristics, extraction methods, complications, and surgical interventions. Methods: A documentary study was conducted by reviewing the medical records of patients diagnosed with FB aspiration in the 1976-2025 period at the São Paulo State University School of Medicine Hospital, located in the city of Botucatu, Brazil. Results: A total of 240 patients were analyzed; 60% were male, with a median age of 3 years (IQR, 1-10 years). A history consistent with FB aspiration was present in 82%. Radiological findings included atelectasis, in 30.7%; radiopaque FBs, in 22.6%; normal chest X-rays, in 19.2%; and hyperinflation, in 18.3%. Rigid bronchoscopy was performed in 92% of the patients, flexible bronchoscopy was performed in 3.5%, and laryngoscopy was performed in 1.3%. In 3%, the FB was spontaneously expelled. The sensitivity of clinical and radiological findings was 83% and 83.2%, respectively. Ten patients required surgery, and 79 developed complications. Conclusions: Any suspected FB aspiration should be investigated, even when clinical and radiological findings are negative. Prolonged FB retention in the bronchial tree can lead to severe and irreversible complications. Most FBs are radiolucent, predominantly consisting of grains or seeds. Endoscopic removal remains the mainstay of treatment, with only a minority of cases requiring surgery. Early intervention is essential to prevent complications.

Resumo em Inglês:

ABSTRACT Climate change has consistently been shown to result from human activity. The rise in average global temperature, driven by greenhouse gas emissions, has increased the frequency of extreme weather events such as floods, droughts, hurricanes, wildfires, and heat waves, as well as increasing airborne allergens and air pollution levels. These consequences have direct and indirect impacts on human health, particularly affecting individuals with cardiorespiratory disease. This review analyzed the main mechanisms whereby climate change impacts human health, with a focus on respiratory effects. Urgent mitigation efforts to reduce carbon emissions and prepare for extreme weather events are needed and must involve coordinated efforts across society. Physicians play a crucial role in communicating to patients how climate change affects health and in encouraging contributions to mitigation efforts by everyone.

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ABSTRACT Hypersensitivity pneumonitis (HP) is an interstitial lung disease triggered by inhalation of a variety of environmental antigens. HP ranges from acute manifestations to progressive fibrosis and can be classified as nonfibrotic or fibrotic based on imaging and histopathological features. The pathophysiological mechanism of HP involves an exaggerated immune cell response and, in chronic stages, fibroblast activation leading to fibrosis. Diagnosis requires integrated assessment of exposure history, HRCT findings, BAL findings, and histopathological findings, as well as multidisciplinary discussion. In nonfibrotic HP patients, HRCT typically shows ground-glass opacities, centrilobular nodules, and mosaic attenuation, whereas, in fibrotic HP patients, HRCT often shows reticulation, traction bronchiectasis, and honeycombing. Typical histological features include cellular bronchiolitis, poorly formed granulomas, and interstitial fibrosis. Recent advances in imaging-including artificial intelligence-based pattern recognition-and investigation of biomarkers are improving precision and will likely contribute to the diagnostic investigation of HP. Management strategies depend on disease phenotype and severity, with antigen avoidance remaining the cornerstone of therapy. Immunomodulators such as corticosteroids, azathioprine, and mycophenolate may be used when there is evidence or suspicion of active inflammatory disease, whereas nintedanib is indicated for progressive fibrotic forms. Emerging phosphodiesterase 4B inhibitors have shown promise based on recent evidence. A greater number of comorbidities are observed in patients with fibrotic HP and are associated with worse survival, particularly pulmonary hypertension. Understanding genetic predisposition, comorbidities, and the transition from inflammation to fibrosis is essential to guide personalized treatment and improve outcomes. This review provides an update of pathophysiology, current diagnostic approaches, and therapeutic options, including emerging strategies.