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- Issue 2 - "Update on Adverse Respiratory Effects of Indoor Air Pollution" Part 1): Indoor Air Pollution and Respiratory Diseases: A General Update and a Portuguese Perspective.Publication . Rufo, J C; Annesi-Maesano, I; Carreiro-Martins, P; Moreira, A; Sousa, A C; Pastorinho, M R; Neuparth, N; Taborda-Barata, LObjective: To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population. Results: Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances. Conclusions: Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.
- Cutaneous IgG4-Related Disease Treated with DupilumabPublication . Pestana, Mafalda; João, Alexandre; Palma-Carlos, Susana; Leiria-Pinto, Paula; João, Ana L.We present a 59-year-old male with a prolonged history of severe, treatment-resistant pruritic dermatosis and associated systemic symptoms, including fatigue and diarrhea. Dermatologic examination revealed widespread erythematous-brownish papules and nodules, prompting a skin biopsy that showed dense infiltration by immunoglobulin G4 (IgG4)-positive plasma cells, leading to a diagnosis of IgG4-related disease (IgG4-RD). The patient was treated with dupilumab, resulting in complete skin lesion resolution and significant improvement in quality of life. IgG4-RD, a rare inflammatory disease with potential multiorgan involvement, frequently challenges diagnosis due to diverse clinical presentations. This case highlights dupilumab effectiveness as a novel therapy for IgG4-RD with cutaneous involvement, offering a promising alternative for patients who do not respond well to corticosteroids.
- Acoustic and Clinical Data Analysis of Vocal Recordings: Pandemic Insights and Lessons.Publication . Carreiro-Martins, Pedro; Paixão, Paulo; Caires, Iolanda; Matias, Pedro; Gamboa, Hugo; Soares, Filipe; Gomez, Pedro; Sousa, Joana; Neuparth, NunoBackground/Objectives: The interest in processing human speech and other human-generated audio signals as a diagnostic tool has increased due to the COVID-19 pandemic. The project OSCAR (vOice Screening of CoronA viRus) aimed to develop an algorithm to screen for COVID-19 using a dataset of Portuguese participants with voice recordings and clinical data. Methods: This cross-sectional study aimed to characterise the pattern of sounds produced by the vocal apparatus in patients with SARS-CoV-2 infection documented by a positive RT-PCR test, and to develop and validate a screening algorithm. In Phase II, the algorithm developed in Phase I was tested in a real-world setting. Results: In Phase I, after filtering, the training group consisted of 166 subjects who were effectively available to train the classification model (34.3% SARS-CoV-2 positive/65.7% SARS-CoV-2 negative). Phase II enrolled 58 participants (69.0% SARS-CoV-2 positive/31.0% SARS-CoV-2 negative). The final model achieved a sensitivity of 85%, a specificity of 88.9%, and an F1-score of 84.7%, suggesting voice screening algorithms as an attractive strategy for COVID-19 diagnosis. Conclusions: Our findings highlight the potential of a voice-based detection strategy as an alternative method for respiratory tract screening.
- Recommendations for Reducing the Environmental Impact of Inhalers in Portugal: Consensus DocumentPublication . Campos, Luís; Rosa, Paula; Carreiro Martins, Pedro; Xavier, Bilhota; Leuschner, Pedro; M Marques, Maria Inês; Albino, José; Robalo Cordeiro, Carlos; Ordem dos MédicosThis consensus document addresses the reduction of the environmental impact of inhalers in Portugal. It was prepared by the Portuguese Council for Health and the Environment and the societies representing the specialties that account for these drugs' largest volume of prescriptions, namely the Portuguese Society of Pulmonology, the Portuguese Society of Allergology and Clinical Immunology, the Portuguese Society of Pediatrics, the Portuguese Society of Internal Medicine, the Portuguese Association of General and Family Medicine and also a patient association, the Respira Association. The document acknowledges the significant impact of pressurized metered-dose inhalers on greenhouse gas emissions and highlights the need to transition to more sustainable alternatives. The carbon footprint of pressurized metered-dose inhalers and dry powder inhalers in Portugal was calculated, and the level of awareness among prescribing physicians on this topic was also estimated. Finally, recommendations were developed to accelerate the reduction of the ecological footprint of inhalers.
- Recomendações para a Redução do Impacto Ambiental dos Inaladores em Portugal: Documento de ConsensoPublication . Campos, L; Rosa, P; Carreiro-Martins, P; Xavier, B; Leuschner, P; Marques, MI; Albino, J; Robalo Cordeiro, CThis consensus document addresses the reduction of the environmental impact of inhalers in Portugal. It was prepared by the Portuguese Council for Health and the Environment and the societies representing the specialties that account for these drugs’ largest volume of prescriptions, namely the Portuguese Society of Pulmonology, the Portuguese Society of Allergology and Clinical Immunology, the Portuguese Society of Pediatrics, the Portuguese Society of Internal Medicine, the Portuguese Association of General and Family Medicine and also a patient association, the Respira Association. The document acknowledges the significant impact of pressurized metered-dose inhalers on greenhouse gas emissions and highlights the need to transition to more sustainable alternatives. The carbon footprint of pressurized metered-dose inhalers and dry powder inhalers in Portugal was calculated, and the level of awareness among prescribing physicians on this topic was also estimated. Finally, recommendations were developed to accelerate the reduction of the ecological footprint of inhalers.
- Optimizing the Use of Systemic Corticosteroids in Severe Ssthma (ROSA II Project): a National Delphi Consensus StudyPublication . Marques, J; Duarte-Ramos, F; Ferreira, MB; Lima, R; Lopes, C; Sokolova, A; Tonin, FS; Loureiro, CC
- Laringoscopia Contínua Durante o Exercício: Proposta de um Protocolo Clínico com Base em Revisão BibliográficaPublication . Chantre, T; Moreira, I; Barroso, M; Oliveira, M; Leiria Pinto, P; Sousa, HObjetivos - Estabelecimento de um protocolo de Laringoscopia Contínua durante o Exercício (LCE). Desenho do Estudo – Revisão Bibliográfca Sistemática. Material e Métodos - Revisão bibliográfca nas bases de dados MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature, baseada no modelo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), entre 2001 e 2021. Os estudos incluídos na revisão bibliográfica analisaram protocolos de LCE tanto em idade pediátrica como em adultos e foram escritos em língua inglesa ou portuguesa. Foram excluídos os artigos que apenas discutiram a Obstrução Laríngea Induzida pelo Exercício, mas não o protocolo de LCE e os artigos cujo objetivo de estudo não foi o de investigar os resultados do protocolo de LCE. A partir dos resultados obtidos, foi elaborado um protocolo clínico para o Centro Hospitalar Universitário Lisboa Central e testado num grupo de 10 voluntários sadios. Resultados – A pesquisa produziu um total de 679 artigos, sendo que após aplicação dos critérios de inclusão e exclusão foram selecionados 21 estudos. Nesses houve um total de 1026 doentes analisados, com um rácio masculino: feminino de 1:1.7. A idade média à realização da LCE variou de 9 a 45 anos. O método de exercício preferencial nos protocolos estudados foi a passadeira de corrida (n = 17; 81%), seguida da bicicleta estática (n = 4, 19%) e da máquina de remo (n = 1; 4.8%). O protocolo de LCE proposto incluí um protocolo de Bruce modificado, sendo a LCE terminada quando os doentes se encontravam em exaustão ou com sintomas respiratórios limitantes. Imediatamente antes e após a LCE foi realizada uma espirometria. Os movimentos glóticos e supraglóticos foram avaliados em repouso, com esforço moderado e esforço máximo, em cada fase do ciclo respiratório. Conclusões - A partir dos dados de uma revisão bibliográfica, foi desenvolvido um protocolo para a realização de LCE, demonstrando viabilidade e adequação à realidade de uma instituição portuguesa quando testado em voluntários sadios. São necessários novos estudos com pacientes doentes para validar esses resultados
- Molecular Profile of Sensitization to Dermatophagoides Pteronyssinus Dust Mite in PortugalPublication . Limão, R; Spínola Santos, A; Araújo, L; Cosme, J; Inácio, F; Tomaz, E; Ferrão, A; Santos, N; Sokolova, A; Môrete, A; Falcão, H; Cunha, L; Ferreira, A; Bras, A; Ribeiro, F; Lozoya, C; Leiria-Pinto, P; Prates, S; Plácido, J; Coimbra, A; Taborda-Barata, L; Pereira Santos, MC; Pereira Barbosa, M; Pineda, FBackground and objectives: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas. Methods: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South. Results: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496). Conclusion: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size.
- Clinical Standards for Diagnosis, Treatment and Prevention of Post-COVID-19 Lung DiseasePublication . Visca, D; Centis, R; Pontali, E; Zampogna, E; Russell, AM; Migliori, GB; Andrejak, C; Aro, M; Bayram, H; Berkani, K; Bruchfeld, J; Chakaya, JM; Chorostowska-Wynimko, J; Crestani, B; Dalcolmo, MP; D’Ambrosio, L; Dinh-Xuan, AT; Duong-Quy, S; Fernandes, C; García-García, JM; de Melo Kawassaki, A; Carrozzi, L; Martinez-Garcia, MA; Carreiro Martins, P; Mirsaeidi, M; Mohammad, Y; Naidoo, RN; Neuparth, N; Sese, L; Silva, DR; Solovic, I; Sooronbaev, TM; Spanevello, A; Sverzellati, N; Tanno, L; Tiberi, S; Vasankari, T; Vasarmidi, E; Vitacca, M; Annesi-Maesano, IBACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.
- Validation of App and Phone Versions of the Control of Allergic Rhinitis and Asthma Test (CARAT)Publication . Jácome, C; Pereira, AM; Almeida, R; Amaral, R; Correia, MA; Mendes, S; Vieira-Marques, P; Ferreira, JA; Lopes, I; Gomes, J; Vidal, C; López Freire, S; Méndez Brea, P; Arrobas, A; Valério, M; Chaves Loureiro, C; Santos, LM; Couto, M; Araujo, L; Todo Bom, A; Azevedo, JP; Cardoso, J; Emiliano, M; Gerardo, R; Lozoya, C; Pinto, PL; Castro Neves, A; Pinto, N; Palhinha, A; Teixeira, F; Ferreira-Magalhães, M; Alves, C; Coelho, D; Santos, N; Menezes, F; Gomes, R; Cidrais Rodrigues, JC; Oliveira, G; Carvalho, J; Rodrigues Alves, R; Moreira, AS; Costa, A; Abreu, C; Silva, R; Morête, A; Falcão, H; Marques, ML; Câmara, R; Cálix, MJ; Bordalo, D; Silva, D; Vasconcelos, MJ; Fernandes, RM; Ferreira, R; Freitas, P; Lopes, F; Almeida Fonseca, J