These data suggest that SP-D not only reduces allergen-induced eosinophilic inflammation and airway hyperresponsiveness but also provides protection against early airway obstruction by inhibition of early mediator release.

Background: Exhaled carbon monoxide (CO Exh ) measurement is used to confirm smoking status in smoking cessation programs, but the cut-off level is still a matter for discussion. The objective of this study was to compare CO Exh levels in smokers and non-smokers to validate the method in a Brazilian population and to estimate the probability of the patient still smoking according to different cut-off points. Methods: In this cross-sectional study we studied non-atopic Caucasian volunteers with no respiratory infection or steroid therapy in the preceding four weeks. Exclusion criteria were: pregnancy; breast feeding; age<18 and >65 years old; and subjects not signing informed consent. Participants filled out a questionnaire and had their CO Exh levels measured. Bayes' theorem was used to calculate the posttest probabilities. Results: We included 393 subjects of whom 239 (61%) were smokers. The mean CO Exh was 14.7 +/-9.4ppm and 4.3 +/-2.5ppm (p<0.001) in smokers and nonsmokers, respectively. Patients with CO Exh below 8ppm had a likelihood ratio below 1 of still smoking. The levels 9ppm and 10ppm provided likelihood ratios of 1.50 and 1.93, respectively. Better discriminant power was obtained at >11ppm, when the likelihood ratio became 63.80 (95%CI 16.1-253.1). Conclusions: In smoking cessation practice, a likelihood ratio approach may be useful to determine the probability that an individual is still smoking according to various CO Exh cut-off points instead of using a fixed value for all patients.

Introdução: Aproximadamente um terço da população adulta mundial usa produtos derivados do tabaco. Devido ao novo entendimento sobre o vício tabágico e ao surgimento de novas modalidades terapêuticas, as possibilidades de sucesso nas tentativas de abandono do fumo aumentaram significativamente. Objetivos: Avaliar os percentuais de sucesso/fracasso entre os fumantes tratados no Ambulatório de Auxílio ao Abandono do Tabagismo da Pontifícia Universidade Católica do Rio Grande do Sul (AAAT-PUCRS) e analisar possíveis fatores de risco para o fracasso no abandono do tabagismo. Pacientes e métodos: Através de ensaio clínico aberto, não randomizado, avaliaram-se os fumantes que procuraram o AAAT-PUCRS entre julho de 1999 e outubro de 2000, submetidos ao programa padronizado de auxílio ao abandono do tabagismo utilizado na instituição. A análise estatística foi feita por medidas de tendência central para variáveis quantitativas, pelo cálculo do risco relativo (com intervalo de confiança de 95%) para fatores associados e pela análise da curva de Kaplan-Meier para estudo do desfecho ao longo do tempo. Resultados: O estudo incluiu 169 pacientes (67,5% mulheres), com idade média de 46,4 (± 10,4) anos; a maioria fumava em média 20 cigarros/dia por 30 anos. Mesmo sendo esta uma coorte muito recente, pode-se verificar que, em relação aos desfechos sucesso/fracasso pontuais, 49% pararam de fumar, 14% diminuíram significativamente o número de cigarros fumados e 37% fracassaram. Entre as variáveis estudadas, a dependência grave à nicotina foi a única que esteve associada a maior risco de fracasso. Conclusões:Foi possível a obtenção de índices de abandono ao fumo satisfatórios utilizando metodologia padronizada, mas particularizada para cada paciente. O uso de terapêutica farmacológica aliada a técnicas cognitivo-comportamentais foi associado a maiores proporções de sucesso. (J Pneumol 2001;27(5):255-261) Smoking cessation with bupropion and nicotine replacement

Objective: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. Methods: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 µg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85% of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. Results: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9%. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. Conclusion: The overall rate of compliance with maintenance treatment of asthma was low.

Asthma mortality in southern Brazil remains low and appears to be decreasing after reaching a peak in the mid-1990s. The reason for these trends remains unknown.