Suzana Erico Tanni
@unesp.br
Associate Professor of Pulmonology of Botucatu Medical School
Botucatu Medical School, UNESP
Graduated in Medicine from Universidade Estadual Paulista Júlio de Mesquita Filho (1998), PhD in Pathophysiology in Internal Medicine from Botucatu Medical School-Universidade Estadual Paulista Júlio de Mesquita Filho (2008) and Associate Professor in Pulmonology from Botucatu Medical School -Universidade Estadual Paulista Júlio de Mesquita Filho (2018). She is currently a doctor at the São Paulo State University Júlio de Mesquita Filho. Has experience in Medicine, with emphasis on Pulmonology, acting on the following subject: pulmonary diseases; chronic obstructive pulmonary disease and smoking.
RESEARCH INTERESTS
Smoking effects in pulmonary and cardiac function
COPD and inflammation
Scopus Publications
Scopus Publications
Suzana Margareth Lobo, Gaétan Plantefève, Girish Nair, Adilson Joaquim Cavalcante, Nara Franzin de Moraes, Estevao Nunes, Otis Barnum, Claudio Marcel Berdun Stadnik, Maria Patelli Lima, Muriel Lins,et al.
Elsevier BV
Roberta Munhoz Manzano, Alessandro Domingues Heubel, and Suzana Erico Tanni
Springer Science and Business Media LLC
Luiz Vicente Ribeiro Ferreira da Silva Filho1, Rodrigo Abensur Athanazio2, Carolina Rodrigues Tonon3, Juliana Carvalho Ferreira2, and Suzana Erico Tanni3
Sociedade Brasileira de Pneumologia e Tisiologia
Objective: To evaluate the effect of treatment with the combination of three cystic fibrosis transmembrane conductance regulator (CFTR) modulators-elexacaftor+tezacaftor+ivacaftor (ETI)-on important clinical endpoints in individuals with cystic fibrosis. Methods: This was a systematic review and meta-analysis of randomized clinical trials that compared the use of ETI in individuals with CF and at least one F508del allele with that of placebo or with an active comparator such as other combinations of CFTR modulators, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) methodology. We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to December 26th, 2022. The risk of bias was assessed using the Cochrane risk-of-bias tool, and the quality of evidence was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We retrieved 54 studies in the primary search. Of these, 6 met the inclusion criteria and were analyzed (1,127 patients; 577 and 550 in the intervention and control groups, respectively). The meta-analysis revealed that the use of ETI increased FEV1% [risk difference (RD), +10.47%; 95% CI, 6.88-14.06], reduced the number of acute pulmonary exacerbations (RD, -0.16; 95% CI, -0.28 to -0.04), and improved quality of life (RD, +14.93; 95% CI, 9.98-19.89) and BMI (RD, +1.07 kg/m2; 95% CI, 0.90-1.25). Adverse events did not differ between groups (RD, -0.03; 95% CI, -0.08 to 0.01), and none of the studies reported deaths. Conclusions: Our findings demonstrate that ETI treatment substantially improves clinically significant, patient-centered outcomes.
Idevaldo Floriano1, Antônio Silvinato1,2, Hélio Arthur Bacha3, Alexandre Naime Barbosa4, Suzana Tanni5, Wanderley Marques Bernardo2, and 6
Sociedade Brasileira de Pneumologia e Tisiologia
Objective: To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. Methods: This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. Results: Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = -0.21 (95% CI, -0.34 to -0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence. Conclusions: In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.
Eder Anderson Rodrigues, Camila Moreno Rosa, Dijon Henrique Salome Campos, Felipe Cesar Damatto, Gilson Masahiro Murata, Lidiane Moreira Souza, Luana Urbano Pagan, Mariana Gatto, Jessica Yumi Brosler, Hebreia Oliveira Almeida Souza,et al.
Springer Science and Business Media LLC
Abstract Background Sodium-glucose cotransporter (SGLT)2 inhibitors have displayed beneficial effects on the cardiovascular system in diabetes mellitus (DM) patients. As most clinical trials were performed in Type 2 DM, their effects in Type 1 DM have not been established. Objective To evaluate the influence of long-term treatment with SGLT2 inhibitor dapagliflozin on cardiac remodeling, myocardial function, energy metabolism, and metabolomics in rats with Type 1 DM. Methods Male Wistar rats were divided into groups: Control (C, n = 15); DM (n = 15); and DM treated with dapagliflozin (DM + DAPA, n = 15) for 30 weeks. DM was induced by streptozotocin. Dapagliflozin 5 mg/kg/day was added to chow. Statistical analysis: ANOVA and Tukey or Kruskal-Wallis and Dunn. Results DM + DAPA presented lower glycemia and higher body weight than DM. Echocardiogram showed DM with left atrium dilation and left ventricular (LV) hypertrophy, dilation, and systolic and diastolic dysfunction. In LV isolated papillary muscles, DM had reduced developed tension, +dT/dt and -dT/dt in basal condition and after inotropic stimulation. All functional changes were attenuated by dapagliflozin. Hexokinase (HK), phosphofructokinase (PFK) and pyruvate kinase (PK) activity was lower in DM than C, and PFK and PK activity higher in DM + DAPA than DM. Metabolomics revealed 21 and 5 metabolites positively regulated in DM vs. C and DM + DAPA vs. DM, respectively; 6 and 3 metabolites were negatively regulated in DM vs. C and DM + DAPA vs. DM, respectively. Five metabolites that participate in cell membrane ultrastructure were higher in DM than C. Metabolites levels of N-oleoyl glutamic acid, chlorocresol and N-oleoyl-L-serine were lower and phosphatidylethanolamine and ceramide higher in DM + DAPA than DM. Conclusion Long-term treatment with dapagliflozin attenuates cardiac remodeling, myocardial dysfunction, and contractile reserve impairment in Type 1 diabetic rats. The functional improvement is combined with restored pyruvate kinase and phosphofructokinase activity and attenuated metabolomics changes.
Carolina Rodrigues Tonon, Suzana Erico Tanni, Juliana Rocha, Irma Godoy, Bertha Furlan Polegato, Filipe Welson Leal Pereira, Danilo Martins, Robson Aparecido Prudente, Estefania Thome Franco, Fernando Brizola,et al.
Elsevier BV
Alexandre Naime Barbosa, Alberto Chebabo, Carlos Starling, Clevy Pérez, Clóvis Arns Cunha, David de Luna, Estevão Portela Nunes, Gabriela Zambrano, Juliana Carvalho Ferreira, Julio Croda,et al.
Springer Science and Business Media LLC
Abstract Background Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population. Methods Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system. Results Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged. Conclusion This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.
Juli Thomaz de Souza, Marcos F. Minicucci, Natália C. Ferreira, Bertha F. Polegato, Marina Politi Okoshi, Gabriel P. Modolo, Bethan E. Phillips, Philip J. Atherton, Kenneth Smith, Daniel Wilkinson,et al.
Springer Science and Business Media LLC
Abstract Background Stroke is a leading cause of mortality and disability, and its sequelae are associated with inadequate food intake which can lead to sarcopenia. The aim of this study is to verify the effectiveness of creatine supplementation on functional capacity, strength, and changes in muscle mass during hospitalization for stroke compared to usual care. An exploratory subanalysis will be performed to assess the inflammatory profiles of all participants, in addition to a follow-up 90 days after stroke, to verify functional capacity, muscle strength, mortality, and quality of life. Methods Randomized, double-blind, unicenter, parallel-group trial including individuals with ischemic stroke in the acute phase. The duration of the trial for the individual subject will be approximately 90 days, and each subject will attend a maximum of three visits. Clinical, biochemical, anthropometric, body composition, muscle strength, functional capacity, degree of dependence, and quality of life assessments will be performed. Thirty participants will be divided into two groups: intervention (patients will intake one sachet containing 10g of creatine twice a day) and control (patients will intake one sachet containing 10g of placebo [maltodextrin] twice a day). Both groups will receive supplementation with powdered milk protein serum isolate to achieve the goal of 1.5g of protein/kg of body weight/day and daily physiotherapy according to the current rehabilitation guidelines for patients with stroke. Supplementation will be offered during the 7-day hospitalization. The primary outcomes will be functional capacity, strength, and changes in muscle mass after the intervention as assessed by the Modified Rankin Scale, Timed Up and Go test, handgrip strength, 30-s chair stand test, muscle ultrasonography, electrical bioimpedance, and identification of muscle degradation markers by D3-methylhistidine. Follow-up will be performed 90 days after stroke to verify functional capacity, muscle strength, mortality, and quality of life. Discussion The older population has specific nutrient needs, especially for muscle mass and function maintenance. Considering that stroke is a potentially disabling event that can lead the affected individual to present with numerous sequelae, it is crucial to study the mechanisms of muscle mass loss and understand how adequate supplementation can help these patients to better recover. Trial registration The Brazilian Clinical Trials Registry (ReBEC) RBR-9q7gg4. Registered on 21 January 2019.
Francesca Sperotto, Alba Gutiérrez-Sacristán, Simran Makwana, Xiudi Li, Valerie N. Rofeberg, Tianxi Cai, Florence T. Bourgeois, Gilbert S. Omenn, David A. Hanauer, Carlos Sáez,et al.
Elsevier BV
Arianna Dagliati, Zachary H. Strasser, Zahra Shakeri Hossein Abad, Jeffrey G. Klann, Kavishwar B. Wagholikar, Rebecca Mesa, Shyam Visweswaran, Michele Morris, Yuan Luo, Darren W. Henderson,et al.
Elsevier BV
Dave Singh, Diego Litewka, Rafael Páramo, Adrian Rendon, Abdullah Sayiner, Suzana E. Tanni, Sudeep Acharya, Bhumika Aggarwal, Afisi S. Ismaila, Raj Sharma,et al.
Springer Science and Business Media LLC
Dave Singh, Diego Litewka, Rafael Páramo, Adrian Rendon, Abdullah Sayiner, Suzana E. Tanni, Sudeep Acharya, Bhumika Aggarwal, Afisi S. Ismaila, Raj Sharma,et al.
Springer Science and Business Media LLC
Suzana Tanni, Fernando Wehrmeister, Robson Prudente, Felipe Damatto, Carlos Breda Neto, Leiliane Oliveira, Luana Pagan, Mariana Gatto, Letícia Vieira, Liana Coelho,et al.
MDPI AG
(1) Background: A high concentration of sodium chloride on in vitro cell culture leads to reduced SARS-CoV-2 replication. Therefore, our aim was to evaluate the effects of inhaling hypertonic NaCl particles (BREATHOX®) on the duration of COVID-19-induced acute symptoms. (2) Methods: A prospective, open label, randomized, standard of care-controlled group (SOC) pilot trial compared inhaled oral and nasal administered BREATHOX® (2.0 mg NaCl, particles size between 1–10 μm), with five or ten inhalations per day for ten days. The primary endpoint was the time to resolve COVID-19-related symptoms. Safety outcomes included adverse clinical and laboratory events. (3) Results: A total of 101 individuals were screened and 98 were randomly assigned to BREATHOX® ten sessions per day (Group 1; 33 patients), BREATHOX® five sessions per day (Group 2; 32 patients), or SOC (33 patients), and followed up for 28 days. There was an association with cough frequency after 10 days BREATHOX® compared to SOC [Group 1: hazard ratio (HR) 2.01, 95% confidence interval (CI) 1.06–3.81; Group 2: HR 2.17, 95% CI 1.17–4.04]. No differences between the groups for the reported symptoms’ resolution time were seen after 28 days. After combining both BREATHOX® groups, the period to cough resolution 10 days after randomization was significantly lower than in SOC (HR 2.10, 95% CI 1.20–3.67). An adverse event occurred in 30% of Group 1, 36% of Group 2, and 9% in SOC individuals. One patient from SOC had a serious adverse event. Nasal burning, sore or itchy nose, and dry mouth were considered related to BREATHOX® use and resolved after stopping inhalations. (4) Conclusion: BREATHOX® inhalation is safe and may be effective in reducing the duration of COVID-19-induced coughing.
André Luís Bertani, Suzana Erico Tanni, and Irma Godoy
Springer Science and Business Media LLC
Abstract Objectives Our aim was to assess the use of dual/poly tobacco in a sample of pregnant women. Design: cross-sectional survey. Methods Twenty prenatal care units in Botucatu, Sao Paulo, Brazil. We evaluated 127 high-risk pregnant smokers during prenatal care. Those who were 12–38 weeks pregnant and were currently smoking conventional cigarettes. The study enrollment took place between January 2015 and December 2015. The dual/poly prevalence of tobacco products during pregnancy and the characteristics related to smoking in pregnant smokers through a specific questionnaire containing questions related to sociodemographic characteristics, comorbidities, gestational history, smoking history, secondhand smoke exposure, nicotine dependence, motivation stage and use of alternative forms of tobacco. Results Mean age was 26.9 ± 6.6 years, most had only elementary education and belonged to lower income economic groups. Twenty-five (19.7%) smoked conventional cigarettes only while 102 used conventional and alternative forms of tobacco products. Smoking pack-years was significantly lower in those only smoking conventional cigarettes than in dual/poly users. Proportion of patients with elevated degree of nicotine dependence was higher in conventional cigarettes users. On the other side, alcohol intake was higher in dual/poly smokers when compared to conventional cigarettes group. The alternative forms of smoking were associated with significantly higher occurrences of comorbidities as pulmonary, cardiovascular and cancer. Conclusions for Practice The prevalence of alternative forms users of smoking products is high during pregnancy. These data reinforce the importance of a family approach towards smoking in pregnant women and education about the risks of alternative forms of tobacco.
Hellen Christina Neves Rodrigues, Mikaelly Luiz Silva, Milena dos Santos Mantovani, Juliana Medeiros da Silva, Marielle Fernanda Panelli Domingues, Suzana Érico Tanni, Paula Schmidt Azevedo, Marcos Ferreira Minicucci, Marina Nogueira Berbel Buffarah, Amanda Gomes Pereira,et al.
Elsevier BV
Rachel E. Christensen, Michael D. Yi, Bianca Y. Kang, Sarah A. Ibrahim, Noor Anvery, McKenzie Dirr, Stephanie Adams, Yasser S. Amer, Alexandre Bisdorff, Lisa Bradfield,et al.
Elsevier BV
Mariana L. Lafetá, Vitor C. Souza, Thaís C.F. Menezes, Carlos G.Y. Verrastro, Frederico J. Mancuso, André Luis P. Albuquerque, Suzana E. Tanni, Meyer Izbicki, Júlio P. Carlstron, Luiz Eduardo Nery,et al.
European Respiratory Society (ERS)
RationalePost-coronavirus disease 2019 (COVID-19) survivors frequently have dyspnoea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID-19 patients remain incompletely characterised. The objectives of the present study were to clarify the mechanisms of exercise intolerance in post-COVID-19 survivors after hospitalisation.MethodsThis prospective study evaluated consecutive patients previously hospitalised due to moderate-to-severe/critical COVID-19. Within mean±sd90±10 days of onset of acute COVID-19 symptoms, patients underwent a comprehensive cardiopulmonary assessment, including cardiopulmonary exercise testing with earlobe arterialised capillary blood gas analysis.Measurements and main results87 patients were evaluated; mean±sdpeak oxygen consumption was 19.5±5.0 mL·kg−1·min−1, and the tertiles were ≤17.0, 17.1–22.2 and ≥22.3 mL·kg−1·min−1. Hospitalisation severity was similar among the three groups; however, at the follow-up visit, patients with peak oxygen consumption ≤17.0 mL·kg−1·min−1reported a greater sensation of dyspnoea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with peak oxygen consumption >17 mL·kg−1·min−1. By multivariate logistic regression analysis (receiver operating characteristic curve analysis) adjusted for age, sex and prior pulmonary embolism, a peak dead space fraction of tidal volume ≥29 and a resting forced vital capacity ≤80% predicted were independent predictors of reduced peak oxygen consumption.ConclusionsExercise intolerance in the post-COVID-19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population.
Harrison G. Zhang, Jacqueline P. Honerlaw, Monika Maripuri, Malarkodi Jebathilagam Samayamuthu, Brendin R. Beaulieu-Jones, Huma S. Baig, Sehi L’Yi, Yuk-Lam Ho, Michele Morris, Vidul Ayakulangara Panickan,et al.
Springer Science and Business Media LLC
Guilherme das Posses Bridi, Suzana Erico Tanni, and Bruno Guedes Baldi
Elsevier BV
Ana Natália Ribeiro Batista, Thaís Garcia, Robson Prudente, Maurício F. Barbosa, Pamela Modesto, Estefânia Franco, Irma de Godoy, Sergio Paiva, Paula Azevedo, and Suzana Erico Tanni
Frontiers Media SA
BackgroundThere is a possibility that cardiac morphometric characteristics are associated with the lipid profile, that is, the composition and concentration of triglycerides, total cholesterol, HDL, LDL, and others lipoproteins in young smokers without comorbidities. Thus, this study aimed to evaluate the association of cardiac morphometric characteristics, myocardial fat deposition, and smoking cessation with the lipid profile of young smokers.MethodsA clinical and laboratory evaluation of lipids and the smoking status was performed on 57 individuals, including both a smoker group and a control group. Cardiac magnetic resonance imaging (MRI) with proton spectroscopy was performed to identify cardiac changes and triglyceride (TG) deposition in myocardial tissue.ResultsNo differences were observed between the groups (control vs. smokers) in relation to the amount of myocardial TG deposition (p = 0.47); however, when TG deposition was correlated with cardiac MRI variables, a positive correlation was identified between smoking history and myocardial TG deposition [hazard ratio (95% CI), 0.07 (0.03–0.12); p = 0.002]. Furthermore, it was observed that the smoking group had lower high-density lipoprotein cholesterol [51 (45.5–59.5) mg/dl vs. 43 (36–49.5) mg/dl, p = 0.003] and higher TG [73 (58–110) mg/dl vs. 122 (73.5–133) mg/dl, p = 0.01] and very-low-density lipoprotein cholesterol [14.6 (11.6–22.2) mg/dl vs. 24.4 (14.7–26.6) mg/dl, p = 0.01] values. In the control and smoking groups, a negative correlation between TGs and the diameter of the aortic root lumen and positive correlation with the thickness of the interventricular septum and end-diastolic volume (EDV) of both the right ventricle (RV) and left ventricle (LV) were noted. Moreover, in the RV, positive correlations with the end-systolic volume (ESV) index (ESVI), stroke volume (SV), ESV, and EDV were observed. Regarding serum free fatty acids, we found a negative correlation between their values and the diameter of the lumen of the ascending aortic vessel. Lipoprotein lipase showed a positive correlation with the SV index of the RV and negative correlation with the diameter of the lumen of the ascending aortic vessel.ConclusionSeveral associations were observed regarding cardiac morphometric characteristics, myocardial fat deposition, and smoking cessation with the lipid profile of young smokers.
Rodrigo Torres-Castro and Suzanna Tanni
Frontiers Media SA
Suzana Erico Tanni, Bruno Guedes Baldi, Irma Godoy, Hélio Arthur Bacha, Alexandre Naime Barbosa, and Wanderley Marques Bernardo
FapUNIFESP (SciELO)
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had a direct impact on health care systems worldwide. By February 1, 2023, more than 753 million people had been infected with the virus, and more than 6.8 million deaths had occurred1. These death rates are related to the spread of the virus and are currently more common in places where vaccination rates are low. The worldwide incidence still fluctuates, with over 5 million cases per week. Failure to control viral transmission facilitates the occurrence of new mutations and immune escape, which may determine the persistence of the disease for a much longer period than expected1. An additional problem is the high prevalence of patients with persistent signs and symptoms after acute COVID-19 infection2-4. This condition involves several organs with different severities related to the pathophysiological mechanisms of viral infection5,6. Cellular penetration through linkage with angiotensin-converting enzyme (ACE)-2 receptors, which are present in different cell types, can cause damage and lead to the perpetuation of inflammatory processes7,8. Additionally, it has been hypothesized that an autoimmune process with an exaggerated innate immune response and activation and persistence of cytokine release may be involved in the pathophysiology of this long-term syndrome. The cross-reactivity of specific antibodies against SARS-CoV-2 with host proteins, resulting in autoimmunity, has been reported. In fact, patients with severe COVID-19 may present elevated serum levels of inflammatory markers, such as interleukins 1, 6, and 1-beta, granulocyte colony-stimulating factor, and alpha tumor necrosis factor. Thus, respiratory, cardiocirculatory, gastrointestinal, hepatic, renal, and other systems can be affected directly and perpetually, even when the acute infection is resolved7-10. Other theories have been proposed, which may explain the sequelae of organs during acute infections. Some findings show that patients with COVID-19 with persistent symptoms may stock the virus in various potential tissue reservoirs throughout the body, which may not be identified by nasopharyngeal swabs11. Another theory suggests that delayed viral clearance is secondary to immune exhaustion, which may lead to chronic inflammation and inadequate tissue repair. Mitochondrial dysfunction, impaired immunometabolism, and changes in the microbiome may also occur and may be involved in the persistence of symptoms9. In this context, the incomparable and long-term impact of signs and symptoms may lead to devastating repercussions, with a reduction in the quality of life, professional performance, and exercise capacity. Evidence from the literature still shows great difficulty and variability in defining this clinical condition, as it is not possible to clearly define whether the longterm manifestations are caused directly or indirectly by the
Diane R Batista1, Idevaldo Floriano2, Antonio Silvinato3, Hélio A Bacha4, Alexandre Naime Barbosa5, Suzana E Tanni1, and Wanderley M Bernardo6
Sociedade Brasileira de Pneumologia e Tisiologia
Rodrigo Abensur Athanazio1, Suzana Erico Tanni8, Juliana Ferreira1, Paulo de Tarso Roth Dalcin3,4, Marcelo B de Fuccio5, Concetta Esposito6, Mariane Gonçalves Martynychen Canan7, Liana Sousa Coelho8, Mônica de Cássia Firmida9,et al.
Sociedade Brasileira de Pneumologia e Tisiologia
Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.
Taline Lazzarin, Raquel Simões Ballarin, Filipe Welson Leal Pereira, Paula Schmidt Azevedo, Suzana Erico Tanni, and Marcos Ferreira Minicucci
Elsevier BV