Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-06-29T12:35:17Z No. of bitstreams: 1 MARCELO_CARDOSO_BARROS.pdf: 2634751 bytes, checksum: 548db4114b1331853464efe3afad47f5 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-07-06T14:42:37Z (GMT) No. of bitstreams: 1 MARCELO_CARDOSO_BARROS.pdf: 2634751 bytes, checksum: 548db4114b1331853464efe3afad47f5 (MD5) / Made available in DSpace on 2018-07-06T15:04:25Z (GMT). No. of bitstreams: 1 MARCELO_CARDOSO_BARROS.pdf: 2634751 bytes, checksum: 548db4114b1331853464efe3afad47f5 (MD5) Previous issue date: 2018-02-22 / Objective: To evaluate CT phenotypes, airflow limitation and exacerbation-like episodes in heavy smokers. Methods: This cross-sectional study enrolled 172 smokers, with > 30 pack-years exposure, who underwent pulmonary function tests (PFTs) and quantitative computed tomography (QCT). Subjects were classified by presence or absence of airflow limitation according to the current GOLD criteria of post-bronchodilator FEV1/FVC < 0,7. QCT analysis of data in Airway Inspector software resulted in the establishment of two disease-predominant phenotypes groups: emphysema-predominant (EP) (>6 % of pixels < -950 HU) and non-emphysema-predominant (NEP) (<6 % of pixels < -950 HU). Results: The overall mean age was 63.39 ? 6.04 years, 58% were men, mean packyears smoking history was 70.7 ? 34.32 and mean body mass index (BMI) was 26.96 (?5.69). Most of the 58% of male subjects were distributed in the airflow limitation group, which had also a higher mean pack-years smoking history (77.20 ? 38.03 vs. 60.53 ? 24.50, p=0.009) and mean emphysema index (17.01 ? 9.96 vs. 4.52 ? 3.55, p<0.001), than the group without airflow limitation. About 8.9% of those subjects with no airflow limitation had exacerbation-like episodes, and 23,8% show emphysemapredominant phenotype. According to QTC analysis, the EP group exhibited worse FEV1/FVC mean ratio (55.62 ? 13.3) compared to the NEP (79.10 ? 9.78), p<0.001. Conclusions: Despite of no persistent airflow limitation, 8,9% of the heavy smokers had exacerbation-like episodes and QCT findings of emphysema. Those in the EP phenotype group, had worse PFTs values, higher smoking history, male predominance and also experienced more exacerbation-like episodes than NEP. / Objetivo: avaliar fumantes com alta carga tab?gica, analisando padr?es espirom?tricos, fenot?picos tomogr?ficos e desfechos cl?nicos. Material e M?todo: Foi realizado um estudo transversal com 172 fumantes de um protocolo de rastreamento para detec??o de c?ncer de pulm?o, com carga tab?gica acima de 30 anos-ma?o, que realizaram pelo menos uma tomografia computadorizada e uma espirometria dentro de um intervalo de um ano. Inicialmente os pacientes foram separados em dois grupos, com fun??o pulmonar normal (FPN) e fun??o pulmonar alterada (FPA), e posteriormente fez-se uma suban?lise de acordo com o fen?tipo tomogr?fico. Resultados: encontrou-se idade m?dia de 63,39 ? 6,04 anos, a maioria eram homens (58%) e a carga tab?gica m?dia foi 70,7 ? 34,32 anos-ma?o. Os pacientes com FPA experimentaram mais infec??es respirat?rias no ano anterior do que os indiv?duos com FPN, respectivamente (n = 29 e n = 5; p = 0,05). Os participantes do grupo com FPN eram mais jovens e com maior propor??o de mulheres que o grupo com FPA, respectivamente (61,48 ? 5,32 anos; 64,61 ? 6,17 anos; p <0,001; n = 39 (58%), n = 33 (31%); p <0,001). A carga tab?gica dos indiv?duos com FPN era inferior em rela??o ao grupo com FPA, respectivamente (60,53 ? 24,50 anos-ma?o e 77,20 ? 38,03 anos-ma?o; p<0.009). Cerca de 9% dos indiv?duos com fun??o pulmonar normal apresentaram epis?dios infecciosos no trato respirat?rio e quase um quarto dos participantes com FPN, 23,8%, tinham fen?tipo enfisematoso na an?lise tomogr?fica. O grupo com fen?tipo tomogr?fico enfisema-predominante (EP) apresentou os piores resultados de fun??o pulmonar em compara??o com o grupo de fen?tipo n?o-enfisematoso (NEP). Conclus?o: Neste estudo mesmo os fumantes com FPN apresentaram achados tomogr?ficos compat?veis com enfisema, assim como desenvolveram epis?dios de infec??o no trato respirat?rio similares a exacerba??o do DPOC. O fen?tipo EP teve os piores ?ndices de fun??o pulmonar e maior n?mero de epis?dios infecciosos no trato respirat?rio nos ?ltimos 12 meses.