Pré, pós com e sem tratamento ESPIROMETRIA Pré, pós com e sem tratamento Rogério Rufino UERJ

Rogério Rufino SEM CONFLITOS DE INTERESSE

Padronização de broncodilatação Brasil ATS / ERS Mitos e verdades na BD Variabilidade Valores de BD em normais Associação de medicamentos Padronização de broncodilatação Brasil ATS / ERS Agenda

VEF1 – 25ml VEF1/ano Estimativas e erros Função Pulmonar 2,11L 1,26L 20 45 70 76 100 130 ANOS

Estabilidade da relação VEF1/CVF Rev Mal Respir 2002 ; 19 : 230-40 > 70 anos Estabilidade da PaO2 Estabilidade da relação VEF1/CVF Diminuição do VEF1 relacionada a redução da altura (até 0,5cm/ano) Ware JH, et al. Longitudinal and cross-sectional estimates of pulmonary function decline in never-smoking adults. Am J Epidemiol 1990 ; 132 : 685-700.

VEF1 Verdade ou mito? BD + BD Associação (medicamento) Variabilidade (espontânea) (medicamento) BD + BD Associação VEF1 Verdade ou mito? SmartArt custom animation effects: upward arrow process (Basic) To reproduce the SmartArt effects on this slide, do the following: On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click SmartArt. In the Choose a SmartArt Graphic dialog box, in the left pane, click Process. In the Process pane, click Upward Arrow (sixth row, third option from the left), and then click OK to insert the graphic into the slide. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text. (Note: To create a bulleted list below each heading, select the heading text box in the Type your text here dialog box, and then under SmartArt Tools, on the Design tab, in the Create Graphic group, click Add Bullet. Enter text into the new bullet text box.) On the slide, select the graphic. Under SmartArt Tools, on the Design tab, in the SmartArt Styles group, do the following: Click Change Colors, and then under Colorful click Colorful Range - Accent Colors 3 to 4 (third option from the left). Click More, and then under Best Match for Document click Intense Effect (fifth option from the left). On the Home tab, in the Font group, select Calibri from the Font list, and then select 24 from the Font Size list. Select the text in the first text box from the left. Under SmartArt Tools, on the Format tab, in the WordArt Styles group, click the arrow next to Text Fill, and then under Theme Colors click Olive Green, Accent 3, Darker 25% (fifth row, seventh option from the left). Select the text in the second text box from the left. Under SmartArt Tools, on the Format tab, in the WordArt Styles group, click the arrow next to Text Fill, and then under Theme Colors click Aqua, Accent 5, Darker 25% (fifth row, ninth option from the left). Select the text in the third text box from the left. Under SmartArt Tools, on the Format tab, in the WordArt Styles group, click the arrow next to Text Fill, and then under Theme Colors click Purple, Accent 4, Darker 25% (fifth row, eighth option from the left). To reproduce the animation effects on this slide, do the following: On the Animations tab, in the Animations group, click Custom Animation. On the slide, select the graphic. In the Custom Animation task pane, do the following: Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Basic, click Wipe. Under Modify: Wipe, in the Direction list, select From Left. Under Modify: Wipe, in the Speed list, select Fast. Also in the Custom Animation task pane, select the wipe effect. Click the arrow to the right of the wipe effect, and then click Effect Options. In the Wipe dialog box, on the SmartArt Animation tab, in the Group graphic list, select One by one. Also in the Custom Animation task pane, click the double arrow under the wipe effect to expand the contents of the list of effects. Also in the Custom Animation task pane, select the second wipe effect and then do the following: Click Change, point to Entrance, and then click More Effects. In the Change Entrance Effect dialog box, under Exciting, click Curve Up. Under Modify: Curve Up, in the Start list, select With Previous. Under Modify: Curve Up, in the Speed list, select Very Fast. Also in the Custom Animation task pane, select the third wipe effect and then do the following: Click Change, point to Entrance, and then click More Effects. In the Change Entrance Effect dialog box, under Moderate, click Descend. Under Modify: Descend, in the Start list, select With Previous. Under Modify: Descend, in the Speed list, select Very Fast. Click the arrow to the right of the third wipe effect, and then click Timing. In the Descend dialog box, on the Timing tab, in the Delay box, enter 0.5. Also in the Custom Animation task pane, select the fourth wipe effect and then do the following: Under Modify: Curve Up, in the Start list, select On Click. Also in the Custom Animation task pane, select the fifth wipe effect and then do the following: Under Modify: Descend, in the Start list, select After Previous. Also in the Custom Animation task pane, select the sixth wipe effect and then do the following: Also in the Custom Animation task pane, select the seventh wipe effect and then do the following: To reproduce the background effects on this slide, do the following: Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Linear. In the Direction list, click Linear Right (first row, fourth option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list. Also under Gradient stops, customize the gradient stops that you added as follows: Select Stop 1 from the list, and then do the following: In the Stop position box, enter 39%. Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%. Click the button next to Color, and then under Theme Colors click Olive Green, Accent 3, Lighter 60% (third row, seventh option from the left). To increase the size of the SmartArt graphic so that it spans the entire slide, do the following: On the slide, select the graphic. Point to the top right corner of the graphic border, until a two-headed arrow appears. Drag the top right corner of the graphic border into the top right corner of the slide. Point to the bottom left corner of the graphic border, until a two-headed arrow appears. Drag the bottom left corner of the graphic border into the bottom left corner of the slide. Lancet Respir Med 2013 Sep;1(7):564-73.

PRIMEIRA VERDADE Mito ou realidade? 200ml 86ml PRIMEIRA VERDADE Mito ou realidade? 250ml/s 1965 a 1990 (três períodos) – 2322 homens e 2073 mulheres Diurnal Variation in Lung Function in Subgroups from Two Dutch Populations Consequences for Longitudinal Analysis Am J Respir Crit Care Med Vol 159. pp 1163–1171, 1999

2.235 pessoas Mito ou realidade? SEGUNDA VERDADE

Diretrizes para Testes de Função Pulmonar Volume Previsto Pré-broncodilatação Pós-broncodilatação tempo J Pneumol 28(Supl 3) – outubro de 2002

Diretrizes para Testes de Função Pulmonar Volume PósBd – PréBd= Negativa em mL CVF Pré-broncodilatação Pós-broncodilatação tempo 10 J Pneumol 28(Supl 3) – outubro de 2002

Diretrizes para Testes de Função Pulmonar Volume PósBd – PréBd= Positiva em mL CVF Previsto Pós-broncodilatação Pré-broncodilatação tempo J Pneumol 28(Supl 3) – outubro de 2002

Diretrizes para Testes de Função Pulmonar Volume PósBd – PréBd= Positivo em mL VEF1 PósBd – PréBd= Positivo em mL CVF Pós-broncodilatação Pré-broncodilatação tempo 1 8 J Pneumol 28(Supl 3) – outubro de 2002

Diretrizes para Testes de Função Pulmonar Previsto Pós-broncodilatador Pré-broncodilatador t segundos J Pneumol 28(Supl 3) – outubro de 2002

VEF1 CVF CV CI SBPT 200ml 7% 350ml 400ml 300ml SmartArt custom animation effects: horizontal bullet list (Intermediate) To reproduce the SmartArt effects on this slide, do the following: On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click SmartArt. In the Choose a SmartArt Graphic dialog box, in the left pane, click List. In the List pane, click Horizontal Bullet List (second row, first option from the left), and then click OK to insert the graphic into the slide. On the slide, in the graphic, select the third “topic” rectangle from the left. Under SmartArt Tools, on the Design tab, in the Create Graphic group, click the arrow next to Add Shape, and then click Add Shape After. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text for the topic headings and bullet points. (Note: To create a bulleted list below the new, fourth “topic” rectangle, select the topic heading text box in the Type your text here dialog box, and then under SmartArt Tools, on the Design tab, in the Create Graphic group, click Add Bullet. Enter text into the new bullet text box. Repeat the process to add a second bullet.) Select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following: In the Height box, enter 4.44”. In the Width box, enter 9.47”. Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following: Click Align to Slide. Click Align Middle. Click Align Center. On the slide, select the graphic. On the Design tab, in the Themes group, click Colors, and then under Built-in click Technic. (Note: if this action is taken in a PowerPoint presentation containing more than one slide, the color scheme will be applied to all of the slides.) Under SmartArt Tools, on the Design tab, in the SmartArt Styles group, do the following: Click Change Colors and then under Colorful click Colorful Range – Accent Colors 5 to 6 (fifth option from the left). Click More, and then under Best Match for Document click Intense Effect (fifth option from the left). Press and hold SHIFT, and then select all four “topic” rectangles. Under SmartArt Tools, on the Format tab, in the Shapes group, click Change Shape, and then under Rectangles click Round Single Corner Rectangle (seventh option from the left). On the Home tab, in the Font group, select Gill Sans MT Condensed from the Font list. On the Home tab, in the Paragraph group, click Align Text Left. On the Home tab, in the bottom right corner of the Drawing group, click the Format Shape dialog box launcher. In the Format Shape dialog box, in the left pane, click Text Box. In the Text Box pane, under Text layout, in the Vertical alignment list, select Bottom. Press and hold SHIFT, and then select all four bulleted-list rectangles. On the Home tab, in the Font group, select Gill Sans MT Condensed from the Font list, and then enter 22 in the Font Size box. On the Home tab, in the bottom right corner of the Drawing group, click the Format Shape dialog box launcher. In the Format Shape dialog box, in the left pane, click Text Box. In the Text Box pane, under Internal margin, do the following: In the Left box, enter 0.1”. In the Top box, enter 0.2”. In the Right box, enter 0.1”. In the Bottom box, enter 0.1”. Select the first bulleted-list rectangle from the left. Under SmartArt Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, in the left pane, click Fill, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Linear. Click the button next to Direction, and then click Linear Down (first row, second option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list. Also under Gradient stops, customize the gradient stops as follows: Select Stop 1 from the list, and then do the following: In the Stop position box, enter 0%. Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 225, Green: 222, Blue: 215. In the Transparency box, enter 0%. Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%. In the Transparency box, enter 100%. Select the second bulleted-list rectangle from the left. Under SmartArt Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 222, Green: 225, Blue: 219. Select the third bulleted-list rectangle from the left. Under SmartArt Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, in the left pane, click Fill, select Gradient fill in the Fill pane, and then do the following: Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 214, Green: 220, Blue: 218. Select the fourth bulleted-list rectangle from the left. Under SmartArt Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, in the left pane, click Fill, select Gradient fill in the Fill pane, and then do the following: Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 216, Green: 217, Blue: 218. To reproduce the animation effects on this slide, do the following: On the Animations tab, in the Animations group, click Custom Animation. On the slide, select the graphic. In the Custom Animation task pane, do the following: Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Basic, click Peek In. Under Modify: Peek In, in the Direction list, select From Bottom. Under Modify: Peek In, in the Speed list, select Fast. Also in the Custom Animation task pane, select the animation effect. Click the arrow to the right of the animation effect, and then click Effect Options. In the Expand dialog box, on the SmartArt Animation tab, in the Group graphic list, select One by one. Also in the Custom Animation task pane, click the double arrow under the animation effect to expand the contents of the list of effects, and then do the following: Select the first animation effect, and then under Modify: Peek In, in the Start list, select With Previous. Press and hold CTRL, select the second, fourth, sixth, and eighth animation effects (peek-in effects for the bulleted lists), and then do the following: Under Modify: Peek In, in the Start list, select With Previous. Under Modify: Peek In, in the Direction list, select From Top. To reproduce the background effects on this slide, do the following: Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Radial. Click the button next to Direction, and then click From Center (third option from the left). Also under Gradient stops, customize the gradient stops that you added as follows: Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 35% (fifth row, first option from the left). J Pneumol 28(Supl 3) – outubro de 2002

Valores de literatura mundial BD Guidelines Parâmetros BD positivo ATS VEF1 ou CVF >12 % e 200ml ERS VEF1 % > 10% ACCP VEF1 > 15% ATS/ERS VEF1 e ou CVF 1- Am Rev Respir Dis. 1991;144:1202-1218. 2- Eur Respir J. 1995;8:1398-1420. 3- Chest. 1974;65:552-553. 4- Eur Respir J. 2005;26:948-968.

Broncodilatador Variáveis B2 de curta duração (SBPT) VEF1 200ml 7% (ATS) 12% Broncodilatador Variáveis Efetivo SmartArt custom animation effects: horizontal organization chart (Intermediate) Tip: The instructions below describe how to reproduce the exact organization chart and animation effects in the example above. In the animation procedures, the number of animation effects that require modification in the Custom Animation task pane will vary if the chart contains a different number of managers and employees. To reproduce the background effects on this slide, do the following: On the Home tab, in the Slides group, click Layout, and then click Blank. On the Design tab, in the Background group, click Background Styles, and then click Style 8 (second row, fourth option from the left). (Note: If this action is taken in a PowerPoint presentation containing more than one slide, the background style will be applied to all of the slides.) To insert and arrange the SmartArt effects on this slide, do the following: On the Insert tab, in the Illustrations group, click SmartArt. In the Choose a SmartArt Graphic dialog box, in the left pane, click Hierarchy. In the Hierarchy pane, click Horizontal Labeled Hierarchy (second row, second option from the left), and then click OK to insert the graphic into the slide. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, next to the first first-level bullet, enter DIRECTOR (or the name of the director). Next to the bullets for the second-level rectangles, enter MANAGER 1 and MANAGER 2 (or the names of the managers). Also in the Type your text here dialog box, do the following: In the second first-level bullet, enter LEVEL 1. In the third first-level bullet, enter LEVEL 2. In the fourth first-level bullet, enter LEVEL 3. On the slide, do the following to add employee rectangles: Right-click the MANAGER 1 rectangle, point to Add Shape, and then click Add Shape Below. Right-click the MANAGER 2 rectangle, point to Add Shape, and then click Add Shape Below. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, next to each of the five third-level bullets, enter EMPLOYEE (or the names of the employees). Select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following: In the Height box, enter 6.82”. In the Width box, enter 9.3”. Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following: Click Align to Slide. Click Align Bottom. Click Align Center. Press and hold SHIFT, and then select all of the rectangles in the graphic. Under SmartArt Tools, on the Format tab, in the Shapes group, click Change Shape, and then under Rectangles click Snip Diagonal Corner Rectangle (fifth option from the left). Press and hold SHIFT, and then select all three large level rectangles in the graphic. On the LEVEL 1 rectangle, on the middle of the left edge, drag the blue square adjustment handle slightly to the left to increase the width of all three rectangles. Press and hold SHIFT, and then select all of the director, manager, and employee rectangles. On the director rectangle, on the middle of the left edge, drag the blue square adjustment handle slightly to the left to increase the width of all the selected rectangles. If you would like to modify the number of directors, managers, and employees in the chart to match the structure of your organization, do one or more of the following: To add a rectangle within a particular level, right-click one of the rectangles in that level, point to Add Shape, and then click Add Shape After or Add Shape Before. To add a rectangle above another rectangle, right-click the lower-level rectangle, point to Add Shape, and then click Add Shape Above. To add a rectangle below another rectangle, right-click the higher-level rectangle, point to Add Shape, and then click Add Shape Below. To delete a rectangle, select the rectangle and then press DELETE. To add text to new rectangles, select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text. To reproduce the LEVEL 1 rectangle effects on this slide, do the following: On the slide, select the LEVEL 1 rectangle. On the Home tab, in the Font group, enter 24 in the Font Size box, click Character Spacing and then click Loose, and then click the arrow next to Font Color and click Blue, Accent 1, Lighter 40% (fourth row, fifth option from the left). On the Home tab, in the bottom right corner of the Drawing group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Linear. Click the button next to Direction, and then click Linear Down (first row, second option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list. Also under Gradient stops, customize the gradient stops as follows: Select Stop 1 from the list, and then do the following: In the Stop position box, enter 0%. Click the button next to Color, and then under Theme Colors click Black, Background 1 (first row, first option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%. In the Transparency box, enter 100%. Also in the Format Shape dialog box, click Line Color in the left pane, select Gradient line in the Line Color pane, and then do the following: Click the button next to Color, and then under Theme Colors click Blue, Accent 1, Lighter 40% (fourth row, fifth option from the left). Also in the Format Shape dialog box, click Line Style in the left pane. In the Line Style pane, in the Width box, enter 1.5 pt. Also in the Format Shape dialog box, click Text Box in the left pane, and then do the following in the Text Box pane: Under Text layout, in the Vertical alignment list, select Top. Under Internal margin, in the Left box, enter 0.19”. Under Internal margin, in the Top box, enter 0.4”. Under Internal margin, in the Right box, enter 0.19”. Under Internal margin, in the Bottom box, enter 0.19”. To reproduce the LEVEL 2 rectangle effects on this slide, do the following: On the slide, select the LEVEL 2 rectangle. On the Home tab, in the Font group, enter 24 in the Font Size box, click Character Spacing and then click Loose, and then click the arrow next to Font Color and click Purple, Accent 4, Lighter 40% (fourth row, eighth option from the left). Click the button next to Color, and then under Theme Colors click Purple, Accent 4, Lighter 40% (fourth row, eighth option from the left). To reproduce the LEVEL 3 rectangle effects on this slide, do the following: On the slide, select the LEVEL 3 rectangle. On the Home tab, in the Font group, enter 24 in the Font Size box, click Character Spacing and then click Loose, and then click the arrow next to Font Color and click Olive Green, Accent 3, Lighter 40% (fourth row, seventh option from the left). On the Home tab, in the Drawing group, click the Format Shape Dialog Box Launcher. In the Format Shape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list select Linear. Click the button next to Color, and then under Theme Colors click Olive Green, Accent 3, Lighter 40% (fourth row, seventh option from the left). To reproduce the director rectangle effects on this slide, do the following: On the slide, select the director rectangle. Press the RIGHT ARROW key as needed to move the rectangle slightly off the right edge of the LEVEL 1 rectangle. On the Home tab, in the Font group, enter 23 in the Font Size box, and then click Text Shadow. On the Home tab, in the bottom right corner of the Drawing group, click the Format Shape dialog box launcher. In the Format Shape dialog box, in the left pane, click Fill, select Gradient fill in the Fill pane, and then do the following: Click the button next to Color, and then under Theme Colors click Blue , Accent 1, Darker 25% (fifth row, fifth option from the left). Also in the Format Shape dialog box, click Line Color in the left pane. In the Line Color pane, select Solid line, click the button next to Color, and then click Blue, Accent 1, Darker 25% (fifth row, fifth option from the left). Also in the Format Shape dialog box, click Line Style in the left pane. In the Line Style pane, in the Width box, enter 1 pt. Also in the Format Shape dialog box, click Shadow in the left pane. In the Shadow pane, click the button next to Presets, and then under Outer click Offset Center (second row, second option from the left). To reproduce the manager rectangle effects on this slide, do the following: Press and hold SHIFT, and then select the manager rectangles. Press the RIGHT ARROW key as needed to move the manager rectangles slightly off the right edge of the LEVEL 2 rectangle. On the Home tab, in the Font group, enter 23 pt in the Font Size box, and then click Text Shadow. Click the button next to Color, and then under Theme Colors click Purple , Accent 4, Darker 25% (fifth row, eighth option from the left). Also in the Format Shape dialog box, click Line Color in the left pane. In the Line Color pane, select Solid line, click the button next to Color, and then click Purple, Accent 4, Darker 25% (fifth row, eighth option from the left). Also in the Format Shape dialog box, click Shadow in the left pane. In the Shadow pane, click the button next to Presets , and then under Outer click Offset Center (second row, second option from the left). To reproduce the employee rectangle effects on this slide, do the following: Press and hold SHIFT, and then select the employee rectangles. Press the RIGHT ARROW key as needed to move the employee rectangles slightly off the right edge of the LEVEL 3 rectangle. Click the button next to Color, and then under Theme Colors click Olive Green, Accent 3, Darker 25% (fifth row, seventh option from the left). To vertically position the director, manager, and employee rectangles on the slide, do the following: Press and hold SHIFT, and then select the top three employee rectangles. Press the UP ARROW key as needed to move the rectangles up, just below the Level 3 text box. Select the MANAGER 1 rectangle. Press the UP ARROW key as needed to move this rectangle up slightly, to realign the connecting lines to the top three employee rectangles. Select the director rectangle. Press the UP ARROW key as needed to move this rectangle up slightly, to realign the connecting lines to the manager rectangles. To reproduce the line effects on this slide, do the following: Press and hold SHIFT, and then select all of the connecting lines. On the Home tab, in the bottom right corner of the Drawing group, click the Format Shape dialog box launcher. In the Format Shape dialog box, in the left pane, click Line Color, select Solid line in the Line Color pane, and then do the following: Click the button next to Color, and then under Theme Colors click White, Text 1 (first row, second option from the left). In the Transparency box, enter 80%. Also in the Format Shape dialog box, click Line Style in the left pane. In the Line Style pane, do the following: In the Width box, enter 2.5 pt. In the Dash type list select Round Dot (second option from the top). To reproduce the animation effects for the rectangles on this slide, do the following: On the Animations tab, in the Animations group, click Custom Animation. On the slide, select the graphic. In the Custom Animation task pane, do the following: Click the arrow next to Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Moderate, click Descend. Under Modify: Descend, in the Speed list, select Fast. Also in the Custom Animation task pane, select the animation effect (descend effect). Click the arrow to the right of the effect, and then click Effect Options. In the Descend dialog box, on the SmartArt Animation tab, in the Group graphic list, select By level one by one. Also in the Custom Animation task pane, click the double arrow under the animation effect to expand the contents of the list of effects, and then do the following: Press and hold CTRL, and then select the first four animation effects (descend effects). Under Modify: Descend, in the Start list, select With Previous. Select the first animation effect. Click the arrow to the right of the effect, and then click Timing. In the Descend dialog box, on the Timing tab, in the Delay box, enter 2. Select the second animation effect. Click Change, point to Entrance, and then click More Effects. In the Change Entrance Effect dialog box, under Moderate, click Rise Up. Select the third animation effect, and then do the following: Click Change, point to Entrance, and then click More Effects. In the Change Entrance Effect dialog box, under Moderate, click Rise Up. Click the arrow to the right of the effect (rise up entrance effect), and then click Timing. In the Rise Up dialog box, on the Timing tab, in the Delay box, enter 0.5. Select the fourth animation effect, and then do the following: Click the arrow to the right of the effect, and then click Timing. In the Rise Up dialog box, on the Timing tab, in the Delay box, enter 1. To reproduce the animation effects for the connecting lines on this slide, do the following: Press and hold CTRL, and then select the fifth and ninth animation effects (descend entrance effects) in the Custom Animation task pane. Click Change, point to Entrance, and then click More Effects. In the Change Entrance Effect dialog box, under Basic, click Wipe. Under Modify: Wipe, do the following: In the Start list, select On Click. In the Direction list, select From Left. In the Speed list, select Fast. Press and hold CTRL, and then select the seventh and 11th animation effects (descend entrance effects). Click Change, point to Entrance, and then click More Effects. In the Change Entrance Effect dialog box, under Basic, click Wipe. Under Modify: Wipe, do the following: In the Start list, select With Previous. With the seventh and 11th animation effects still selected, click the arrow to the right of the eleventh effect (wipe entrance effect), and then click Timing. In the Wipe dialog box, on the Timing tab, in the Delay box, enter 0.5. Select the eighth animation effect (descend entrance effect). Click the arrow to the right of the effect, and then click Timing. In the Descend dialog box, on the Timing tab, in the Delay box, enter 0.5. Press and hold CTRL, and then select the 13th, 15th, and 17th animation effects (descend entrance effects). Click Change, point to Entrance, and then click More Effects. In the Change Entrance Effects dialog box, under Basic, click Wipe. Under Modify: Wipe, do the following: Select the 13th animation effect (wipe entrance effect). Click the arrow to the right of the effect, and then click Timing. In the Wipe dialog box, on the Timing tab, in the Delay box, enter 1. Select the 15th animation effect (wipe entrance effect). Click the arrow to the right of the effect, and then click Timing. In the Wipe dialog box, on the Timing tab, in the Delay box, enter 1.5. Select the 17th animation effect (wipe entrance effect). Click the arrow to the right of the effect and select Timing. In the Wipe dialog box, on the Timing tab, in the Delay box enter 2 seconds. Select the 12th, 14th, 16th, and 18th animation effects (descend entrance effects). Under Modify: Descend, in the Start list, select With Previous. J Pneumol 28(Supl 3) – outubro de 2002 Am Rev Respir Dis. 1991;144:1202-1218

7% VEF1 200ml 12% SmartArt custom animation effects: continuous picture list (Basic) To reproduce the SmartArt effects on this slide, do the following: On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click SmartArt. In the Choose a SmartArt Graphic dialog box, in the left pane, click List. In the List pane, double-click Continuous Picture List (third row, fourth option from the left) to insert the graphic into the slide. On the slide, select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following: In the Height box, enter 5.05”. In the Width box, enter 7.57”. Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following: Click Align to Slide. Click Align Middle. Click Align Center. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text. Select the graphic. Under SmartArt Tools, on the Design tab, in the SmartArt Styles group, click More, and then under Best Match for Document click select Moderate Effect (fourth option from the left). Click each of the three picture placeholders in the SmartArt graphic, and then in the Insert Picture dialog box, select a picture and click Insert. Press and hold CTRL, and then select the three circle pictures on the slide. Under Picture Tools, on the Format tab, in the Picture Styles group, click Picture Effects, point to Glow, and then do the following: Under Glow Variations, click Accent color 1, 8 pt glow (second row, first option from the left). Point to More Glow Colors, and then under Theme Colors click Orange, Accent 6, Lighter 80% (second row, 10th option from the left). Select the left-right arrow at the bottom of the SmartArt graphic. Under SmartArt Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Linear. Click the button next to Direction, and then select Linear Right (first row, fourth option from the left). Under Gradient stops, click Add or Remove until three stops appear in the drop-down list. Also under Gradient stops, customize the gradient stops as follows: Select Stop 1 from the list, and then do the following: In the Stop position box, enter 0%. Click the button next to Color, and then under Theme Colors click Orange, Accent 6, Darker 25% (fifth row, 10th option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 50%. Click the button next to Color, and then click More Colors. In the Colors dialog box, on the Custom tab, enter values for Red: 255, Green: 192, Blue: 0. Select Stop 3 from the list, and then do the following: In the Stop position box, enter 100%. Press and hold CTRL, and then select the three rounded rectangles on the slide. On the Home tab, in the Font group, select Gill Sans MT from the Font list, enter 30 pt in the Font Size box, click the arrow next to Font Color, and then click White, Background 1 (first row, first option from the left). Under SmartArt Tools, on the Format tab, in the Shape Styles group, click Shape Effects, point to Reflection, and then under Reflection Variations click Tight reflection, touching (first row, first option from the left). Under SmartArt Tools, on the Format tab, in the Shape Styles group, click Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, in the left pane, click Fill, select Gradient fill in the Fill pane, and then do the following: In the Direction list, select Linear Down (first row, second option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list. In the Stop position box, enter 19%. Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left). Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 50% (second row, second option from the left). To reproduce the animation effects on this slide, do the following: On the Animations tab, in the Animations group, click Custom Animation. On the slide, select the graphic. In the Custom Animation task pane, do the following: Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Moderate, click Stretch. Under Modify: Stretch, in the Speed list, select Fast. Also in the Custom Animation task pane, click the arrow to the right of the animation effect, and then click Effect Options. In the Stretch dialog box, on the SmartArt Animation tab, in the Group graphic list, select One by One. Also in the Custom Animation task pane, click the double arrows under the animation effect to expand the list of effects. Press and hold CTRL, and then select all of the animation effects in the Custom Animation task pane. Under Modify: Stretch, in the Start list, select With Previous. Select the first animation effect (stretch effect for the left-right arrow) in the Custom Animation task pane. Under Modify: Stretch, click the arrow to the right of the effect, and then click Timing. In the Stretch dialog box, on the Timing tab, do the following: In the Delay box, enter 0.5. In the Speed box, enter 1.5 seconds. Press and hold CTRL, and then select the second and third animation effects (stretch effects for the left panel) in the Custom Animation task pane. Under Modify: Stretch, in the Direction list, select From Right. Also in the Custom Animation task pane, with the second and third animation effects still selected, click the arrow to the right of one of those effects, and then click Timing. In the Stretch dialog box, on the Timing tab, in the Delay box, enter 1, and then click OK. Press and hold CTRL, and then select the sixth and seventh animation effects (stretch effects for the right panel) in the Custom Animation task pane. Under Modify: Stretch, in the Direction list, select From Left. Also in the Custom Animation task pane, with the sixth and seventh animation effects still selected, click the arrow to the right of one of those effects, and then click Timing. In the Stretch dialog box, on the Timing tab, in the Delay box, enter 1. To reproduce the background effects on this slide, do the following: Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Radial. Click the button next to Direction, and then click From Center (third option from the left). Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 25% (fourth row, second option from the left).

O que representa esta diferença 7% e 12%? VEF1 pós BD – VEF 1 pré BD VEF 1 previsto X 100 = variação % de broncodilatação SBPT (7%) VEF1 pós BD – VEF 1 pré BD VEF 1 pré BD X 100 = variação % de broncodilatação ATS (12%) J Pneumol 28(Supl 3) – outubro de 2002 Am Rev Respir Dis. 1991;144:1202-1218

ID 50871 The Universal Applicability Of The American Thoracic Society Equation For Bronchodilation As Measured By Spirometry B66-NOVEL AND TRADITIONAL LUNG FUNCTION ASSESSMENT

ID 50871 The Universal Applicability Of The American Thoracic Society Equation For Bronchodilation As Measured By Spirometry B66-NOVEL AND TRADITIONAL LUNG FUNCTION ASSESSMENT

ID 50871 The Universal Applicability Of The American Thoracic Society Equation For Bronchodilation As Measured By Spirometry B66-NOVEL AND TRADITIONAL LUNG FUNCTION ASSESSMENT

TERCEIRA VERDADE COMBINAÇÃO DE DROGAS BRONCODILATADORAS 20 DPOC (15 homens) Estáveis e moderados Mito ou VERDADE TERCEIRA VERDADE Hadcroft J, Calverley PMA .Thorax 2001;56:713–72 Calverley PMA, Albert P, Walker P. Lancet Respir Med 2013;1: 564–73

DROGAS BRONCODILATADORAS Lama – Laba – Ulama – Ulaba Medicamento Posologia Duração Início da ação Salbutamol (ou fenoterol) 100mcg 4-6h 22±9 min Ipratrópio 20mcg 6-8h Formoterol (Salmeterol) 12mcg (50mcg) 12h 32±1 min (169±32 min) Indacaterol 150mcg 24h 30±4 min Tiotropio 5mcg 30 min Glicopirronio 50mcg Indacaterol/glicopirronio ---- Carmoterol (vilatenrol) 30h (24h) Aclidinio 600mcg 32h Broncodilatadores GOLD updated Jan 2014

VEF1 “trough” 23:30 (+/-15min) 51 pacientes DPOC moderado a grave VEF1 “trough” 23:30 (+/-15min) Dose resposta Tashkin and Fabbri. Respiratory Research 2010, 11:149

Conclusões Mitos e Verdades na BD Variabilidade Valores de BD em normais Associação de medicamentos Padronização de broncodilatação Brasil (2002) Mais atual (adequada ) ATS / ERS (2005-2014) ERS se adequando à SBPT! Conclusões

Laboratório de Função Pulmonar Agnaldo José Lopes Elizabeth Bessa Thiago Bártholo Técnicos Edinete do Rosário Limeira Pedro Henrique Quintanilha Cinara Fronten Monique Cupello Policlínica Piquet Carneiro Hospital Universitário Pedro Ernesto pneumologiappc@gmail.com / pneumo.uerj@gmail.com Tels. 2334-2392 / 2868-8248