that has been made in this area, even in a short period of time. Tobacco dependence is increasingly acknowledged as a chronic condition that can require multiple interventions. In addition, recent evidence supports the critical role of counseling, in individual and group interventions, as well as in conjunction with pharmacological treatment.The evidence-based selection method was applied in order to identify appropriate references in the specialized litera- IntroductionThis update represents the strong commitment of the Brazilian Thoracic Association to smoking cessation. It provides health professionals with a comprehensive instrument to deal with the principal aspects of tobacco dependence. It includes new and effective clinical treatments and highlights changes in procedures in certain situations.The comparison between this content and that of the previous guidelines shows the significant scientific progress The use of the strength of recommendation associated with the bibliographic citations in the text has as the following principal objectives: to clarify the information source; to stimulate the search for stronger scientific evidence; and to introduce a didactic and simple way to aid in the critical evaluation on the part of the reader, who is the one responsible for making the decisions concerning the patient being treated. Diagnostic approach Clinical evaluationThe smoker should be submitted to clinical evaluation upon admission to the smoking cessation program. The objective is to identify functional alterations in the lungs, the existence of smoking related diseases (SRDs), possible contraindications and drug interactions during the pharmacological treatment of the dependence. The profile of the smoker, the level of nicotine dependence and the motivation to stop smoking are also evaluated at this time.This evaluation (Chart 1) should include accurate clinical history, complete physical examination, and some complementary tests, depending on local diagnostic resources.Chest X-ray is an essential tool during the treatment. A good physician-patient relationship, together with professional sensitivity and observation skills, will indicate the most appropriate time. Some people are afraid of what they might find, avoiding treatment so that they do not have to face the situation. ture. This was followed by critical review by pairs, who ultimately presented their recommendations.The decision to adopt any of these guidelines should be made by the professional, taking into consideration the resources available in the locale and the specific circumstances of the patient. Although this document describes the principal recommendations in each situation, there is limited space for publishing. Therefore, additional references are provided to those interested in broadening their scientific knowledge on this subject.These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, in public or private health care clinics. This is the role of the government and the public poli...

Autores e colaboradores Diretrizes para Cessação do Tabagismo Número de substâncias identificadas em 15 funções químicas existentes no fumo Funções Número de químicas substâncias Amidas, imidas 237 Ácidos carboxílicos 227 Lactonas 150 Ésteres 474 Aldeídos 108 Cetonas 521 Álcoois 379 Fenóis 282 Aminas 196 N-eterocíclicos 921 Hidrocarbonetos 755 Nitrilas 106 Éteres 311 Carboidratos 42 Anidridos 11 Total 4.720

Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.

Aspergillosis is a multifaceted disease whose clinical manifestations (allergic, saprophytic and invasive forms) are determined by the host immune response. Allergic bronchopulmonary aspergillosis is characterized by corticosteroid-dependent asthma, fever, hemoptysis and destruction of the airways, which can evolve to fibrosis with honeycombing. The treatment consists of the combined use of a corticosteroid and itraconazole. Invasive pulmonary aspergillosis, which has a worse prognosis, is diagnosed based on histopathological documentation and positive culture of a sterile specimen. The treatment response obtained with voriconazole is better, in terms of survival and safety, than that obtained with amphotericin B. In patients with chronic pulmonary disease who are mildly immunocompromised, chronic necrotizing pulmonary aspergillosis causes progressive destruction of the lung. Such patients are treated with oral itraconazole. Chronic cavitary pulmonary aspergillosis causes multiple cavities, with or without aspergilloma, accompanied by pulmonary and systemic symptoms. In patients with chronic pulmonary disease, the aspergilloma is characterized by chronic productive cough and hemoptysis, together with a cavity containing a rounded, sometimes mobile, mass separated from the cavity wall by airspace. Surgical resection is the definitive treatment for both types of aspergillosis. Triazole fungicides provide long-term treatment benefits with minimal risk.