A good question is pending in the air

EDITORIAL

A good question is pending in the air

Thais Helena Abrahão Thomaz Queluz

Livre-Docente, Assistant Professor of the Discipline of Pneumology, Department of Clinical Medicine at the Faculdade de Medicina de Botucatu-Unesp. Department of Clinical Medicine

In this issue of the Jornal Brasileiro de Pneumologia, there is an article by Moreira et cols⁽¹⁾ proposing a method for the objective assessment of clubbing. Based upon the importance of clubbing as overall indicator of chronic pulmonary disease and more rarely of other clinical disabilities the authors present a simple and quick form of achieving profile images of the index fingers. : Shadow images of the index finger are achieved by striking a vertical source of light on the finger placed upon a transparent glass plane and from this image are determined the profile and hyponychial angles as well as the ratio between distal phalangean and interphalangean depths.

The method was applied to 452 normal adults and to 306 bearers of various pulmonary diseases. In the latter, results achieved were confronted with presence, absence or doubt of the clinical diagnosis of clubbing. Patients with clinical clubbing and those with a doubtful presence of the sign exhibited significantly different values of the variables under study from those of individuals without clubbing.

Interestingly, the values attained were higher in the smoker controls than in non-smokers. The authors suggest that pulmonary modifications provoked by smoking may alter the finger extremities, albeit at sub-clinical level.

Testing this hypothesis is a valid research perspective, that is to say, may modifications in the small airways cause clubbing? A study with smokers and non smokers correlating pulmonary function tests (spirometry and gas exchange ) with the values of the profile and hyponychial angles and with the ratio between distal phalangean and interphalangean depths according to the method proposed by the authors, would be beneficial.

As such, in addition to the scientific aspect and to the enhancement of a clinical sign relevant for pneumology, the study by Moreira et cols ⁽¹⁾ is a good example of a not expensive clinical research, with results that can be immediately put into practice. Above all, no pun intended, it left a good question pending in the air.

References

1. Moreira JS, Porto NS, Moreira ALS. Avaliação objetiva do Hipocratismo Digital em imagens da sombra de dedos indicadores. Estudo em pacientes pneumopatas e em indivíduos normais. J Bras Pneumol 2004; 126-133.

Thais H A T Queluz

Faculdade de Medicina de Botucatu – Unesp

Botucatu, SP 18618-000

E-mail: [e-mail]

Publication Dates

• Publication in this collection
  15 June 2004
• Date of issue
  Apr 2004