Pulmonary Function in People Living With Human Immunodeficiency Virus: A Meta-Analysis

Background: HIV can infect bronchial epithelial cells rendering individuals susceptible to lung damage. Our objective was to determine the effects of human immunodeficiency virus (HIV) infection on pulmonary function tests. Methods: We performed a meta-analysis after conducting a literature search in PubMed, Embase, Cochrane Library and Virtual Health Library databases from inception to December 31st, 2022. We employed the inverse variance method with a random effects model to calculate the effect estimate as the mean difference (MD) and 95% confidence interval (CI). We calculated the heterogeneity with the I2 statistic and performed a meta-regression analysis by age, sex, smoking, CD4 T-cells count and antiretroviral therapy. We also conducted a sensitivity analysis according to the studies’ publication date, and excluding the study with the greatest weight in the effect. The PROSPERO registry number was CRD42023401105. Results: The meta-analysis included 20 studies, with 7621 living with HIV and 7410 control participants. The pooled MD (95%CI) for the predicted percentage of FEV1, FVC and DLCO were −3.12 (−5.17, −1.06); p=0.003, −1.51 (−3.04, 0.02); p=0.05, and −5.26 (−6.64, −3.87); p<0.001, respectively. The pooled MD for FEV1/FVC was −0.01 (−0.02, −0.01); p=0.002. In all cases, there was a considerable heterogeneity. The meta-regression analysis showed that among studies heterogeneity was not explained by patient age, smoking, CD4 T-cells count or antiretroviral therapy. Conclusion: Pulmonary function tests are impaired in people living with HIV, independently of age, smoking, CD4 T-cells count, and geographical region. (AU)

Association between occupational exposure and chronic obstructive pulmonary disease and respiratory symptoms in the Spanish population

Introduction: The aim of this study was to analyze the impact of occupational exposure on chronic obstructive pulmonary disease (COPD) and respiratory symptoms in the general Spanish population.MethodsThis was a study nested in the Spanish EPISCAN II cross-sectional epidemiological study that included participants who had completed a structured questionnaire on their occupational history, a questionnaire on respiratory symptoms, and forced spirometry. The data were analyzed using Chi-square and Student's t tests and adjusted models of multiple linear regression and logistic regression.ResultsWe studied 7502 subjects, 51.1% women, with a mean age of 60±11 years. Overall, 53.2% reported some respiratory symptoms, 7.9% had respiratory symptoms during their work activity, 54.2% were or had been smokers, and 11.3% (851 subjects) met COPD criteria on spirometry. A total of 3056 subjects (40.7%) reported exposure to vapors, gases, dust or fumes (VGDF); occupational exposure to VGDF was independently associated with the presence of COPD (OR 1.22, 95% CI: 1.03–1.44), respiratory symptoms (OR 1.45, 95%: CI 1.30–1.61), and respiratory symptoms at work (OR 4.69, 95% CI: 3.82–5.77), with a population attributable fraction for COPD of 8.2%.ConclusionsOccupational exposure is associated with a higher risk of COPD and respiratory symptoms in the Spanish population. These results highlight the need to follow strict prevention measures to protect the respiratory health of workers. (AU)

Asociación bidireccional entre uso de tabaco y riesgo de depresión en el estudio de cohorte SUN / Bidirectional association between tobacco use and depression risk in the SUN cohort study

Evaluamos la asociación del consumo de tabaco o su abandono con el riesgo de depresión y determinamos si presentar depresión se asoció al inicio de fumar. Diseño: estudio de cohortes prospectivo de 16.519 graduados universitarios españoles sin depresión al inicio del estudio. El consumo de tabaco se determinó al inicio y tras cuatro años de seguimiento. Los casos incidentes de depresión fueron autoinformados en los cuestionarios de seguimiento. Usamos modelos de regresión de Cox para estimar los Hazard Ratios (HR) de depresión según el nivel de tabaquismo inicial y sus cambios. Se estimaron los Odds Ratios (OR) para la asociación entre prevalencia de tabaquismo a lo largo de la vida y comienzo del hábito con modelos de regresión logística. Se observó un HR (IC 95%) para fumadores de 1,24 (1,05-1,46) en comparación con los que nunca habían fumado. Los participantes con la exposición más alta al tabaco (≥ 20 paquetes-año) tuvieron un incremento relativo del riesgo de depresión de 38%. Dejar de fumar durante los primeros cuatro años de seguimiento se asoció inversamente con la depresión (HR = 0,63; IC 95% = 0,40-0,99). Observamos un incremento significativo del riesgo de aparición de tabaquismo en los participantes con prevalencia de depresión a lo largo de la vida (OR multivariable = 1,44; IC 95% = 1,13-1,83). Encontramos una asociación bidireccional entre el consumo de tabaco y la depresión en la cohorte SUN. El control del tabaco y las campañas sanitarias de abstinencia deberían considerarse estrategias efectivas de salud pública para prevenir y manejar los trastornos depresivos. (AU)

We assessed the association of tobacco use or smoking cessation with depression risk and determined if the presence of a depressive disorder was associated with smoking onset. We conducted a prospective cohort study (SUN Project) based on 16,519 Spanish university graduates without depression at baseline. Tobacco use was determined at baseline and after four years of follow-up. Incident cases of depression were ascertained according to a previously validated report of a clinical diagnosis of depression during follow-up. Multivariable Cox regression models were used to estimate hazard ratios (HR) of depression according to previous smoking status. We used logistic regression models as a secondary analysis to estimate Odds Ratios (OR) of smoking onset during the first four years of follow-up according to lifetime depression prevalence at baseline. The multivariable HR (95% CI) for current smokers was 1.24 (1.05-1.46) as compared to participants who had never smoked. Participants with the highest exposure to tobacco (≥ 20 packsyears) had a significant 38% relative increment in depression risk. Smoking cessation during the first four years of follow-up was inversely associated with depression (HR = 0.63; 95% CI = 0.40-0.99). Finally, a significant increment in the risk of smoking onset for participants with lifetime depression prevalence was observed (multivariable OR = 1.44; 95% CI = 1.13-1.83). A bidirectional association between tobacco use and depression in the SUN cohort was found. Therefore, tobacco control and health promotion campaigns for smoking cessation could be considered as effective strategies of public health for the prevention and management of depressive disorders. (AU)

¿Cómo afecta el tabaquismo en la elección de pareja estable? / How does smoking tobacco affect choosing a stable partner?

El objetivo de este estudio fue analizar el rechazo hacia los fumadores decara al establecimiento de una relación de pareja estable. La muestra constó de 445 participantes que fueron reclutados mediante el método de bola denieve. Se utilizó un cuestionario elaborado ad hoc que fue aplicado en líneade forma individual. Se evaluó la influencia del tabaquismo en la elecciónde pareja estable, estable con convivencia en el mismo hogar y estable conconvivencia en el hogar e hijos en común. Los resultados mostraron unimportante rechazo hacia personas fumadoras para los distintos tipos derelación. Se hallaron diferencias estadísticamente significativas en funcióndel nivel de estudios, el tabaquismo de los participantes y el tabaquismo desus parejas. Se encontró mayor nivel de rechazo hacia personas fumadorasen los participantes con estudios universitarios, en los no fumadores y enaquellos con pareja no fumadora. Los principales motivos de rechazohicieron referencia a higiene, salud y gasto económico. En conclusión, eltabaquismo puede obstaculizar el establecimiento de una relación de parejaestable. Este argumento podría ser incorporado al listado de inconvenientesasociados al tabaquismo de cara a la prevención y el tratamiento. (AU)

This study aimed to analyze the rejection towards smokers when considering a stable relationship. The sample included 445 participants who were recruited using the snowball method. A questionnaire created adhoc was answered online by each participant. The effect of tobacco usewas evaluated in choosing a stable partner, a stable partner to live with,and a stable partner to live with and have children. The results showed asignificant rejection towards smokers for the different types of relationships.Statistically significant differences were found depending on the participants’educational background and tobacco use, and their partner’s tobacco use.A higher level of rejection towards smokers was found in participants withuniversity studies, in non-smokers, and those with a non-smoker partner. Themain reasons for rejection were related to hygiene, health, and householdeconomy. In conclusion, tobacco use can interfere with the establishment ofa stable relationship. This argument could be added to the list of drawbacksassociated with tobacco use for prevention and treatment. (AU)

Effects of Smoking Social Cues on Inhibitory Control in Smokers: An Event-Related Potential Study

Objective: Reduced inhibitory control is a general characteristic of smokers and becomes increasingly pronounced in smoking-related contexts. However, research has rarely considered differences in the effects of various smoking-related cues. To fill this research gap, this study compared the effects of smoking object-related and smoking social-related cues on inhibitory control in smokers. Methods: We used a visual Go/NoGo paradigm with three types of long-lasting backgrounds (neutral, smoking object, and smoking social background) to record the error rates, reaction times, and amplitudes of the N2 and P3 event-related potentials (ERPs) by 25 smokers and 25 non-smokers. Results: (1) Smokers displayed smaller NoGo-N2 amplitudes than controls under the neutral background; (2) smokers displayed smaller NoGo-N2 amplitudes under the smoking social background and smoking object background than they did under the neutral background; (3) relative to neutral and smoking object backgrounds, smokers displayed higher commission error rates, shorter reaction times, and larger NoGo-P3 amplitudes under smoking social background. Conclusion: Smoking-related stimuli impair inhibitory control in smokers, especially when these stimuli are socially related. (AU)

¿Está justificado hacer un screening a largo plazo para el cáncer de pulmón en los pacientes con un carcinoma de cabeza y cuello? / Is long-term screening for lung cancer justified in patients with head and neck carcinoma?

Objetivo Los pacientes con un carcinoma escamoso de cabeza y cuello (CECC) tienen un mayor riesgo de aparición de segundas neoplasias localizadas en el pulmón que la población general. El objetivo del presente estudio es evaluar la incidencia a largo plazo de segundas neoplasias pulmonares tras el diagnóstico de un CECC y considerar la conveniencia de la realización de un cribado de cáncer de pulmón en estos pacientes. Material y métodos Realizamos un estudio retrospectivo en 4.954 pacientes con un tumor índice localizado en la cavidad oral, orofaringe, hipofaringe o laringe durante el periodo 1985-2017. Resultados Durante el periodo de seguimiento 469 pacientes (9,5%) presentaron una segunda neoplasia pulmonar. La incidencia de segunda neoplasia pulmonar fue del 1,26% anual, y se mantuvo prácticamente constante a lo largo de los 25 años de seguimiento analizados. Según los resultados de un estudio multivariante, los pacientes varones, con edades comprendidas entre los 50 y los 80 años, con antecedentes de tabaquismo y con tumores localizados en la orofaringe o en la supraglotis fueron los que presentaron un mayor riesgo de segunda neoplasia pulmonar. Conclusiones Los pacientes con un CECC como tumor índice tienen un alto riesgo de segundas neoplasias localizadas en el pulmón. Para conseguir un diagnóstico precoz de estas segundas neoplasias sería conveniente establecer protocolos de cribado basados en el uso de la TAC pulmonar de baja dosis, que deberían mantenerse indefinidamente durante el periodo de seguimiento. (AU)

Objective Patients with head and neck squamous cell carcinoma (HNSCC) have a higher risk of second lung neoplasms than the general population. The aim of the present study is to evaluate the long-term incidence of second lung malignancies after the diagnosis of a HNSCC and to consider the convenience of the screening for lung cancer in these patients. Material and methods We conducted a retrospective study performed on 4,954 patients with an index tumor located in the oral cavity, oropharynx, hypopharynx, or larynx during the period 1985-2017. Results During the follow-up period 469 patients (9.5%) presented a second pulmonary neoplasm. The incidence of second lung neoplasm was 1.26% per year and remained practically constant throughout the 25-year follow-up period analyzed. According to the results of a multivariate study, male patients, aged between 50 and 80 years, with a history of tobacco use, and with tumors located in the oropharynx or the supraglottis were those with the highest risk of second lung neoplasms. Conclusion Patients with a HNSCC index tumor have a high risk of second neoplasms located in the lung. In order to achieve an early diagnosis of these second neoplasms, it would be advisable to establish screening protocols based on the use of low-dose lung CT, which should be maintained indefinitely during the follow-up period. (AU)

Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023

Introduction: There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. Material and methods: 12 PICO questions are formulated from a GLOBAL PICO question: “Efficacy and safety of pharmacological treatment of tobacco dependence”. A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. Results: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. Conclusions: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence. (AU)

The effect of smoking and electronic cigarettes on rat testicles / El efecto del tabaquismo y los cigarrillos electrónicos en los testículos de ratas

Objective: After the negative effects of smoking on public health were proven, smoking cessation campaigns were initiated by health ministries and non-governmental organizations. Many drugs have been tried to reduce the addiction to smoking and the nicotine contained in it. Recently, e-cigarettes (EC) are widely used for smoking cessation efforts, although the effects and possible harms are not fully known. In our study, we planned to show the effect of cigarette and EC smoke on the male urogenital system. Methods: Adult male wistar rats were exposed to cigarette and EC smoke in a specially designed glass bell jar. Urine cotinine levels, testicular weights, gonadosomatic index, sperm count and sperm motility, testicular histology, and biochemical findings were compared with the control group. Results: In some rats in the cigarette and EC group, the seminiferous tubules were disorganized, and the germ cells and Sertoli cells were separated and shed. Stopped germ cell separation, cavity formation, necrosis, fibrosis, and atrophy were observed in severe cases. Higher PCO levels were found in the cigarette group compared to controls. Tissue homogenates levels of LPO were higher in both EC and cigarette groups compared to controls. No significant differences were observed between groups in terms of sperm motility and sperm count. (AU)

Objetivo: Una vez demostrados los efectos negativos del tabaquismo sobre la salud pública, los ministerios de salud y las ONG iniciaron campañas contra el consumo de tabaco. Hasta la fecha se han empleado múltiples fármacos en diferentes intentos por reducir la adicción al tabaco y el contenido de nicotina. Recientemente, el uso de cigarrillos electrónicos (CE) ha experimentado una amplia difusión como método para dejar de fumar, si bien sus efectos y posibles daños todavía no se conocen por completo. El objetivo de este estudio es determinar los efectos de cigarrillos y de CE sobre el sistema urogenital masculino. Métodos: Se expusieron ejemplares masculinos adultos de rata Wistar al humo de cigarrillos y de CE en una campana de cristal especialmente diseñada para dicha prueba. Se compararon niveles de nicotina en orina, peso testicular, índice gonadosomático, recuento y movilidad de espermatozoides, histología testicular y variables bioquímicas con los de un grupo de control. Resultados: En algunas ratas del grupo de cigarrillo y de CE los túbulos seminíferos presentaban desorganización y las células germinales y de Sertoli mostraban separación y desprendimiento. En casos graves se apreció separación detenida de células germinales, formación de cavidades, necrosis, fibrosis y atrofia. En el grupo de cigarrillo se encontraron niveles más altos de PCO en relación con los individuos del grupo control. Los niveles de homogenato de tejido de LPO fueron más elevados tanto en los grupos de CE como de cigarrillos, en comparación con el grupo de control. No se observan diferencias significativas entre grupos en cuanto al recuento y la movilidad de espermatozoides. (AU)