Self-reported influenza vaccination and protective serum antibody titers in a cohort of COPD patients.

BACKGROUND: COPD patients are advised vaccination against seasonal influenza, yet few studies have evaluated the protective antibody titers obtained in this patient group. AIMS: 1) To describe protective titers in COPD patients who self-reported influenza vaccination compared with vaccinated subjects without COPD and unvaccinated COPD patients, 2) analyze whether clinical parameters predicted influenza-specific antibody titers, and 3) whether antibody titers to influenza A at baseline could predict exacerbation risk or 5 years all-cause mortality. METHODS: Influenza A (H1N1 and H3N2) titers were measured by haemagglutination inhibition assay in serum from 432 COPD patients and 77 controls in the Bergen COPD Cohort Study, at yearly visits between 2006/09. Titers of 40 or above were considered protective. We examined the variables sex, age, body composition, smoking, GOLD stage, yearly exacerbations, inhaled steroids, and Charlson score as predictive of titers, both univariately and in a multivariable model estimated by generalized estimating equations. The exacerbation incidence rate ratios and mortality hazard ratios were assessed by negative binominal and cox regression models respectively. RESULTS: At baseline, 59% of COPD patients reported influenza vaccination during the last season. Levels of predictive titers varied considerably each season, but trended lower in COPD patients compared with controls. Neither sex, age, body composition, smoking, comorbidities, GOLD stage nor use of inhaled steroids consistently predicted titers. Having high titers at baseline did not impact later risk for exacerbations, but seemed to be associated with higher all-cause mortality, even after adjustment for COPD disease characteristics. CONCLUSION: Vaccination coverage for influenza is imperfect for COPD patients in Norway, and there is a concern that immunization is suboptimal.

Cavitating Langmuir turbulence in the terrestrial aurora.

Langmuir cavitons have been artificially produced in Earth's ionosphere, but evidence of naturally occurring cavitation has been elusive. By measuring and modeling the spectra of electrostatic plasma modes, we show that natural cavitating, or strong, Langmuir turbulence does occur in the ionosphere, via a process in which a beam of auroral electrons drives Langmuir waves, which in turn produce cascading Langmuir and ion-acoustic excitations and cavitating Langmuir turbulence. The data presented here are the first direct evidence of cavitating Langmuir turbulence occurring naturally in any space or astrophysical plasma.

Quantitative computed tomography: emphysema and airway wall thickness by sex, age and smoking.

We investigated how quantitative high-resolution computed tomography (HRCT) measures of emphysema and airway wall thickness (AWT) vary with sex, age and smoking history. We included 463 chronic obstructive pulmonary disease (COPD) cases and 431 controls. All included subjects were current or ex-smokers aged > or = 40 yrs, and all underwent spirometry and HRCT examination. The HRCT images were quantitatively assessed, providing indices on lung density and airway dimensions. The median (25-75th percentile) %LAA950 (% low-attenuation area < -950 HU) was 8.9 (3-19) and 4.7 (1-16) in male and female COPD cases, respectively, and 0.71 (0.3-1.6) and 0.32 (0.1-0.8) in male and female controls, respectively. %LAA950 was higher in ex-smokers and increased with increasing age and with increasing number of pack-years. The mean+/-SD standardised AWT was 0.504+/-0.030 and 0.474+/-0.031 in male and female COPD cases, respectively, and 0.488+/-0.028 and 0.463+/-0.025 in male and female controls, respectively. AWT decreased with increasing age in cases, and increased with the degree of current smoking in all subjects. We found significant differences in quantitative HRCT measures of emphysema and AWT between varying sex, age and smoking groups of both control and COPD subjects.

[Smoking cessation practice among Norwegian hospital physicians]. / Norske sykehuslegers praksis ved røykeavvenning.

BACKGROUND: Limited data is available as to what extent Norwegian hospital doctors ask their patients about their smoking habits, and to what extent doctors offer their patients help in smoking cessation. MATERIAL AND METHODS: A random sample of 1,025 hospital doctors was mailed a questionnaire. After 14 days a reminder letter was sent to non-responders; 76% of the doctors responded. RESULTS: Altogether 98% of the doctors stated that they asked their patients with smoking-related disease about their smoking habits. In cases of non-smoking related disease, 73% of the doctors stated that they asked about the smoking habits of their patients (83% of female and 69% of male doctors). If doctors knew that a patient wanted to quit smoking, 25% of them stated that they often recommended nicotine replacement therapy. Less than 7% of the doctors regularly offered smoking cessation courses, handed out self-assistant material, or gave the patients other smoking cessation advice. INTERPRETATION: The study indicates that doctors often ask their patients about their smoking habits, but there is clear potential for improvement as to the smoking cessation advice.