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Certified Smoking Cessation Units in Spain: High Potential for Detection of Undiagnosed Chronic Obstructive Pulmonary Disease and Profile of Newly Diagnosed Cases.

PURPOSE: Smokers attending smoking cessation units (SCUs) may offer a unique opportunity for early recognition of undiagnosed chronic obstructive pulmonary disease (COPD). We aimed at assessing the impact of SCUs on the early diagnosis of COPD and describing the clinical and smoking profile of newly-diagnosed COPD cases at SCUs certified by the Spanish Society of Respiratory Diseases and Thoracic Surgery (SEPAR). PATIENTS AND METHODS: A multicenter cross-sectional observational cohort study (DIPREPOQ study) was performed in eight SEPAR-certified SCUs in Spain. Adult current smokers with no previously diagnosed respiratory disease and having one o more respiratory symptoms were included. Lung functional tests were performed and previously undiagnosed COPD cases were identified and characterized based on national guidelines. RESULTS: Out of 401 individuals newly attending the SCUs, 252 participants were included and 73 (28.9%) met the definition of previously undiagnosed COPD. A characterization of patients with COPD being newly recognized in SCUs showed: age (mean±SD) 61±9 years; men 59%; active work status 53.1%; functional class I/II dyspnea 82.8%, GOLD state mild/moderate/severe 57%/31%/12%; non-exacerbators 90%, CAT 14±4; emphysema in X-rays 40%. Most common co-morbidities were cardiovascular and psychiatric (anxiety and depression) ones. Usual smoking history included a lengthy smoking history (41±9 years) and a current consumption of 24±9 cigarettes/day. CONCLUSIONS AND IMPLICATIONS: Consistently certified SCUs can have a substantial contribution to early diagnosis of COPD. A typical profile of newly detected cases is reported, with most patients being men at their early sixties, with mild symptoms and with high and lengthy smoking history. Our study reports a high usefulness of lung functional tests to detect undiagnosed COPD in appropriately selected participants attending SCUs at a large national scale, using a standardized methodology. This is likely to be facilitated by the certification of SCUs using well-defined requirements by national scientific societies.

Lung Disease Associated With Marijuana Use. / Patología pulmonar asociada al consumo de marihuana.

Marijuana is the most widely usedillegal drug in the world, with a prevalence of 2.5%-5%, and the second most commonly smoked substance after tobacco. The components of smoke from combustion of marijuana are similar to those produced by the combustion of tobacco, but they differ in terms of psychoactive components and use. Inhalation of cannabis smoke affects the respiratory tract, so the available evidence must be updated in order to provide pulmonologists with the latest scientific information. In this article, we review the impact of cannabis consumption on the lungs, taking into account that the respiratory route is the most popular route of cannabis consumption.

[Smoking intervention in patients with cardiovascular diseases]. / Intervenciones en tabaquismo en pacientes con enfermedades cardiovasculares.

Smoking tobacco is the main cardiovascular risk factor and has a dose-dependent response. It has been shown that an aggressive policy, not only against consumption, achieves a significant decrease in cardiovascular deaths. Thus, we must provide and carry out activities to prevent or decrease the incidence of smoking (primary prevention), and to the early detection of the smoker and to reduce the prevalence (secondary prevention), and lastly to act on the effects of tobacco smoke, preventing complication and remissions (tertiary prevention). Thus, all health care levels must act in order that smokers do not develop cardiovascular disease when they quit smoking, both from Primary, as well as specialist care.

Comparison between two five year periods (1998/2002 and 2003/2007) on the production, impact and co-authorship of publications on tobacco and smoking by Spanish authors using the Science Citation Index.

OBJECTIVE: The aim of this study was to compare the production, impact and co-authorship of publications by Spanish authors on smoking and tobacco between two time periods (1998/2002 vs 2003/2007) using Science Citation Index (SCI). METHODS: The literature search was performed in the SCI-Expanded on 20 November 2008. All types of documents by Spanish authors were selected. The search was restricted to the title, and the key words used were "smok*" and "tobac*". The statistical analysis was descriptive (95% CI). RESULTS: A total of 588 documents were obtained, with 399 (67.85%) original papers, 54 (9.18%) letters to the editor, and 35 (5.95%) editorials. Productivity increased between the 98/02 to 03/07 periods: 234 (39.8%) documents versus 354 (60.2%). We have found significant differences between the two periods (98/02 vs 03/07) in total mean annual documents (47 ± 8 vs 71 ± 16 [p=0.024]) and total mean annual original papers (34 ± 6 vs 46 ± 9 [p=0.041]). The mean number of citations per document was 14.1 ± 2.1 for 98/02 period and 5.6 ± 2.5 for 03/07 period (p=0.003). The co-authorship annual index had increased; with a mean of 6.77 signatures/document for 98/02 period to a mean of 6.87 for 03/07 period. Authors and institution networks collaborations had increased between the two periods. CONCLUSIONS: Spanish production and co-authorship of documents on smoking and tobacco have increased between these two periods. The earlier period documents received more citations.

[Present and future of the SEPAR Smoking and Health Area]. / Presente y futuro del Area de Tabaquismo de la SEPAR.

Smoking is the primary avoidable cause of premature death and morbidity in our country. According to data from the WHO, tobacco costs more than 5 million lives per year, a figure that is assumed to continue increasing and will be 10 million by the year 2030. As health professionals we are obliged to be actively involved in this serious health problem, by correctly identifying, diagnosing and treating all smokers to help them in the process of giving up and help them achieve total abstinence. There is scientific evidence that smoking is the direct cause and reason for the worsening of many respiratory diseases, which due to their nature are basically the responsibility of the pneumologist, who officially, according to the Health Service Administration, is the specialist and expert in this area. The Smoking and Health Area of SEPAR was started in 1995. Its primary objectives were to increase the awareness of the smoking problem among the members of our Scientific Society, improve their scientific knowledge of this diseases, to help in diagnostic and treatment interventions in smokers, and lastly, to promote interventions for the prevention and treatment of smoking by the health and political Administrations. Nowadays it is one of the most dynamic areas of SEPAR and has more than 400 members. There are many unresolved challenges in our area, but the fundamental one which continues to occupy a particular place for the Administration, for our patients, for other health professionals of other specialties and scientific societies, and for all SEPAR professionals, is a key aspect of which there is no doubt: to defend the health and well-being of our population against the main cause of avoidable disease and death, tobacco.