RESUMEN
Objective: The purpose of this study was to evaluate the degree of agreement between the Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) in daily smokers admitted to smoking cessation clinics from National Healthcare System in Spain and Argentine Republic. Material and methods: An observational, longitudinal, multicenter study (prospective cohort) conducted in smoking clinics in daily clinical practice. The patients were consecutively included as they attended the consultations. The statistical analysis was descriptive, and correlation and concordance tests as well as analysis and regression models were used. Results: In total, 308 subjects were included [161 women (52.3%)], with a mean age of 51.4 (10.8) years. We found an absence of agreement and the existence of a proportional difference between both tests [Regression coefficient for global series: 0.55 (0.52-0.59) p < .001]. This difference increased as the value of the FTCD score increased; that is, the higher the value of the FTCD score was, the greater the difference in relation to the value of the HSI score. Likewise, Cohen's kappa concordance coefficient, according to various combinations of categorization of both tests, showed that the agreement between these variables was only good. Approximately 20% of the subjects were not classified with the same degree of dependence by the two tests. Thus, a classification mismatch existed. Conclusions: We found an absence of agreement between both tests. These data imply that we should not substitute one test for the other when we analyze nicotine dependence in a population of smokers.
Asunto(s)
Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Fumar Tabaco/psicología , Tabaquismo/diagnóstico , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nicotina , Estudios Prospectivos , Psicometría/estadística & datos numéricos , España , Tabaquismo/epidemiologíaRESUMEN
INTRODUCTION: The aim of this study was to explore the utility of measuring motivation to quit smoking as a predictor of abstinence maintenance among smokers who wanted to quit and who were included in a multicenter study conducted in daily clinical practice. METHODS: This observational, longitudinal (prospective cohort), multicenter study was conducted in smoking clinics in Spain and the Argentine Republic in daily clinical practice. Motivation was assessed using three quantitative motivation tests and a Visual Analogue Scale. Statistical analysis included descriptive, association measures and logistic regression models. RESULTS: Of a total of 404 subjects, 273 were ultimately included for analysis (147 women; 53.8%), mean age 51±11 years). In one year, 53.5% (36.13% by intention to treat) of subjects (146) were successful in quitting smoking [men: 45.2% (66) and women: 54.8% (80)], with no differences between sexes. None of the scales utilized was associated, in an unquestionable or direct way, with long-term abstinence, although three of them, in a very complex model, with additional variables and added interactions, were associated with the 'result' variable, when other variables intervened in certain circumstances. CONCLUSIONS: None of the analyzed motivational scales alone demonstrated an association with success or failure in quitting smoking; thus, their use in isolation is of no value. Some of the scales analyzed might be related to the maintenance of abstinence but in complex models where other variables intervene, which makes interpretation considerably difficult. Therefore, the predictive capacity of the tests analyzed, based on the models, was low.
RESUMEN
INTRODUCTION: The Smoking and the Diffuse Interstitial Lung Diseases (ILD) groups of ALAT and SEPAR collaborated in the preparation of this document. MATERIALS AND METHODS: This document uses PICO methodology to answer various questions on the relationship between tobacco use and diffuse ILD. RESULTS AND CONCLUSIONS: The main recommendations are: a) moderate level of evidence and strong recommendation to consider smoking as a risk factor for the development and/or modification of the progression of diffuse ILD; b) moderate level of evidence to identify an increase in mortality in diffuse ILD, irrespective of histologic pattern. Low evidence for ascribing it to smoking and strong recommendation for the early identification of patients with diffuse ILD. Further studies are needed to evaluate the effect of smoking cessation in patients with diffuse ILD; c) low level of evidence and weak recommendation for defining the impact of passive smoking in diffuse ILD; d) low level of evidence to demonstrate that smoking cessation improves the outcomes of patients diagnosed with diffuse ILD and strong recommendation to advise smoking cessation in smokers with diffuse ILD, and e) low level of evidence to support the clinical or epidemiological usefulness of active case finding for diffuse ILD in smoking cessation programs, and strong recommendation justifying the performance of spirometry in active case finding, based not on current smoking status, but on previous accumulated consumption, even in asymptomatic cases.
Asunto(s)
Enfermedades Pulmonares Intersticiales , Cese del Hábito de Fumar , Contaminación por Humo de Tabaco , Humanos , Fumar , EspirometríaRESUMEN
OBJECTIVE: To evaluate the association between degrees of nicotine dependence measured by the Fagerström test (FTCD) and different tests of motivation to stop smoking. MATERIAL AND METHODS: Observational study, multicenter conducted in smoking clinics in daily clinical practice. Demographics, smoking status, FTCD scores, and motivation test results were collected: Richmond test (TR), Henri Mondor Paris motivation test (HMP), Khimji-Watts test (KW), and the visual analog scale of motivation to stop smoking. The statistical analysis was descriptive, and correlation and analysis tests and regression models were used. RESULTS: A total of 314 subjects were included [162 women (51.59%)]. Males smoked an average of 3.3 cigarettes/day more than women (95% CI: 0.9-5.6 cigarettes/day, p=0.006) and their cumulative consumption was 7.8 pack-years higher than in women (95% CI: 2.1 to 13.5 pack-years). We found no association between FTCD and the motivation tests to stop smoking used in this study. CONCLUSIONS: We found no association between the degree of dependence and the motivation to quit smoking measured by the aforementioned instruments.
Asunto(s)
Motivación , Cese del Hábito de Fumar/psicología , Tabaquismo/psicología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
El asma es una enfermedad crónica de la vía aérea prevalente en nuestro país, con frecuente mal control. Algunos especialistas de la Asociación de Alergia e Inmunología Clínica y la Asociación Argentina de Medicina Respiratoria han realizado recomendaciones sobre el manejo y tratamiento del asma mediante la metodología de consenso RAND/UCLA Delphi modificada sobre la base de la evidencia científica (GRADE). Este documento provee recomendaciones basadas en la opinión de especialistas y fundamentada en evidencia científica seleccionada en cuanto a la importancia de mejorar la adherencia al tratamiento y seguimiento a través de diferentes estrategias. Así mismo, provee recomendaciones actualizadas en aspectos críticos del tratamiento del asma leve al grave. Se recomienda, para mejorar la adherencia, el uso de planes personalizados de manejo (1 °C), uso de herramientas a través de teléfonos móviles (1B) y educación (1 °C). Con respecto a la inmunoterapia sublingual solo debe ser indicada a pacientes con asociación con rinitis alérgica, asociada a ácaros y síntomas de asma a pesar del tratamiento adecuado con FEV1 > 70 % (1B). Se recomienda fuertemente en el asma leve (escalón 2 GINA) el uso de broncodilatadores de acción rápida asociados a corticoides inhalados a demanda (1A). En asma grave, se recomienda el uso de la triple terapia inhalada con anticolinérgicos de acción prolongada, beta 2 de acción prolongada y corticoides inhaladas (1B). El uso de biológicos en asma grave está fuertemente indicado en fenotipo T2 con dupilumab (1A), T2 alérgico con omalizumab (1A) y en el T2 eosinofílico con benralizumab, o mepolizumab, con sus características distintivas (1A).
Asthma is a common chronic airway disease in our country, although with high poor control. Some specialists of the Asociación de Alergia e Inmunología Clínica and Asociación Argentina de Medicina Respiratoria have made recommendations for management and treatment of asthma, using a RAND/UCLA modified Delphi consensus methodology, based on GRADE evidence. This document provides recommendations based on specialist opinions about different strategies to improve adherence. Besides, it provides recommendations about critical issues of mild to severe asthma treatment. It´s recommended to improve adherence, personalized control-based management plan (1 °C), mobile devices (1B) and education (1 °C). Sublingual immunotherapy must be prescribed only in patients with allergic rhinitis, mite associated, and persistent symptoms although appropriate treatment with FEV1 > 70 % (1B). Use of fast action bronchodilators associated with inhaled corticosteroids prn in mild asthma (GINA stage 2) has strong recommendation (1A). Use of triple inhaled therapy (long acting anticholinergics, long acting beta 2 agonists and inhaled corticosteroids) is recommended in severe asthma (1B). Biologics has strong recommendations severe asthma: in phenotype T2 with dupilumab (1A), in phenotype allergic T2 with omalizumab (1A) and phenotype eosinophilic T2 with benralizumab or mepolizumab with distinctive characteristic (1A).
Asunto(s)
Cese del Hábito de Fumar , Humanos , Fumadores , Fumar/epidemiología , Derivación y ConsultaRESUMEN
Objetivo: Comprobar si el grado de autoeficacia (AE) para dejar de fumar es diferente según quién remita al fumador a la consulta de tabaquismo y evaluar si el grado de AE medida según procedencia tiene impacto en el resultado (éxito o fracaso). Método: Estudio observacional, longitudinal (cohorte prospectiva), multicéntrico, en consultas para dejar de fumar de España y Argentina. Para valorar la motivación, fueron utilizados test cuantitativos (Richmond, Henry Mondor de Paris y Khimji Watts) y una escala semicuantitativa. La AE se midió con una pregunta de dos cuestionarios distintos (pregunta 4 del cuestionario de Richmond y pregunta 3 del cuestionario de Khimji-Watts). El análisis estadístico incluyó modelos descriptivos, de asociación y de regresión. Resultados: Muestra de 182 sujetos (90 [49,5%] mujeres, edad media 51,4 años [DE: 11; IC 26-77]). Con la pregunta 3 de AE del test Khimji-Watts se encontró asociación con la procedencia en los varones: acudir por voluntad propia incrementa la AE frente a los que acuden enviados desde atención primaria o desde otras especialidades. Ninguna de las variables de AE presentó asociación con el resultado en dejar de fumar, pero las mujeres que acudieron por voluntad propia o enviadas desde atención primaria tienen más probabilidades de dejar de fumar. Los varones procedentes de otras especialidades y con edades medias tienen más probabilidades de fracaso. Conclusiones: Los varones que acuden a dejar de fumar por voluntad propia presentan puntuaciones más altas de AE que aquellos que acuden enviados por atención primaria y otras especialidades. No hemos encontrado una mayor abstinencia final según la puntuación de AE y la procedencia.(AU)
Objective: To check whether the degree of self-efficacy to quit smoking is different depending on who refers the smoker to the smoking cessation clinics, considering as origin: primary care, from another medical specialist or by the patients own volition, and to assess whether the degree of self-efficacy measured by who refers the patient has an impact on the outcome (success or failure). Methods: Observational, longitudinal (prospective cohort), multicentre study in smoking cessation clinics in Spain and Argentina (daily clinical practice). Quantitative tests (Richmond, Henry Mondor de Paris and Khimji Watts) and one semiquantitative test were used to assess motivation. Self-efficacy was measured with one question from two different questionnaires (question 4 of the Richmond questionnaire and question 3 of the Khimji-Watts questionnaire). Statistical analysis included descriptive, association, and regression models. Results: 182 subjects [90 (49.5%) women, mean age 51.4 years (11; 25-77)]. With question three of the auto-efficacy of the Khimji-Watts test an association was found with the origin in men: attending of their own free will increases self-efficacy compared to those who attend sent from primary care or from other specialties. None of the self-efficacy variables was associated with the outcome of quitting smoking, but women who attended of their own free will or referred from primary care are more likely to quit smoking. Men from other specialties and with middle ages are more likely to fail. Conclusions: Men referred for QS by his OV have higher SE scores (KWT3 question) than those referred by PC and OS. We did not find a higher final abstinence according to SE score and source.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Autoeficacia , Cese del Hábito de Fumar , Fumadores , Tabaquismo , Motivación , Análisis de Regresión , Enfermedades Respiratorias , España , ArgentinaRESUMEN
Introducción: Entre 2014 y 2016, se realizó en Argentina el estudio EPOC.AR, a fin de determinar la prevalencia de EPOC en el país. El presente trabajo se realizó para comparar las características de tabaquismo en fumadores con y sin EPOC de dicho estudio, conocer cuántos recibieron Consejo Médico, las características de sus intentos previos de abandono y la exposición a humo de tabaco de segunda mano. Material y Métodos: La asociación entre tabaquismo y sus características y EPOC se evaluó por Odds Ratio, su intervalo de confianza del 95% y valor p correspondiente al test de hipótesis, utilizando la técnica de chi cuadrado. Resultados: Se incluyeron 3469 encuestas en mayores de 39 años, 42.2% hombres. Fueron fumadores actuales o anteriores 70.7% y el 53.3% de ellos tenía características espirométricas de EPOC. El 34.7% es fumador actual, de los que 73,4% piensa en dejar de fumar, 64% recibió consejo y sólo 7.3% refiere haber utilizado algún tratamiento. El 40.2% de los encuestados refirió exposición a humo ambiental y el 56.1% refirió exposición laboral a humo de tabaco: Entre los fumadores del EPOC.AR, la mayoría fuman menos de 20 cigarrillos por día, hay mayor prevalencia de EPOC en hombres y mayor porcentaje de nunca fumadores con EPOC en mujeres. Alto porcentaje piensa dejar de fumar, algo menor en los que tienen EPOC, que tuvieron más intentos previos de dejar. Casi la mitad no recibió consejo médico y muy bajo porcentaje utilizó fármacos para dejar. Existe alta exposición a humo de segunda mano en casas y trabajo. Conclusiones: los fumadores del EPOC.AR fuman menos de 20 cigarrillos/día, hay más hombres, una alto porcentaje quiere dejar y muy pocos reciben consejo médico o fármacos.
Asunto(s)
Humanos , Enfermedad Pulmonar Obstructiva Crónica , Tabaquismo , Fumar , Cese del Hábito de Fumar , FumadoresRESUMEN
Introduction: The COPD.AR Study was conducted between 2014 and 2016 in Argentina to determine the prevalence of COPD in the country. This work was carried out to compare the smoking characteristics of smokers with and without COPD of said study, to know how many of them received medical advice, the characteristics of their previous attempts to quit and their exposure to secondhand tobacco smoke. Materials and Methods: The association between smoking characteristics and COPD was evaluated by Odds Ratio, its 95% confidence interval and p value corresponding to the hypothesis test, using the chi square technique. Results: We included 3469 surveys of subjects older than 39 years, 42.2% men. 70.7% were current or former smokers and 53.3% had spirometric characteristics of COPD. 34.7% are current smokers, 73.4% out of which think about quitting; 64% received advice about it and only 7.3% reported having used some treatment. 40.2% of the respondents reported exposure to environmental smoke, and 56.1% reported occupational exposure to tobacco smoke. The majority of COPD.AR smokers smoke less than 20 cigarettes per day; there is a higher prevalence of COPD in men and a higher percentage of never smokers with COPD in women. A high percentage thinks of quitting smoking, a little lower among patients with COPD, who had more previous attempts to quit. Almost half of the subjects did not receive any medical advice and a very low percentage used drugs to quit. There is high exposure to secondhand smoke in homes and workplaces. Conclusions: COPD.AR smokers smoke less than 20 cigarettes a day; there are more men, a high percentage want to quit and very few receive medical advice or drugs.
Asunto(s)
Humanos , Enfermedad Pulmonar Obstructiva Crónica , Tabaquismo , Fumar , Cese del Hábito de Fumar , FumadoresRESUMEN
Streptococcus pneumoniae is responsible for several clinical syndromes, such as community-acquired pneumonia, sinusitis, otitis media, and others. The most severe clinical entity caused by this bacteria is undoubtedly invasive pneumococcal disease. Certain factors are known to increase the risk of presenting invasive pneumococcal disease, the most important being smoking habit and underlying concomitant diseases. This article comprises a consensus document on antipneumococcal vaccination in smokers, drawn up by a Smoking Expert Group from the Spanish Society of Pulmonology and Thoracic Surgery and the Latin American Chest Association.
Asunto(s)
Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Fumar , Vacunación , Adhesión Bacteriana , Comorbilidad , Análisis Costo-Beneficio , Susceptibilidad a Enfermedades , Humanos , Esquemas de Inmunización , Huésped Inmunocomprometido , Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/economía , Sistema Respiratorio/efectos de los fármacos , Sistema Respiratorio/inmunología , Sistema Respiratorio/microbiología , Sistema Respiratorio/patología , Factores de Riesgo , Humo/efectos adversos , Fumar/efectos adversos , Fumar/epidemiología , España/epidemiología , Nicotiana , Contaminación por Humo de Tabaco/efectos adversos , Vacunación/economíaRESUMEN
Objetivo: Evaluar la existencia de asociación entre el grado de dependencia por la nicotina medido por el test de Fagerström (FTCD) y diferentes test de motivación para dejar de fumar. Material y métodos: Estudio observacional y multicéntrico realizado en consultas de tabaquismo en la práctica clínica diaria. Se recogieron variables demográficas, de estatus de fumador y las puntuaciones del FTCD y los test de motivación: test de Richmond (TR), test motivacional Henri Mondor de París (HMP), test Khimji-Watts (KW) y la escala analógica visual de motivación para dejar de fumar. El análisis estadístico fue descriptivo y se utilizaron test de correlación y análisis y modelos de regresión. Resultados: Fueron incluidos 314 sujetos (162 mujeres [51,59%]). Los varones fumaron en promedio 3,3cig/día más que las mujeres (IC95%: 0,9-5,6cig/día, p = 0,006) y tuvieron un consumo acumulado superior a las mujeres en 7,8 años-paquete (IC95%: 2,1 a 13,5 años-paquete). No se encontró asociación entre el FTCD y los test de motivación para dejar de fumar empleados en este estudio. Conclusiones: No hemos encontrado asociación entre el grado de dependencia y la motivación para dejar de fumar medidos por los instrumentos mencionados
Objective: To evaluate the association between degrees of nicotine dependence measured by the Fagerström test (FTCD) and different tests of motivation to stop smoking. Material and methods: Observational study, multicenter conducted in smoking clinics in daily clinical practice. Demographics, smoking status, FTCD scores, and motivation test results were collected: Richmond test (TR), Henri Mondor Paris motivation test (HMP), Khimji-Watts test (KW), and the visual analog scale of motivation to stop smoking. The statistical analysis was descriptive, and correlation and analysis tests and regression models were used. Results: A total of 314 subjects were included [162 women (51.59%)]. Males smoked an average of 3.3 cigarettes/day more than women (95% CI: 0.9-5.6 cigarettes/day, p = 0.006) and their cumulative consumption was 7.8 pack-years higher than in women (95% CI: 2.1 to 13.5 pack-years). We found no association between FTCD and the motivation tests to stop smoking used in this study. Conclusions: We found no association between the degree of dependence and the motivation to quit smoking measured by the aforementioned instruments
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cese del Uso de Tabaco/psicología , Tabaquismo/psicología , Motivación , Índice de Severidad de la EnfermedadRESUMEN
No disponible
Asunto(s)
Humanos , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Cese del Hábito de Fumar/métodos , Dispositivos para Dejar de Fumar Tabaco/estadística & datos numéricos , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Resultado del Tratamiento , Reducción del Daño , Reducción del Consumo de Tabaco/métodosRESUMEN
No disponible