Fagerström Test and Heaviness Smoking Index. Are they Interchangeable as a Dependence Test for Nicotine?

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.

Prevalence of and Attitudes towards Smoking among Spanish Health Professionals.

BACKGROUND: The MPOWER strategy encourages suitable monitoring of the tobacco epidemic among health professionals in all countries. OBJECTIVE: To analyse the prevalence of and attitudes towards tobacco use among Spanish health professionals. METHODS: A study was conducted based on an online survey. The study population consisted of health professionals (primary care physicians, specialist physicians and nurses). The questionnaire used included questions about tobacco consumption, knowledge of and attitudes towards smoking. The sample size was calculated according to a database with 9,500 e-mail addresses and listings of health centres and hospitals all over Spain. Statistical analysis was done using the SPSS software programme. RESULTS: The study group comprised a total of 612 health professionals: 322 were women (52.6%), 196 were nurses and 416 were physicians. 11.7% of health professionals were smokers (9.6% regular smokers and 2.1% occasional smokers) and 41.3% were ex-smokers. Within the group of daily smokers, differences were observed between the nurses and the physicians: 11.2 versus 8.9% (p = 0.009). Smoking was recognized as a chronic disorder by 58.2% of health professionals, and 54.6% knew that the most effective intervention to help quit is a combination of psychological and pharmacological treatment. 56% of health professionals always asked their patients about their tobacco consumption. CONCLUSIONS: 11.7% of Spanish health professionals are smokers. We found that they have low knowledge about strategies to quit smoking and that there is a low level of therapeutic intervention on smokers.

Would Adding an Anesthesic to Nicotine Mouth Spray Increase Smoking Cessation Rates? Would this Justify Starting a Research Project?

Letter to the editor.

Carta al editor.

The impact of smoking on bronchiectasis and its comorbidities.

INTRODUCTION: Bronchiectasis, characterized by irreversible bronchial dilatation, is a growing global health concern with significant morbidity. This review delves into the intricate relationship between smoking and bronchiectasis, examining its epidemiology, pathophysiology, clinical manifestations, and therapeutic approaches. Our comprehensive literature search on PubMed utilized MESH terms including 'smoking,' 'smoking cessation,' 'bronchiectasis,' and 'comorbidities' to gather relevant studies. AREAS COVERED: This review emphasizes the role of smoking in bronchiectasis development and exacerbation by compromising airways and immune function. Interconnected comorbidities, including chronic obstructive pulmonary disease, asthma, and gastroesophageal reflux disease, create a detrimental cycle affecting patient outcomes. Despite limited studies on smoking cessation in bronchiectasis, the review stresses its importance. Advocating for tailored cessation programs, interventions like drainage, bronchodilators, and targeted antibiotics are crucial to disrupting the inflammatory-infection-widening cycle. EXPERT OPINION: The importance of smoking cessation in bronchiectasis management is paramount due to its extensive negative impact on related conditions. Proactive cessation programs utilizing technology and targeted education for high-risk groups aim to reduce smoking's impact on disease progression and related comorbidities. In conclusion, a personalized approach centered on smoking cessation is deemed vital for bronchiectasis, aiming to improve outcomes and enhance patients' quality of life in the face of this complex respiratory condition.

[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.

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.

Prevalence, Knowledge and Perceptions of Smoking and Tobacco Products and Vape Among SEPAR Members.

Introduction: The professional dedicated to respiratory health has an exemplary role in tobacco control, promoting smoking cessation in their patients. However, multiple circumstances cause a low implementation. Therefore, the objective of the study is to identify the consumption, knowledge and perception of tobacco and its emerging products in a representative sample of professionals involved in the treatment of respiratory patients integrated into the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Methods: Descriptive analysis of a structured online interview addressed to 5340 SEPAR members. Results: In a sample of 802 respondents, more than 33% have smoked at some time and 6.6% continue to smoke. More than 66% consider smoking as a chronic disease. More than 90% consider their role model important and advise their patients to quit smoking, but less than half carry out a smoking intervention. Only 35% of them believe that the ban on smoking in health centers is always complied. More than 75% do not consider nicotine delivery devices an option for smoking cessation or harm reduction. 22% are unaware of water pipes and 29% of heated tobacco. Conclusions: Professionals specialized in respiratory diseases are highly sensitized to smoking. Despite this, there are still weak points such as the insufficient implementation of smoking cessation interventions or the scant training in smoking and in new emerging products.

Introducción: El profesional dedicado a la salud respiratoria tiene un papel ejemplar en el control del tabaquismo, promoviendo el abandono del hábito tabáquico en sus pacientes. Sin embargo, múltiples circunstancias provocan una baja implementación. Por tanto, el objetivo del estudio es identificar el consumo, el conocimiento y la percepción sobre el tabaco y sus productos emergentes en una muestra representativa de profesionales implicados en el tratamiento de pacientes respiratorios integrados en la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Métodos: Análisis descriptivo de una entrevista estructurada en línea dirigida a 5.340 miembros de la SEPAR. Resultados: En una muestra de 802 encuestados, más del 33% ha fumado alguna vez y el 6.6% sigue fumando. Más del 66% considera el tabaquismo como una enfermedad crónica. Más del 90% considera importante su modelo a seguir y aconseja a sus pacientes que dejen de fumar, pero menos de la mitad realiza una intervención para dejar de fumar. Solo el 35% de ellos cree que la prohibición de fumar en los centros de salud se cumple siempre. Más del 75% no considera que los dispositivos de suministro de nicotina sean una opción para dejar de fumar o reducir los daños. El 22% desconoce las pipas de agua y el 29% el tabaco calentado. Conclusiones: Los profesionales especialistas en enfermedades respiratorias están altamente sensibilizados al tabaquismo. A pesar de ello, aún existen puntos débiles como la insuficiente implantación de intervenciones para dejar de fumar o la escasa formación en tabaquismo y en nuevos productos emergentes.

Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases.

On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.

[COVID-19 and Smoking: A Systematic Review and Meta-Analysis of the Evidence]. / COVID-19 y tabaquismo: revisión sistemática y metaanálisis de la evidencia.

OBJECTIVE: The aim of this study was to determine if tobacco use in patients with Covid-19 is associated with a negative disease course and adverse outcome, and if smoking, current and past, is associated with a greater possibility of developing COVID-19. MATERIAL AND METHODS: A systematic review (SR) and meta-analysis (MA) of previously published works were performed. The search strategy included all known descriptors for Covid-19 and tobacco and was conducted in different databases. Appropriate statistical models were used to address the effect size in meta-analysis, namely random effects and fixed effects model. RESULTS: Thirty-four articles were identified in the SR of which 19 were included in the MA. Being a smoker or former smoker was shown to be a risk factor for worse progression of Covid-19 infection (OR 1.96, 95% CI, 1.36 - 2.83) and a greater probability of presenting a more critical condition (OR 1.79 95% CI, 1.19 - 2.70). As limitations of the MA, we found that most of the studies analyzed were observational with limited publication bias. Two studies that disagreed with the rest were included, although after withdrawing them from the MA, smoking was maintained as a risk factor for worse progress. CONCLUSION: Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death.

Worldwide production on sleep apnea from 2009-2018. Analysis of the ability to secure funding and international collaboration networks.

BACKGROUND: Obstructive sleep apnea (OSA) is an emerging health problem, but information on scientific production in this subject area is scarce. We aim to evaluate the scientific production on OSA from 2009 to 2018 to illustrate its worldwide distribution, topic areas, and ability to secure funding, as well as to describe international collaboration networks in this field. METHODS: Articles published between 2009 and 2018 were extracted from the Science Citation Index Expanded via Web of Science (WoS) using the search term "obstructive sleep apn*". Publication year, number and country of authors, journal, subject category, key words, funding source and number of citations received were recorded. We also conducted network analyses for key words and international collaboration. RESULTS: 12,666 articles on OSA were located, which had increased from 895 documents in 2009 to 1592 in 2018. The progressive growth in scientific production on OSA had outpaced the growth rate of total WoS production since 2012.50% of the articles declared some type of funding, with a citation index higher than manuscripts that were not funded. The manuscripts were distributed in journals from 135 subject categories of the WoS, and keyword distribution showed a dispersed pattern with a high number of nodes. The international collaboration rate was 18.2%, and the country network showed the United States as the hegemonic node. CONCLUSION: World production on OSA has grown at a higher rate than global production and shows notable thematic dispersion as well as a high ability to secure funding, which increases its impact.

WITHDRAWN: Reply to "Smoker, Former Smoker and COVID-19: Nicotine Does Not Protect Against SARS-CoV-2"

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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.

Gender Differences in Original Archivos de Bronconeumología Publications, 2001-2018. / Diferencias de género en las publicaciones originales de Archivos de Bronconeumología en el periodo 2001-2018.

INTRODUCTION: Gender inequality exists in scientific publications. The aim of this study was to determine changing patterns in gender differences and factors associated with the positioning of authors' names in original articles published in Archivos de Bronconeumología (AB). METHODS: We performed a bibliometric study of articles published in AB between 2001 and 2018. Author gender was analysed in four scenarios: first author, last author, middle authors, and mentee authors. Comparisons were made by authors' specialties, funding received, multicentre studies, specialist areas, and others. Multivariate models adjusted for the percentage of registered physicians in the Spanish health system were created to predict the female gender of the first, middle, and last author. RESULTS: A total of 828 publications were analysed in which women appeared as first authors in 286 (34.5%) and last authors in 169 (20.4%). A gradual increase in women as first authors was observed (P = .0001), but not as last authors (P = .570). Overall, the average number of female authors increased over time (from 1.6 ± 1.4 in 2001-2005 to 3.3 ± 2.3 in 2016-2018, P = .0001), with no differences in male averages. The adjusted multivariate models reflected a positive bi-directional relationship between the first author and the middle authors, and a negative association between the first author being Spanish and the last author being female (OR 0.57; 95% CI 0.36-0.88, P = .012). CONCLUSIONS: Gender differences were found in various aspects of authorship in AB, summarized by a greater participation of women as first and intermediate authors, but not as last authors.

Altmetrics Analysis of Archivos de Bronconeumología From 2014 to 2018. / Análisis de las métricas alternativas de Archivos de Bronconeumología durante el periodo 2014-2018.

INTRODUCTION: Alternative metrics or altmetrics are non-traditional measurements of scientific production that reflect a publication's influence in social networks and similar channels of dissemination. The aim of this study was to analyze the media impact of Archivos de Bronconeumología according to 2 altmetric aggregators and website visits. METHODS: This was an observational study of the original articles and review and consensus articles published in Archivos de Bronconeumología during the period 2014-2018. Data from the PlumX Metrics and Altmetric aggregators and visits to the Archivos de Bronconeumología website were analyzed. Five comparisons were made: by specialty area, by funding received, by number of participating centers, by document type, and by topic. In a subanalysis, altmetrics were correlated with the conventional citation system. RESULTS: We analyzed 273 papers, of which 186 were original articles (68.1%). The papers that achieved greater media impact in the 2 aggregators analyzed, and in terms of website visits, were pulmonology papers and review and consensus articles. The mean Altmetric Attention Score was 1.9±4.4 (range 0-59), which is above average for the date of publication of the paper. A statistically significant weak to moderate correlation was identified between altmetrics and conventional citations. CONCLUSIONS: Review articles, consensus documents, and pulmonology papers had a greater media impact. Mean Altmetric Attention Score was higher than the average based on the date of publication. A weak to moderate correlation between altmetrics and conventional citations was identified.

Questions and Answers on Smoking in Patients With Diffuse ILD. Use of PICO Methodology. / Preguntas y respuestas relacionadas con tabaquismo en pacientes con EPID. Aplicación de metodología con formato PICO.

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.

[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.

[Network of international scientific collaboration on smoking: analysis of coauthorship through the Science Citation Index (1999-2003)]. / Redes de colaboración científica internacional en tabaquismo: análisis de coautorías mediante el Science Citation Index durante el periodo 1999-2003.

OBJECTIVE: The aim of this study was to analyze patterns of scientific collaboration and the visibility generated by coauthorship of articles on smoking among different countries on a world-wide basis through the Science Citation Index-Expanded (SCI-expanded) from 1999 to 2003. MATERIAL AND METHODS: We selected articles on smoking resulting from collaboration among different countries in the SCI-Expanded (1999-2003). The underlying networks of collaboration among countries were analyzed by comparing production (number of articles published), visibility (number of citations received) and centrality (node degree, intermediation and proximity). RESULTS: A total of 3,484 articles were obtained, in which 5,008 institutions from 79 countries participated. The most productive country was the United Kingdom, with Germany and France in the second and third places. The United Kingdom also published the largest number of articles with inter-institutional collaboration (570 articles), with the USA and Germany in second and third places. The USA published the largest number of articles with international collaboration with the United Kingdom and France in the second and third places. All countries received a greater number of citations for articles resulting from international and inter-institutional collaboration than for those performed without collaboration. Networks of collaboration were completely connected through a single component and the annual increase in size of these inter-country networks was due to new countries joining the periphery of the network. CONCLUSIONS: We found a positive correlation between international and inter-institutional collaboration and the number of citations received by articles on smoking research. The number of citations per year remained constant throughout the 5-year study period.