[Cigarette smoking in pregnancy: observational prospective study in three towns of Tuscany Region (Central Italy)]. / Fumo di sigaretta in gravidanza: studio osservazionale prospettico in tre città della Toscana.

OBJECTIVE: to assess the prevalence of smoking in pregnancy and its changes after childbirth, and the characteristics associated with a greater likelihood of smoking during pregnancy in a sample of women attending three university hospitals in Tuscany (Central Italy). DESIGN: observational prospective multicentric study. SETTING AND PARTICIPANTS: 1,036 women in ninth month of pregnancy were enrolled at the teaching hospitals of Careggi (Firenze), Pisa and Siena. Women filled a standardized, self-administered questionnaire at enrolment. A second questionnaire was administered by phone to the smoking, ex-smoking and abstinent-during-pregnancy women one year after the delivery. RESULTS: 60.5% of women was never smoker, 17.4% was ex-smoker, 14% of women stopped smoking during pregnancy, and 8.4% were current smokers. Smoking in pregnancy was significantly associated with being younger than 31 years old (OR 1.75; 95%CI 1.01-1.84) and unmarried (OR 1.75; 95%CI 1.10- 2.78), having a low school degree (OR 2.31; 95%CI 1.58-3.36) and a smoking partner (OR 3.03; 95%CI 2.32-3.96). The absolute risk of smoking during pregnancy was 42%. One year after delivery, 44%of women who stopped smoking in pregnancy relapsed. CONCLUSIONS: a not negligible percentage of women residents in Tuscany Region smokes during pregnancy. Relapses after delivery are high. Even if recently in Italy a smoke free legislation was implemented, the study shows a low attention toward passive smoking during pregnancy. Smoking cessation interventions specifically tailored for pregnant women and relapses prevention need to be implemented in Tuscany by all health care professionals who care for women during pregnancy and after delivery.

Reduced Peak Inspiratory Effort through the Diskus((R)) and the Turbuhaler((R)) due to Mishandling is Common in Clinical Practice.

OBJECTIVES: A minimum peak inspiratory flow (PIF) through dry powder inhalers (DPIs) is required for effective drug delivery to the lungs. Some patients are unable to generate the minimally effective PIF through the DPI. However, little information is available about the 'real life' prevalence of reduced peak inspiratory effort through the Diskus((R)) and the Turbuhaler((R)) as a result of mishandling METHODS: We investigated peak inhalation effort through the Diskus((R)) and the Turbuhaler((R)) by both direct observation and the In-Check Dial((R)), a portable PIF meter, in a large sample of patients consecutively referred to our laboratory who were familiar with these devices. Patients with reduced peak inspiratory effort repeated the PIF measurement after a session of instruction on the need for more forceful effort through the device. RESULTS: We studied 644 patients (mean age 62 years, 42% female). Of these, 62% had chronic obstructive pulmonary disease and 35% had asthma. The mean baseline forced expiratory volume in 1 second was 53% of predicted. 502 patients were using the Diskus((R)) and 185 the Turbuhaler((R)). Overall, 106 patients (16.5%) showed weak inhalation by direct observation at baseline. Of 44 subjects with weak inhalation through the Turbuhaler((R)), 34 (77%) demonstrated a PIF <30 L/min. Post-counselling, only four patients did not achieve a PIF of at least 30 L/min (p < 0.01). Of 62 subjects with weak inhalation through the Diskus((R)), 37 (60%) had a PIF <30 L/min. Post-counselling, all these subjects achieved a PIF of at least 30 L/min (p < 0.001). CONCLUSION: A significant number of patients show a reduced peak inspiratory effort through the Diskus((R)) and the Turbuhaler((R)) in real life. Our results indicate that the cause of this deficiency is often mishandling of the device because, after a brief session of instruction on the need for more forceful inhalation, most patients obtained an acceptable PIF rate. A PIF meter may identify patients with inadequately weak inhalation and offer useful feedback for obtaining the best inspiratory effort.