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.

Is the motivation to quit smoking a predictor of abstinence maintenance?

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.

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.

Is There an Association Between the Degree of Nicotine Dependence and the Motivation to Stop Smoking? / ¿Existe asociación entre el grado de dependencia por la nicotina y la motivación para dejar de fumar?

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.

Recomendaciones en el manejo y tratamiento del asma en la Argentina (REMA). Consenso Delphi modificado RAND/UCLA de la Asociación Argentina de Alergia e Inmunología Clínica y Asociación Argentina de Medicina Respiratoria / Recommendations for the Management and Treatment of Asthma in Argentina (RE.M.A). A RAND/UCLA modified Delphi Consensus Argentinian Association of Allergy and Clinical Immunology and Argentinian Association of Respiratory Medicine

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).

¿Cómo son los fumadores del EPOC. AR? Características de tabaquismo en población con y sin EPOC / How are COPD. AR smokers? Smoking Characteristics of Populations With and Without COPD

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.

How are COPD. AR smokers? Smoking Characteristics of Populations With and Without COPD / ¿Cómo son los fumadores del EPOC. AR? Características de tabaquismo en población con y sin EPOC

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.

SEPAR-ALAT Consensus Document on Antipneumoccal Vaccination in Smokers.

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.

Detección de compromiso respiratorio subdiagnosticado en transportistas de la ciudad de Córdoba / Detection of Underdiagnosed Respiratory Conditions Among Professional Drivers in Córdoba City

Los transportistas pueden constituir una población con características especiales: sedentarismo, tabaquismo y obesidad, que los predispone a numerosas enfermedades crónicas. Los objetivos de este trabajo fueron evaluar la prevalencia de compromiso respiratorio subdiagnosticado de tabaquismo y obesidad en transportistas de la Provincia de Córdoba. Material y métodos: Evaluación de 297 transportistas durante el examen médico para renovación de su licencia, en una clínica de la ciudad de Córdoba, a través de una encuesta anónima auto-administrada y espirometría. Resultados: La prevalencia de síntomas respiratorios fue de 81.1% y la de tabaquismo de 59.3%. El 46.1% fuma > 10 cigarrillos/día. De los sujetos con espirometría obstructiva, el 55.5% tiene historia de tabaquismo. La prevalencia de obesidad fue del 44.1% y de sobrepeso/obesidad 84.8%. No hubo correlación entre IMC aumentado y alteración espirométrica. El grupo de sobrepeso/obesidad tuvo mayor prevalencia de síntomas sugestivos de SAHOS ya sea en el análisis de síntomas individuales (ronquidos p = 0.0001, apneas p = 0.03 y somnolencia p = 0.05) como en forma conjunta (p = 0.016). Conclusiones: Se encontró patología obstructiva subdiagnosticada en el 10% de la población estudiada y un elevado porcentaje de sujetos con síntomas sugestivos de SAHOS. La prevalencia de tabaquismo fue doble de la media nacional y 30% superior a la media de la provincia de Córdoba. La prevalencia de obesidad fue 3 veces más elevada que la reportada en el país, con más del 80% de la muestra con IMC > 25 kg/m2.

Professional drivers may constitute a population with special features: sedentary lifestyle plus prevalence of smoking habit and obesity, which predispose them to several chronic diseases. The objectives of this study were to evaluate the prevalence of underdiagnosed respiratory conditions, smoking habit and obesity, among professional drivers of Cordoba province. Material and Methods: Evaluation of 297 professional drivers during the medical examination for driving license renewal, at a clinic in the city of Córdoba, through a self - administered anonymous questionnaire and spirometry. Results: The prevalence of respiratory symptoms was 81.1% and that of the smoking habit was 59.3%; 46.1% smoked >10 cigarettes/day. In the group of subjects with obstructive spirometry, 55.5% had a history of smoking. The prevalence of obesity was 44.1% and overweight/obesity 84.8%. There was no correlation between increased BMI and spirometric impairment. The group of overweight/obesity had a higher prevalence of symptoms suggestive of OSA, both in the analysis of individual symptoms (snoring p = 0.0001, apnea p = 0.03 and somnolence p = 0.05 ) and in the analysis of all the symptoms together (p = 0.016). Conclusions: Obstructive underdiagnosed pathology was found in 10% of the study population and in a high percentage of subjects with symptoms suggestive of OSA. Smoking habit prevalence was twice the national average and 30% higher than the average of the Cordoba province. The prevalence of obesity was 3 times higher than that reported in the country; over 80% of the sample had a BMI higher than 25 kg/m2.

Determinante ambientales en asma-e infecciones respiratorias: ¿causa o concecuencia?: ¿bemeficio o riesgo? / Environmental determinant in asthma-asthma and respiratory infections: cause or concecuencia? bemeficio or risk?

Sabemos que el mecanismo fisiopatogenico subyacente en el asma bronquial es la inflamación de las vías aéras, responsables de la hiperreactividad bronquial, la obstrucción y de los síntomas. Existen factores capaces de desarrollar inflamación y con ellos ser causante de asma bronquial y otros capaces de actuar sobre una vái aérea ya inflamada y ser responsables de la amplificación de mecanismos inflamatorios que llevará a continuidad de la enfermedad o producirán exacerbaciones.