ABSTRACT
Objetivo: Conocer el perfil y las características de los enfermos diagnosticados de enfermedad pulmonar obstructiva crónica (EPOC) y que nunca han sido fumadores. Diseño: Estudio descriptivo transversal. Emplazamiento: Área Básica de Salud del Pla dUrgell (Atención Primaria de Lleida, España). Participantes: Se incluyeron los 512 pacientes mayores de 40 años diagnosticados de EPOC del Área Básica de Salud con una espirometría compatible al inicio del estudio [cociente < 0,7 entre el volumen de espiración forzada en el primer segundo (FEV1) y la capacidad vital forzada (FVC)]. Mediciones principales: La variable dependiente fue la EPOC en no fumadores y las independientes fueron variables recogidas a partir de la información sobre la historia clínica respiratoria, los factores de riesgo del enfermo y sobre calidad vida. Se diseñó un modelo predictor de padecer EPOC en no fumadores en comparación con los fumadores. Resultados: El 33,2% de los pacientes EPOC nunca habían sido fumadores y de estos, el 59,4% eran mujeres. La media del FEV1 de los no fumadores fue de 70,5 (DE = 17,1), superior a los 62,6 (DE = 18,5) en los fumadores/exfumadores (p < 0,001). La cobertura de la vacunación antineumocócica 23V era mejor en los no fumadores (75,3%), p<0,001. Los EPOC en no fumadores (respecto a los fumadores/exfumadores) eran: mayormente mujeres (OR = 16,46), de mayor edad (OR = 1,1), con mejor FEV1 (OR = 1,1), mejor percepción de calidad de vida, EuroQoL-5D (OR = 0,8), con menor prevalencia de diabetes (OR = 0,5), menor nivel de estudios (OR = 0,2), y con menos hospitalizaciones previas (OR = 0,3). Conclusiones: El estudio evidencia una alta proporción de no fumadores en enfermos EPOC. Nuestro trabajo objetiva que las mujeres de mayor edad y con menor gravedad se asociarían a un mayor riesgo de EPOC en no fumadores. Parece indicar que la EPOC en no fumadores aparecería en edades más tardías y sería más leve que la EPOC relacionada con el tabaquismo
Objective: The objective of the study was to know the profile of patients diagnosed with chronic obstructive pulmonary disease (COPD) and who have never been smokers. Design: A transversal study. Location: Primary Care Centre of Pla dUrgell (Primary care setting in Lleida, Spain). Participants: 512 patients older than 40 years with COPD from Primary Care Centre of Pla dUrgell with a compatible spirometry [forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio < 0.7) to the beginning of the study. Main measurements: The dependent variable was de COPD in non-smokers and the independents were variables collected from the information on the respiratory clinical history, the risk factors of the patients and on quality of life. We designed a predictor model of COPD in non-smokers compared to smokers. Results: 33.2% of COPD patients had never been smokers, 59.4% of whom were women. The average FEV1 for non-smokers was 70.5 (SD = 17.1), higher than 62.6 (SD = 18.5) for smokers/former smokers (p < 0.001). The coverage of pneumococcal vaccination 23V was better in non-smokers (75.3%), p < 0.001. COPD in non-smokers (compared to smokers/former smokers) were: mostly women (OR = 16.46), older (OR = 1.1), with better FEV1 (OR = 1.1), better perception of quality, EuroQoL-5D (OR = 0.8), with lower prevalence of diabetes (OR = 0.5), lower level of studies (OR = 0.2), and with fewer previous hospitalizations (OR = 0.3). Conclusions: The study evidences a high proportion of non-smokers in COPD patients. Our study aims that older women with less severity would be associated with an increased risk of COPD in non-smokers. It seems to indicate that COPD in non-smokers would appear at later ages and would be milder than smoking-related COPD
Subject(s)
Humans , Female , Adult , Pulmonary Disease, Chronic Obstructive/epidemiology , Smoking/epidemiology , Risk Factors , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Cross-Sectional StudiesABSTRACT
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Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/epidemiology , Dyspnea/complications , Bronchitis/epidemiology , Tobacco Smoke Pollution , Cough/epidemiology , Spain/epidemiologyABSTRACT
OBJECTIVE: The objective of the study was to know the profile of patients diagnosed with chronic obstructive pulmonary disease (COPD) and who have never been smokers. DESIGN: A transversal study. LOCATION: Primary Care Centre of Pla d'Urgell (Primary care setting in Lleida, Spain). PARTICIPANTS: 512 patients older than 40 years with COPD from Primary Care Centre of Pla d'Urgell with a compatible spirometry [forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio <0.7) to the beginning of the study. MAIN MEASUREMENTS: The dependent variable was de COPD in non-smokers and the independents were variables collected from the information on the respiratory clinical history, the risk factors of the patients and on quality of life. We designed a predictor model of COPD in non-smokers compared to smokers. RESULTS: 33.2% of COPD patients had never been smokers, 59.4% of whom were women. The average FEV1 for non-smokers was 70.5 (SD=17.1), higher than 62.6 (SD=18.5) for smokers/former smokers (p<0.001). The coverage of pneumococcal vaccination 23V was better in non-smokers (75.3%), p<0.001. COPD in non-smokers (compared to smokers/former smokers) were: mostly women (OR=16.46), older (OR=1.1), with better FEV1 (OR=1.1), better perception of quality, EuroQoL-5D (OR=0.8), with lower prevalence of diabetes (OR=0.5), lower level of studies (OR=0.2), and with fewer previous hospitalizations (OR=0.3). CONCLUSIONS: The study evidences a high proportion of non-smokers in COPD patients. Our study aims that older women with less severity would be associated with an increased risk of COPD in non-smokers. It seems to indicate that COPD in non-smokers would appear at later ages and would be milder than smoking-related COPD.
Subject(s)
Non-Smokers/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/epidemiology , Adult , Age Factors , Aged , Cross-Sectional Studies , Ex-Smokers , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Prevalence , Pulmonary Disease, Chronic Obstructive/physiopathology , Sex Distribution , Spain/epidemiology , Spirometry , Vital CapacityABSTRACT
Antecedentes y objetivo: Se desconoce cuál es la magnitud de la enfermedad pulmonar obstructiva crónica (EPOC) no diagnosticada en nuestro medio en población con factores de riesgo cardiovascular (FRCV). El objetivo fue estimar la prevalencia de EPOC no diagnosticada y sus características en una población con FRCV. Materiales y métodos: Estudio de prevalencia de EPOC en una población con FRCV seleccionada de forma aleatoria. Se les practicó una espirometría entre el 01/01/2015 y el 31/12/2016 y se determinó el porcentaje de pacientes con EPOC que no estaban diagnosticados previamente. Para cada paciente se registraron variables de interés y, en los enfermos con espirometría compatible con EPOC, si tenían o no registrado el diagnóstico en su historia clínica informatizada. La asociación de la EPOC no diagnosticada con las diferentes variables independientes se determinó con las odds ratio ajustadas (ORa) mediante modelos de regresión logística. Resultados: Se estudiaron 2.295 pacientes con FRCV. La prevalencia global de EPOC fue del 14,5%. Se objetivó un infradiagnóstico del 73,3%. Los nuevos diagnosticados de EPOC respecto a los ya diagnosticados con anterioridad presentaron un mayor porcentaje de mujeres (74,1% vs. 36,0%; p=0,081), de nunca fumadores (21,3% vs. 12,4%; p=0,577), de casos leves (GOLD1) (42,6% vs. 32,4%, p=0,008) y con una media inferior de HbA1c (5,5% vs. 5,6%; p=0,008) y de ácido úrico (5,1mg/dl vs. 5,6mg/dl; p=0,011). Las variables asociadas a la EPOC no diagnosticada fueron: el sexo femenino (ORa=1,27; IC95%: 0,74-2,17; p=0,383); la edad (ORa=0,94; IC95%: 0,87-0,99; p=0,018); el tabaquismo (fumador/exfumador) (ORa=0,47; IC95%: 0,22-1,01; p=0,054) y HbA1c (%) (ORa=0,45; IC95%: 0,23-0,88; p=0,019). Conclusiones: El infradiagnóstico de EPOC es muy elevado. Se tendría que valorar el contacto con el sistema sanitario de los enfermos entre 50 y 65 años y con algún FRCV para solicitarles una espirometría
Background and objective: The magnitude of undiagnosed COPD in our population with cardiovascular risk factors (CVRF) is unknown. The objective of this study was to estimate the prevalence of undiagnosed COPD and its specific characteristics in a population with CVRF. Materials and methods: Study the prevalence of COPD in patients with CVRF. Spirometry was performed between 01/01/2015 and 12/31/2016 and the percentage of patients with COPD, who had not previously been diagnosed, was determined. Each patient's variables of interest were recorded; the records of patients who had spirometry showing COPD were checked to confirm whether a diagnosis had been recorded or not. The association of undiagnosed COPD with different independent variables was determined with adjusted odds ratio (aOR) by non conditional logistic regression models. Results: 2,295 patients with CVRF were studied. The overall prevalence of COPD was 14.5%. An underdiagnosis of 73.3% was observed. Newly diagnosed COPD vs. undiagnosed COPD showed to be higher in women (74.1% vs. 36.0%; P=.081), non-smokers (21.3% vs. 12.4%; P=.577), mild cases (GOLD1) (42.6% vs. 32.4%, P=.008) and cases with lower than average HbA1c (5.5% vs. 5.6%; P=.008) and uric acid (5.1mg/dL vs. 5.6mg/dL; P=.011). The variables associated with undiagnosed COPD were: women (aOR=1.27; 95%CI: 0.74-2.17; P=.383); age (aOR=0.94; 95%CI: 0.87-0.99; P=.018); smokers (smoker/non-smoker) (aOR=0.47; 95%CI: 0.22-1.01; P=.054) and HbA1c (%) (aOR=0.45; 95%CI: 0.23-0.88; P=.019). Conclusions: The under-diagnosis of COPD is very high. The contact patients aged between 50 and 65 years-old who have CVRF with their health system should be reassessed, and they need to ask for a spirometry
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pulmonary Disease, Chronic Obstructive/epidemiology , Cardiovascular System/physiopathology , Glycated Hemoglobin/analysis , Pulmonary Disease, Chronic Obstructive/drug therapy , Risk Factors , Cross-Sectional Studies , Spirometry/methods , Tobacco Use DisorderABSTRACT
BACKGROUND AND OBJECTIVE: The magnitude of undiagnosed COPD in our population with cardiovascular risk factors (CVRF) is unknown. The objective of this study was to estimate the prevalence of undiagnosed COPD and its specific characteristics in a population with CVRF. MATERIALS AND METHODS: Study the prevalence of COPD in patients with CVRF. Spirometry was performed between 01/01/2015 and 12/31/2016 and the percentage of patients with COPD, who had not previously been diagnosed, was determined. Each patient's variables of interest were recorded; the records of patients who had spirometry showing COPD were checked to confirm whether a diagnosis had been recorded or not. The association of undiagnosed COPD with different independent variables was determined with adjusted odds ratio (aOR) by non conditional logistic regression models. RESULTS: 2,295 patients with CVRF were studied. The overall prevalence of COPD was 14.5%. An underdiagnosis of 73.3% was observed. Newly diagnosed COPD vs. undiagnosed COPD showed to be higher in women (74.1% vs. 36.0%; P=.081), non-smokers (21.3% vs. 12.4%; P=.577), mild cases (GOLD1) (42.6% vs. 32.4%, P=.008) and cases with lower than average HbA1c (5.5% vs. 5.6%; P=.008) and uric acid (5.1mg/dL vs. 5.6mg/dL; P=.011). The variables associated with undiagnosed COPD were: women (aOR=1.27; 95%CI: 0.74-2.17; P=.383); age (aOR=0.94; 95%CI: 0.87-0.99; P=.018); smokers (smoker/non-smoker) (aOR=0.47; 95%CI: 0.22-1.01; P=.054) and HbA1c (%) (aOR=0.45; 95%CI: 0.23-0.88; P=.019). CONCLUSIONS: The under-diagnosis of COPD is very high. The contact patients aged between 50 and 65 years-old who have CVRF with their health system should be reassessed, and they need to ask for a spirometry.
Subject(s)
Cardiovascular Diseases/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Age Factors , Aged , Female , Glycated Hemoglobin/analysis , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Prevalence , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/diagnosis , Risk Factors , Sex Distribution , Smoking/adverse effects , Spirometry , Uric Acid/bloodABSTRACT
BACKGROUND: The aim of the study was to assess the correlation between the tuberculin skin test (TST) and in vitro interferon-gamma released assays (IGRAs) with risk factors for the spread of infection in smear positive pulmonary tuberculosis (TB) contacts. METHODS: We recruited prospective contacts with smear positive pulmonary TB cases. We looked at human immunodeficiency virus (HIV) infection and other conditions of immunosuppression, presence of BCG vaccination and the degree of exposure to the index case. Patients underwent the TST, chest radiography, sputum analysis when necessary, and IGRA assays (QFN-G-IT and T-SPOT.TB). Presence of cough, diagnostic delay (days between first symptoms and TB diagnostic), contact conditions: room size (square meters) and index of overcrowding (square meters per person) were investigated in the index case. RESULTS: 156 contacts (119 adults, 37 children) of 66 TB patients were enrolled, 2.4 (1-14) contacts per TB case. The positivity of the TST did not correlate with the risk factors studied: presence of cough (p = 0.929); delayed diagnosis (p = 0.244); room size (p = 0.462); overcrowding (p = 0.800). Both QFN-G-IT and T-SPOT.TB, showed significant association with cough (p = 0.001, and p = 0.007) and room size (p = 0.020, and p = 0.023), respectively. CONCLUSIONS: Both IGRA associated better than TST with certain host-related risk factors involved in the transmission of disease, such as the presence of cough.
Subject(s)
Interferon-gamma Release Tests , Tuberculin Test , Tuberculosis, Pulmonary/diagnosis , Adult , BCG Vaccine , Child , Child, Preschool , Communicable Diseases/diagnosis , Cough/etiology , Delayed Diagnosis , Female , HIV Infections/complications , Humans , Interferon-gamma , Male , Prospective Studies , Risk Factors , Sputum , Tuberculosis, Pulmonary/complications , Young AdultABSTRACT
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