Association Between Osteoporosis Self-Assessment Tool for Asians and Airflow Limitation in Japanese Post-Menopausal Women.

Purpose: This study aimed to reveal the association between the osteoporosis self-assessment tool for Asians (OSTA) and airflow limitation (AL) in post-menopausal Japanese women. Participants and Methods: This cross-sectional study included 1580 participants undergoing a comprehensive health examination using spirometry and dual-energy X-ray absorptiometry. The OSTA was calculated by subtracting the age in years from the body weight (BW) in kilograms, and the result was multiplied by 0.2. The OSTA risk level was defined as low (>-1), moderate (-4 to -1), or high (<-4). AL was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7. The association between the OSTA and AL was assessed using logistic regression analysis. Results: The prevalence of AL was significantly higher in the high OSTA group (15.3%) than in the low OSTA group (3.1%) (p<0.001). In multiple linear regression analysis, the OSTA was independently associated with FEV1/FVC. In logistic regression models adjusted for smoking status, alcohol consumption, current use of medication for diabetes, hyperglycemia, rheumatoid arthritis, second-hand smoke, and ovary removal showed a significantly higher risk of AL (odds ratio: 5.48; 95% confidence interval: 2.90-10.37; p<0.001) in participants with OSTA high risk than in those with OSTA low risk. Conclusion: These results suggest that the OSTA high risk indicates reduced BMD at the femoral neck and presence of AL in Japanese post-menopausal women aged ≥45 years.

Clinical significance of chronic bronchitis in different racial groups.

BACKGROUNDS: Limited data are available on racial differences in the clinical features of chronic bronchitis (CB) patients with chronic obstructive pulmonary disease (COPD). In this study, we aimed to compare clinical features among CB patients of different races. We also analyzed the clinical significance of CB, defined classically and based on the COPD Assessment Test (CAT), to validate the CAT-based definition. METHODS: We analyzed patient data extracted from the Korean COPD Subgroup Study (KOCOSS) cohort (2012-2021) and US Genetic Epidemiology of COPD (COPDGene) study (2008-2011). We compared clinical characteristics among CB and non-CB patients of three different races using two CB definitions. RESULTS: In this study, 3,462 patients were non-Hispanic white (NHW), 1,018 were African American (AA), and 1,793 were Asian. The proportions of NHW, AA, and Asian patients with CB according to the classic definition were 27.4%, 20.9%, and 10.7%, compared with 25.2%, 30.9%, and 23.0% according to the CAT-based definition, respectively. The risk of CB prevalence was highest in NHW and lowest in Asian COPD patients. Among all races, CB patients were more likely to be current smokers, have worse respiratory symptoms and poorer health-related quality of life (HrQoL), and to have decreased lung function and exercise capacity. Most of these characteristics showed similar associations with the outcomes between the two definitions of CB. A binominal regression model revealed that CB patients of all races had an increased risk of future exacerbations according to both CB definitions, except for Asian patients with classically defined CB. CONCLUSIONS: The presence of CB was associated with worse respiratory symptoms, HrQoL, exercise capacity and lung function, and more exacerbations, regardless of race or CB definition. The CAT-based definition may be more useful for assessing the risk of future exacerbations in Asian COPD patients.

Adverse childhood experiences and adult disease: Examining mediating pathways in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

OBJECTIVES: Adverse childhood experiences (ACEs) have been linked to adulthood chronic diseases, but there is little research examining the mechanisms underlying this association. We tested pathways from ACEs to adult disease mediated via risk factors of depression, smoking, and body mass index. METHOD: Prospective data from adults 18 to 74 years old from the Hispanic Community Health Study/Study of Latinos and Sociocultural Ancillary Study were used. Retrospectively reported ACEs and hypothesized mediators were measured at Visit 1 (2008-2011). Outcomes of disease prevalence were assessed at Visit 2, approximately 6 years later. The analytic sample includes 5,230 Hispanic/Latino participants with ACE data. Statistical mediation was examined using structural equation modeling on cardiometabolic and pulmonary disease prevalence and reported probit regression coefficients with 95% confidence intervals (CIs). RESULTS: We found a significant association between ACEs and the prevalence of asthma/chronic obstructive pulmonary disorder (standardized ß = .07, 95% CI [0.02, 0.12]). In the mediational model, the direct association was nonsignificant (ß = .02, 95% CI [-0.04, 0.07]) but was mediated by depressive symptoms (ß = .03, 95% CI [0.02, 0.04]). There were no associations between ACEs and the prevalence of diabetes and self-reported coronary heart disease or cerebrovascular disease. However, a small indirect effect was identified via depressive symptoms and coronary heart disease (ß = .02, 95% CI [0.01, 0.03]). CONCLUSION: In this diverse Hispanic/Latino sample, depressive symptoms were found to be a pathway linking ACEs to self-reported cardiopulmonary diseases, although the effects were of small magnitude. Future work should replicate pathways, confirm the magnitude of effects, and examine cultural moderators that may dampen expected associations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Race Adjustment of Pulmonary Function Tests in the Diagnosis and Management of COPD: A Scoping Review.

Aim: Increasing evidence suggests that the inclusion of self-identified race in clinical decision algorithms may perpetuate longstanding inequities. Until recently, most pulmonary function tests utilized separate reference equations that are race/ethnicity based. Purpose: We assess the magnitude and scope of the available literature on the negative impact of race-based pulmonary function prediction equations on relevant outcomes in African Americans with COPD. Methods: We performed a scoping review utilizing an English language search on PubMed/Medline, Embase, Scopus, and Web of Science in September 2022 and updated it in December 2023. We searched for publications regarding the effect of race-specific vs race-neutral, race-free, or race-reversed lung function testing algorithms on the diagnosis of COPD and COPD-related physiologic and functional measures. Joanna Briggs Institute (JBI) guidelines were utilized for this scoping review. Eligibility criteria: The search was restricted to adults with COPD. We excluded publications on other lung disorders, non-English language publications, or studies that did not include African Americans. The search identified publications. Ultimately, six peer-reviewed publications and four conference abstracts were selected for this review. Results: Removal of race from lung function prediction equations often had opposite effects in African Americans and Whites, specifically regarding the severity of lung function impairment. Symptoms and objective findings were better aligned when race-specific reference values were not used. Race-neutral prediction algorithms uniformly resulted in reclassifying severity in the African Americans studied. Conclusion: The limited literature does not support the use of race-based lung function prediction equations. However, this assertion does not provide guidance for every specific clinical situation. For African Americans with COPD, the use of race-based prediction equations appears to fall short in enhancing diagnostic accuracy, classifying severity of impairment, or predicting subsequent clinical events. We do not have information comparing race-neutral vs race-based algorithms on prediction of progression of COPD. We conclude that the elimination of race-based reference values potentially reduces underestimation of disease severity in African Americans with COPD.

Impact of Using Global Lung Initiative Race-neutral Equations for Chronic Respiratory Disease in Western India.

The Global Lung Initiative (GLI) race-neutral equations are considered to be race agnostic, using inverse probability weight, and have lower limits of normality (LLN) different from the GLI mixed equations. In this observational study, we analyzed the impact of using GLI equations to interpret spirometry of 1,169 patients with chronic respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), COPD suspects, small airway obstruction, posttubercular lung disease, and preserved ratio with impaired spirometry (PRISm) (46% females, average age 46 years). Predicted normal and the LLN using GLI equations were significantly higher than those using Indian equations. The GLI race-neutral equations changed the category in 35.17% of males and 42.64% of females compared to Indian equations. The GLI mixed equations categorized a greater percentage of patients to have a mixed ventilatory pattern compared to the GLI race-neutral equations. There was a significant change in the grading of the severity of COPD using Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages based on the percentage of predicted values of FEV1. Although GLI race-neutral equations have greater concordance with Indian equations than GLI Mixed equations, these substantially overdiagnose abnormal ventilatory patterns on spirometry in adult Indians in western India with chronic respiratory disease. A substantial number of patients with normal or obstructive patterns on spirometry are recategorized to have mixed or restrictive patterns. The use of GLI race-neutral equations increases the severity of airflow limitation in COPD patients. GLI race-neutral predictions for FEV1 result in substantially fewer patients demonstrating postbronchodilator responsiveness (PBDR).

Implications of Race Adjustment in Lung-Function Equations.

BACKGROUND: Adjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified. METHODS: We obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks. RESULTS: Among the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011. CONCLUSIONS: The use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).

Changes in Spirometry Interpretative Strategies: Implications for Classifying COPD and Predicting Exacerbations.

BACKGROUND: Recent guidelines for spirometry interpretation recommend both race-neutral reference equations and use of z score thresholds to define severity of airflow obstruction. RESEARCH QUESTION: How does the transition from race-specific to race-neutral equations impact severity classifications for patients with COPD when using % predicted vs z score thresholds, and do changes in severity correspond to clinical risk? STUDY DESIGN AND METHODS: This retrospective cohort study included Black and White patients with COPD and available spirometry from the Johns Hopkins Health System. Global Lung Function Initiative (GLI) 2012 (race-specific) equations and GLI Global (race-neutral) equations were used to determine FEV1 % predicted and z score values. Patients were classified as having mild, moderate, or severe disease according to % predicted or z score thresholds. Associations between a change in severity classification from race-specific to race-neutral with COPD exacerbations and all-cause hospitalizations were evaluated using logistic regression. RESULTS: This cohort included 13,324 patients, of whom 9,232 patients (69.3%) were White (mean age, 65.7 years) and 4,092 patients (30.7%) were Black (mean age, 61.1 years). More Black than White patients showed a change in severity classification between approaches when using % predicted thresholds (20.2% vs 6.1%; P < .001), but not with z score thresholds (12.6% vs 12.3%; P = .68). An increased severity classification with a race-neutral approach was associated with increased risk of exacerbation when using z score thresholds (OR, 2.34; 95% CI, 1.51-3.63), but not when using % predicted thresholds (OR, 1.08; 95% CI, 0.61-1.93). A decreased severity classification with a race-neutral approach was associated with lower risk of exacerbation with both % predicted (OR, 0.49; 95% CI, 0.28-0.87) and z score (OR 0.67; 95% CI, 0.50-0.90) thresholds. INTERPRETATION: The proportions of Black and White individuals reclassified were similar with z score thresholds, and changes in severity corresponded to clinical risk with z scores. These results support recent recommendations for use of race-neutral equations and z score thresholds for spirometry interpretation.

Influence of the CYP2J2 Gene Polymorphisms on Chronic Obstructive Pulmonary Disease Risk in the Chinese Han Population / Influencia de los polimorfismos del gen CYP2J2 en el riesgo de desarrollo de enfermedad pulmonar obstructiva crónica en la población Han China

INTRODUCTION: Cytochrome P450 (CYP) 2J2 is a major enzyme that controls epoxyeicosatrienoic acids biosynthesis, which may play a role in chronic obstructive pulmonary disease (COPD) development. In this study, we aimed to assess the influence of CYP2J2 polymorphisms with COPD susceptibility. MATERIAL AND METHODS: A case-control study enrolled 313 COPD cases and 508 controls was to investigate the association between CYP2J2 polymorphisms and COPD risk. Agena MassARRAY platform was used to genotype CYP2J2 polymorphisms. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the association between CYP2J2 polymorphisms and COPD risk. RESULTS: We observed rs11207535 (homozygote: OR = 0.08, 95%CI = 0.01-0.96, p = 0.047; recessive: OR = 0.08, 95%CI = 0.01-0.94, p = 0.044), rs10889159 (homozygote: OR = 0.08, 95%CI = 0.01-0.92, p = 0.043; recessive: OR = 0.08, 95%CI = 0.01-0.90, p = 0.040) and rs1155002 (heterozygote: OR = 1.63, 95%CI = 1.13-2.36, p = 0.009; dominant: OR = 1.64, 95%CI = 1.15-2.35, p = 0.006; additive: OR = 1.45, 95%CI = 1.09-1.92, p = 0.011) were significantly associated with COPD risk. Allelic tests showed T allele of rs2280274 was related to a decreased risk of COPD and T allele of rs1155002 was associated with an increased COPD risk. Stratified analyses indicated the effects of CYP2J2 polymorphisms and COPD risk were dependent on gender and smoking status (p < 0.05). Additionally, two haplotypes (Ars11207535Crs10889159Trs1155002 and Ars11207535Crs10889159Crs1155002) significantly decreased COPD risk. CONCLUSION: It suggested CYP2J2 polymorphisms were associated with COPD susceptibility in the Chinese Han population

INTRODUCCIÓN: El citocromo P450 (CYP) 2J2 es una enzima importante que controla la biosíntesis de los ácidos epoxieicosatrienoicos, y que podría desempeñar un papel en el desarrollo de la enfermedad pulmonar obstructiva crónica (EPOC). En este estudio, nuestro objetivo fue evaluar la influencia de los polimorfismos de CYP2J2 en la susceptibilidad a la EPOC. MATERIALES Y MÉTODOS: Se realizó un estudio de casos y controles que incluyó 313 casos de EPOC y 508 controles para investigar la asociación entre los polimorfismos de CYP2J2 y el riesgo de desarrollar EPOC. Se utilizó la plataforma Agena MassARRAY para genotipar los polimorfismos de CYP2J2. Se calcularon los odds ratio (OR) con unos intervalos de confianza (IC) del 95% para valorar la asociación entre los polimorfismos de CYP2J2 y el riesgo de la EPOC. RESULTADOS: Observamos que rs11207535 (homocigoto: OR: 0,08, IC 95%: 0,01-0,96; p = 0,047; recesivo: OR: 0,08; IC 95%: 0,01-0,94; p = 0,044), rs10889159 (homocigoto: OR: 0,08, IC 95%: 0,01-0,92; p = 0,043; recesivo: OR: 0,08, IC 95%: 0,01-0,90; p = 0,040) y rs1155002 (heterocigoto: OR: 1,63, IC 95%: 1,13-2,36; p = 0,009; dominante: OR: 1,64, IC 95%: 1,15-2,35; p = 0,006; aditivo: OR: 1,45, IC 95%: 1,09-1,92; p = 0,011) se asociaron significativamente con el riesgo de EPOC. Las pruebas alélicas mostraron que el alelo T de rs2280274 estaba relacionado con una disminución del riesgo de EPOC y el alelo T de rs1155002 se asoció con un mayor riesgo de EPOC. Los análisis estratificados indicaron que los efectos de los polimorfismos de CYP2J2 y el riesgo de EPOC dependían del sexo y del tabaquismo (p < 0,05). Además, 2 haplotipos (Ars11207535Crs10889159Trs1155002 y Ars11207535Crs10889159Crs1155002) reducían significativamente el riesgo de la EPOC. CONCLUSIÓN: El estudio sugirió que los polimorfismos de CYP2J2 se asociaban con la susceptibilidad a la EPOC en la población Han China

Survey and analyses of population at high risk of chronic obstructive pulmonary disease in China, 2014 / 中华流行病学杂志

Objective: To understand the distribution and characteristics of people aged ≥40 years who are at high risk of COPD in China and provide evidence for COPD prevention and control. Methods: The survey was conducted among the subjects selected through multi-stage stratified cluster sampling from 31 provinces (autonomous regions and municipalities) in China for 2014-2015 national chronic obstructive pulmonary disease surveillance. A total of 75 107 people aged ≥40 years in 125 surveillance points were surveyed in face to face interviews. Subjects who met at least one of the following conditions, including chronic respiratory symptoms, exposure to risk factors, medical history of respiratory diseases, and family history, were defined as population at high risk. The weighted proportion of the population at high risk of COPD and 95%CI were estimated by using complex sampling design. Results: Among eligible 74 296 subjects, the proportion of population at high risk of COPD was 89.5% (95%CI: 87.8%-91.2%). The proportion significantly increased with age (P<0.001). The proportion of the population at high risk was significantly higher in men than in women (P<0.001), and in rural area than in urban area (P<0.001). The highest proportion of population at high risk was observed in men in rural area in western China. The proportion of population at high risk of COPD who met at least two conditions was 32.0% (95%CI:29.7%-34.2%), the proportion of those who met at least three conditions was 7.4% (95%CI: 6.6%- 8.3%), and the proportion of those who met all the conditions was 1.5% (95%CI: 1.2%-1.8%). Among population at high risk of COPD, those who only had exposure to one risk factor accounted for 61.7% (95%CI: 59.8%-63.7%). Conclusion: About 90% of people aged ≥40 years in China are at high risk for COPD. It is necessary to conduct population-based screening for COPD and take comprehensive measures to reduce prevalence of risk factors.

Smoking cessation and chronic obstructive pulmonary disease

No abstract available.

Describen las diferencias entre sexos en la supervivencia de los pacientes con enfermedad pulmonar obstructiva crónica: [revisión] / Gender differences in survival of patients with chronic obstructive pulmonary disease: [review]

En los últimos años aumentó la prevalencia de las enfermedades asociadas al tabaco en las mujeres, en especial de la enfermedad pulmonar obstructiva crónica (EPOC). Poco se conoce en la literatura científica sobre los aspectos diferenciales por sexo en la presentación clínica y el pronóstico de la EPOC. La mayoría de los estudios publicados en la literatura sobre diferencias entre sexos en la supervivencia de los pacientes con EPOC fueron realizados en poblaciones de pacientes con enfermedad grave, insuficienica respiratoria y oxigeno terapia crónica domiciliaria (OCD). En general, los datos indican que las mujeres con EPOC tienen mejor supervivencia que los hombres para similar grado de gravedad de la enfermedad. Sin embargo, en los pacientes con EPOC grave e insuficiencia respiratoria que requieren OCD, la supervivencia relativa es mejor entre los hombres que entre las mujeres. En la presente revisión se analiza en detalle cada uno de los estudios existentes sobre las diferencias entre sexos en la supervivencia de los pacientes con EPOC y se discuten las posibles causas en la discordancia de sus hallazgos.(AU)

Describen las diferencias entre sexos en la supervivencia de los pacientes con enfermedad pulmonar obstructiva crónica: [revisión] / Gender differences in survival of patients with chronic obstructive pulmonary disease: [review]

En los últimos años aumentó la prevalencia de las enfermedades asociadas al tabaco en las mujeres, en especial de la enfermedad pulmonar obstructiva crónica (EPOC). Poco se conoce en la literatura científica sobre los aspectos diferenciales por sexo en la presentación clínica y el pronóstico de la EPOC. La mayoría de los estudios publicados en la literatura sobre diferencias entre sexos en la supervivencia de los pacientes con EPOC fueron realizados en poblaciones de pacientes con enfermedad grave, insuficienica respiratoria y oxigeno terapia crónica domiciliaria (OCD). En general, los datos indican que las mujeres con EPOC tienen mejor supervivencia que los hombres para similar grado de gravedad de la enfermedad. Sin embargo, en los pacientes con EPOC grave e insuficiencia respiratoria que requieren OCD, la supervivencia relativa es mejor entre los hombres que entre las mujeres. En la presente revisión se analiza en detalle cada uno de los estudios existentes sobre las diferencias entre sexos en la supervivencia de los pacientes con EPOC y se discuten las posibles causas en la discordancia de sus hallazgos.

Sopro de vida: experiência com a doença pulmonar obstrutiva crônica na pobreza urbana de Fortaleza, Ceará, Brasil / Breath of life: experience with chronic obstructive pulmonary disease in the context of urban poverty in Fortaleza, Ceará State, Brazil

Trata-se de estudo antropológico de pessoas com a doença pulmonar obstrutiva crônica vivenciada na pobreza urbana de Fortaleza, Ceará, Brasil. De março a novembro de 2006, conduzimos com seis pacientes o estudo de casos, a entrevista etnográfica, a narrativa da enfermidade, e a observação participante no atendimento hospitalar e visitas domiciliares. Utilizamos a análise de conteúdo temática e a interpretação semântica contextualizada para interligar a experiência individual aos sistemas de significação, ações tomadas e condicionantes estruturais. Conclui-se que a doença pulmonar obstrutiva crônica provoca sensações, sinais e significados subjetivos. O diagnóstico torna a vida "um sufoco", surgindo limitações e privações de atividades laborais, sexuais, domésticas, familiares e de lazer. Evitar o contato direto com "o catarro" do doente, deixar de fumar ou diminuir a freqüência e evitar fumaça, tratar os sintomas com remédios caseiros e terapias corporais populares, manter a calma durante as crises, rejeitar restrições categóricas e impostas e entregar-se às forças espirituais são estratégias leigas para enfrentar o cansaço, a crise e a baixa auto-estima. A subjetividade da enfermidade, portanto, jamais pode ser excluída na medição da "carga global da doença" no nordeste brasileiro.

This is an anthropological study on the experience of living with chronic obstructive pulmonary disease (COPD) for low-income individuals in the city of Fortaleza, Ceará State, Brazil. From March to November 2006, we conducted case studies of six patients, using ethnographic interviews, illness narratives, and participant-observation during hospital treatment and home visits. Thematic context analysis and contextualized semantic analysis were used to link individual experience to system of significance, actions taken, and structural constraints. Based on the findings, COPD provokes subjective sensations, signs, and meanings. The diagnosis "smothers" patients, provoking hardships and limitations in their manual, sexual, domestic, family, and leisure activities. Lay strategies used to confront acute shortness of breath and low self-esteem include: avoiding direct contact with the patient's "phlegm", quitting or reducing smoking, treating symptoms with home remedies and popular body therapies, remaining calm during attacks, rejecting imposed therapies, and surrendering one's self to spiritual powers. Thus, the subjectivity of illness cannot be excluded from the measurement of the "global burden of disease" in Northeast Brazil.

Comportamiento de la enfermedad pulmonar obstructiva crónica / Status of chronic obstructive pulmonary disease

Se realizó un estudio descriptivo retrospectivo a todos los pacientes dispensarizados con enfermedad pulmonar obstructiva crónica (EPOC) demostrada clínica, radiológica y espirométricamente en los 19 consultorios urbanos del policlínico Yaguajay en el período de un año hasta el 1ro de enero del 2000; con el objetivo de determinar su comportamiento en el área. Para obtener la información se revisaron el total de las historias clínicas familiares de estos consultorios, seleccionándose los pacientes dispensarizados por enfermedad pulmonar obstructiva crónica (EPOC); se comprobó en las historias clínicas individuales la evolución clínica, así como la realización de rayos X y espirometría que confirmaran el diagnóstico. Los datos se obtuvieron a partir de un cuestionario diseñado al efecto y se procesaron con el cálculo porcentual aritmético. Se obtuvo una prevalencia de 0,48 porciento incrementándose su aparición con la edad. Los factores predisponentes más importantes fueron la edad, el hábito de fumar y la exposición ocupacional en trabajadores de industria y agricultores. Se identificó la infección como complicación más frecuente. El seguimiento por parte del médico de la familia fue inadecuado en un porciento elevado. Se recomendó emplear las pruebas funcionales respiratorias siempre que sea posible en los individuos con criterios clínicos y radiológicos de enfermedad pulmonar obstructiva crónica por parte del médico de la familia evitando así encontrarse ante un iceberg epidemiológico. Realizar estudios de diseño analítico que consoliden y/o esclarezcan los resultados obtenidos e identificar los pacientes fumadores con síntomas y deterioro de la función pulmonar y convencerlos para que dejen de fumar utilizando técnicas de educación para la salud(AU)

A retrospective descriptive study was made to all patients dispensarizados (interrogated, examined, diagnosed, treated, followed up, registered and classified) with Chronic Obstructive Pulmonary Disease (COPD) clinically, radiologically and spirometrically demonstrated in the 19 urban family doctors home-offices of the Yaguajay polyclinic, in the period from one year up to January 1st of 2000 with the aim of determining their status in the area. To collect the information, all the family clinical histories of these home-offices were reviewed, and the patients dispensarizados with COPD were selected. The clinical evolution, ,as well as the making of radiographies and spirometric assessment that confirmed the diagnosis, were verified in the individual clinical histories. Data were obtained from an ad hoc designed questionnaire and they were processed with the arithmetic percentage calculation. A prevalence of 0.48 percent was obtained and its onset increased with age. The most important predisponentes factors were age, smoking habit and occupational exposure in industry workers and farmers. Infection was identified as the most frequent complication. The follow-up by a family doctor was inadequate in a high percent. It was recommended to apply functional breathing tests whenever possible in individuals with clinical and radiological approaches of CPOD by a family doctor, thus avoiding to face an epidemiological iceberg. It is recommended to carry out studies of analytic design that consolidate and/or clarify the results obtained and to identify the smoking patients with symptoms and deterioration of lung function and to convince them so that they will stop smoking by using techniques of Education for Health(AU)