Effectiveness of letters to patients with or without Cochrane blogshots on 10-year cardiovascular risk change among women in menopausal transition: 6-month three-arm randomized controlled trial.

BACKGROUND: Health information and patient education on lifestyle changes may have a positive effect on the prevention of many chronic conditions, especially cardiovascular diseases (CVDs). We performed a parallel, three-arm randomized controlled trial (RCT) of 6-month educational intervention in a form of letters containing a reminder of the participant's CVD risk with or without Cochrane blogshots to reduce CVD risk among women aged 45-65 with one or more known CVD risk factors. METHODS: The control group received a letter about their CVD risk at the beginning of the trial. The intervention groups received the initial letter about their CVD risk and remainder letters about their CVD risk every 2 months, with or without Cochrane blogshots: (1) effect of calcium in the prevention of high blood pressure, (2) effect of reducing saturated fat acids in eating habits, and (3) effects of green and black tea in CVD prevention. The primary outcome was CVD risk reduction calculated as the difference between the baseline and 6-month score for a 10-year risk of fatal CVD according to the ACC/AHA guidelines. RESULTS: After both interventions, CVD risk reduction was significantly higher compared to the control group (P < 0.001, Kruskal-Wallis H test). The number of participants who decreased their CV risk was 29% (20/70) in the control group, 69% (48/70) in the group receiving the reminder letters, and 70% (49/70) in the group receiving the reminder letters and blogshots. The number needed to treat to achieve risk reduction was 2.41 (95% CI = 1.77 to 3.78) for letters with a CVD risk reminder and 2.50 (1.81 to 4.03) for letters with a reminder and a blogshot. The group receiving reminder letters with Cochrane blogshots had a significant change in the category of CVD risk, mainly from high to moderate and from moderate to low CVD risk category. CONCLUSIONS: A simple and inexpensive intervention method in a form of letters reminding women about their CVD risk with or without providing additional health information in the form of Cochrane blogshots about interventions for important CVD risk factors may be effective in CVD management and could be considered by primary care providers. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04601558. Retrospectively registered on October 19, 2020.

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia.

BACKGROUND: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS: A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS: More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95-0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5-201.8) Croatian kunas and was similar across the study sites. CONCLUSION: Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.

Clinical trials on drug-drug interactions registered in ClinicalTrials.gov reported incongruent safety data in published articles: an observational study.

OBJECTIVE: To assess safety data of trials on drug-drug interactions (DDIs) reported in ClinicalTrials.gov and published in journal articles, since DDIs are a growing concern. STUDY DESIGN AND SETTING: In an observational study of clinical trials retrieved by the search term "drug-drug interaction(s)," we collected the information on registration and on adverse events (AEs) from ClinicalTrials.gov and corresponding publications. Trials were included if they primarily investigated DDIs, had a National Clinical Trial identifier, and were closed and completed by October 16, 2015. Publication data were extracted until March 2017. RESULTS: Among 1,110 eligible trials, most were in phase 1 (76.8%), industry-funded (68.8%), and started before registration (56.9%). Results were not reported in the registry for 86.8% and not published for 68.1% trials. Published AE data were completely identical to the data submitted to ClinicalTrials.gov for only 15.6% trials. Among 64 trials with results reported both in ClinicalTrials.gov and publications, 34.4% published concordant number for other AEs. CONCLUSION: Discrepancies that emerge from incomplete or changed reporting of AEs in publications emphasize the need to amend and enforce regulatory requirements for timely and complete submission of results, clearer AE reporting for trials focusing on DDIs, and regular assessment of the congruence of AE data submitted to ClinicalTrials.gov and scientific journals during the publication process.

Transparency and public accessibility of clinical trial information in Croatia: how it affects patient participation in clinical trials.

INTRODUCTION: Despite increased visibility of clinical trials through international trial registries, patients often remain uninformed of their existence, especially if they do not have access to adequate information about clinical research, including the language of the information. The aim of this study was to describe the context for transparency of clinical trials in Croatia in relation to countries in Central and Eastern Europe, and to assess how informed Croatian patients are about clinical trials and their accessibility. MATERIALS AND METHODS: We assessed the transparency of clinical trials from the data available in the public domain. We also conducted an anonymous survey on a convenience sample of 257 patients visiting two family medicine offices or an oncology department in south Croatia, and members of national patients' associations. RESULTS: Despite legal provisions for transparency of clinical trials in Croatia, they are still not sufficiently visible in the public domain. Among countries from Central and Eastern Europe, Croatia has the fewest number of registered trials in the EU Clinical Trials Registry. 66% of the patients in the survey were aware of the existence of clinical trials but only 15% were informed about possibilities of participating in a trial. Although 58% of the respondents were willing to try new treatments, only 6% actually participated in a clinical trial. Only 2% of the respondents were aware of publicly available trial registries. CONCLUSIONS: Our study demonstrates that there is low transparency of clinical trials in Croatia, and that Croatian patients are not fully aware of clinical trials and the possibilities of participating in them, despite reported availability of Internet resources and good communication with their physicians. There is a need for active policy measures to increase the awareness of and access to clinical trials to patients in Croatia, particularly in their own language.

Transition from paternalism to shared decision making - a review of the educational environment in Bosnia and Herzegovina and Croatia.

UNLABELLED: In this article we will review the benefits of a system built on partnership of physicians and their patients, highlight some of the factors which impede this transition, and propose ways to address these factors. Also, we are going to analyze the educational environment in Bosnia and Herzegovina and Croatia concerning ethics and communication skills. Personal responsibility of patients for their health should be reflected in their joint involvement in health decisions with their physicians. Patients, insecure about their individual competence surrounding their health decisions, tend to shy away from responsibility, whereas physicians, pressured by the responsibilities of the profession, do not always show sensitivity to all of the patient's concerns. They often treat illnesses instead of patients. A more open and collaborative relationship between the patient and the physician through shared decision making would be a better alternative. In the end, the patient ultimately decides whether a health intervention was satisfactory in fulfilling his or her specific needs. Transition from a paternalistic to a mutual relationship between doctors and patients has already begun. In an era of intense information sharing, shared decision making is a sensitive, ethical, legal, and political concept which needs empathic doctors with well-developed communication skills to integrate their clinical knowledge with patient-centered care. CONCLUSION: Transition from paternalistic to partner relation between physicians and patients is moving slowly ahead in Croatia and Bosnia and Herzegovina. Educational environment is improving but needs intense efforts to develop further.

Decisional conflict and vaccine uptake: cross-sectional study of 2012/2013 influenza season in Croatia.

INTRODUCTION: As scientific, media and individual opinions on the need for seasonal influenza vaccination differ, we explored patients' decisional conflict and perceived physician and social support when making a vaccination choice. MATERIAL AND METHODS: We conducted a survey of patients with previous vaccination experience in a single family medicine office in Split, Croatia. The questionnaire included the Decisional Conflict Scale (DCS), perceived social support, and attitudes and knowledge concerning vaccination. RESULTS: Out of 203 (86%) adult patients with previous vaccination experience, 182 (40.4%) opted to vaccinate in the current season, 98 (48.3%) refused, and 22 (11.3%) were undecided. The median decisional conflict score was highest among those undecided (43.8 out of the maximum 100, interquartile range (IQR) 33.2-52.3), lowest among those opting to vaccinate (17.2, IQR 9.4-26.6), and intermediate among those who refused vaccination (25.0, IQR 17.2-39.1) (p < 0.001, Kruskal-Wallis test and post-hoc Mann-Whitney U tests). The most common self-reported reasons for vaccination were previous vaccination experience (n = 85, 42%) and media information (n = 62, 30%). Those who refused vaccination felt less satisfied with the support they received from their family physician than those who decided to vaccinate (median 6.5 (IQR 0-9) vs. 9 (IQR 5-10) on a scale from 0 to 10), respectively; p = 0.001, Mann-Whitney U test). CONCLUSIONS: Higher decisional conflict of patients who refuse influenza vaccination and those undecided, alongside their perceived low support of the family physician in making that choice, emphasize the importance family doctors play in advising and helping patients make informed decisions about seasonal influenza vaccination.

Factors in traditional families which affect health and health care: a qualitative study.

One of the most powerful influences on the patient is the family and its characteristics. In the recent decades families have changed, one of the most well known changes was a shift from extended to nuclear families. The consequences of this shift on health have been poorly researched, although family factors are being taught at medical schools. The aim of this study is to explore differences and similarities in factors between nuclear and extended families which may affect health and health care of family members. We conducted the qualitative study of family reports. The reports were done by students of family medicine. We examined the reports according to fourtheme: (1) Relations between the members of the family and between them and society, (2) Lifestyle, (3) Use of medical services and confidence in doctors and medicine, (4) Ilnesses and attitude towards illnesses. Differences were found in relations between the closest members of the family, close family interactions, domination issues and family roles, attitudes towards independence, parents and children, interaction with other people, attitude towards medicine, taking care of the sick member of the family and the way families endure illnesses. A quantitative research is needed to verify all the differences which we came across in this study. The qualitative data support the importance of family on health.

Research projects in family medicine funded by the European Union.

OBJECTIVE: This study aimed at synthesizing funding opportunities in the field of family medicine by determining the number of family medicine projects, as well as number of project leaderships and/ or participations by each country. This was done in order to encourage inclusion of physicians in countries with underdeveloped research networks in successful research networks or to encourage them to form new ones. METHODS: We searched the Community Research and Development Information Service project database in February 2013. Study covered the period from years 1992 - 2012, selecting the projects within the field of general/family medicine. The search was conducted in February 2013. RESULTS: First search conducted in the CORDIS database came up with a total of 466 projects. After excluding 241 projects with insufficient data, we analysed 225 remaining projects; out of those, 22 (9.8%) were in the field of family medicine and 203 (90.2%) were from other fields of medicine. Sorted by the number of projects per country, Dutch institutions had the highest involvement in family medicine projects and were partners or coordinators in 18 out of 22 selected projects (81.8%), followed by British institutions with 15 (68.8%), and Spanish with 10 projects (45.5%). Croatia was a partner in a single FP7 Health project. CONCLUSION: Research projects in family medicine funded by the European Union show significant differences between countries. Constant and high-quality international cooperation in family medicine is the prerequisite for improvement and development of scientific research and the profession.

["Early patient contact"--the split model]. / "rani kontakt s pacijentom"--splitski model.

In the 2011/2012 academic year, School of Medicine in Split introduced the subject Clinical and Social Skills for 1st and 2nd year students. During the 25 hours of the 85-hour class, the students spent time in their mentors' general practice offices and made home visits with nurses. The goal of the introduction of this subject was to enable students to meet patients and their surroundings early in their studies; we believed that this would contribute to increased respect towards the profession and better absorption of communication skills, as well as better understanding of the patients and additional motivation to complete their studies. At the end of five-day class, the students wrote down their impressions, revealing that they had adjusted well to this form of the class, and that their expectations were fulfilled. They noticed the value of high-quality communication between the doctor and the patient, gained confidence, and felt more motivated to continue studying. They rated the class as useful and necessary, recommending it to last longer.

Writing letters to patients as an educational tool for medical students.

BACKGROUND: Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine. METHODS: The study included all 6th year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 - poor, 1 - medium, 2 - good) for 1) adequacy and clarity of description of patients' disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. RESULTS: Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (±standard deviation) 5.65 ± 0.79 for patients vs. 4.87 ± 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category "Technical terms unclear to a lay reader". CONCLUSIONS: Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care.

Level of hypertension control: comparison of a rural and urban family practice centre in South Croatia.

AIM: Arterial hypertension is a serious public health problem because of its frequency and poor management. We compared hypertension control between rural and urban environment over 5 years. Initial hypothesis: arterial pressure control is better in urban (Split) than in rural (Trilj) environment. METHODS: Historic prospective study was conducted in two family medicine outpatient clinics. Data for the years 2005, 2006, and 2010 were analyzed. One hundred and seventeen subjects diagnosed with arterial hypertension in 2005 were examined: 66 in a rural and 51 in urban outpatient clinic. Their average age was 60.92 ± 10.03 (range 30-82 years). Blood pressure records at the onset of the study, the first, and fifth year of treatment, risk factors, and therapy were analyzed. T-test and χ(2)-test were used in statistical data analysis. RESULTS: In the urban clinic, more subjects were smokers, had positive family history, were overweight, and had registered hyperlipidemia. Initial mean arterial pressure readings were similar in both the clinics. Decrease was recorded in the following 5 years. During this study the use of ACE inhibitors (ACEI) (Split by 45 %, Trilj by 133 %) and calcium channel blockers (CCB) (Split by 76.9 %, Trilj by 525 %) was increased. The number of patients receiving monotherapy was reduced. CONCLUSIONS: Better arterial pressure control was recorded in the urban clinic, where, after 5 years, despite increased frequency of additional risk factors, the number of normotensive patients was higher than that in the rural one. Hypertension control in both settings was still poor. Hypertensive patients should participate actively in the treatment.

[Why do treated hypertensives disregard our advice? A contribution to the "crash" initiative]. / Zasto lijeceni hipertonicari ne postuju nase savjete? Doprinos inicijativi "crash".

Salt intake contributes to the rise in blood pressure and prevalence of hypertension. In this interventional trial on 110 treated hypertensives over three months a permanently elevated sodium excretion was found, averaging 187.9 +/- 81.5 mmol/day (range 103-297), because of inappropriate salt intake. The treated hypertensives, despite opposite claims, consume large amounts of salt, which, in addition to noncompliance, is the leading cause of poor hypertension control. Dietary education is an important part of preventive care in family medicine, and legal measures to enforce salt labeling on alimentary products are mandatory.

The new curriculum for family medicine at the University of Split, School of Medicine.

According to the new curriculum at the University of Split School of Medicine for the 2010/2011 academic year, the Department of Family Medicine based its teaching on its own expert and research work. The adequacy of the communication with the patient, his or her family and the social environment, as well as the concept of evidence-based medicine (EBM) have been defined as the foundation of expert and research work in family medicine. In accordance with this strategy, the members of the Department are involved in conducting journal clubs, Cochrane systematic reviews, research into the health of families where the father is absent working abroad (there are many such families with emigrant fathers in the region), and some are working on developing student letters to patients as an instrument for encouraging communication and empathy. The proportion of theoretical classes was reduced to provide more time for practice-based classes for students. The Work Diary was also introduced, as well as the student letter to the patient, practice of clinical skills and objective, structured, clinical examination (OSCE). The assessment of students is performed in four parts: the grade given by the students practice supervisor, the grade for student letters to patients, the OSCE exam grade and the written exam grade. Students achieved, on average, very high grades. The Department is also involved in the course on clinical and social skills to first and second year students, taking on the task of introducing students to patients and their surroundings.

Students letters to patients as a part of education in family medicine.

Family medicine fosters holistic approach to patient-centered practice. Current medical curriculum in Croatia does not have well-structured courses or tools to prepare medicals students for successful communication with the patient and for building lasting and beneficial doctor- patient relationship. We explored the value of students practice in writing letters to patients about their illness as a way of building personal and compassionate relationship with patients. Sixth year students at the School of Medicine in Split wrote letters to the patients from consultations under the supervision of the supervisor in a family medicine practice. Structured teaching of communication with the patient brings family medicine back to what has actually always been its main part- communication and doctor-patient relationship. Our future aim is to develop students letters to patients as a new tool in the family medicine course examination. Moreover, we will investigate how they can be used in everyday practice of family medicine.

Prohypertensive effects of non-steroidal anti-inflammatory drugs are mostly due to vasoconstriction.

Non-steroidal anti-inflammatory drugs (NSAIDs) have prohypertensive effects and blunt the effects of many antihypertensives. The mechanism of this interaction is still not understood enough. The objective of this investigation was to determine the level of prohypertensive effects of two NSAIDs (ibuprofen, piroxicam) and paracetamol, co-prescribed with two antihypertensive drugs (lisinopril + hydrochlorothiazide, amlodipine), and to improve the understanding of this interaction. A prospective clinical trial, conducted in a Croatian family practice, included 110 already treated hypertensive patients, aged 56-85 years; 50 control patients and 60 patients who were also taking NSAIDs for osteoarthritis treatment. The antihypertensive regimens remained the same during this study, while NSAIDs and paracetamol were crossed-over in three monthly periods. Blood pressure, body weight, serum creatinine, potassium, sodium, diuresis and 24 h urinary sodium excretion were followed-up. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated mean arterial pressure by 8.9-9.5% (p < 0.001). Body weight increased significantly in the lisinopril/ hydrochlorothiazide + piroxicam subgroup only, while creatinine, urinary output and electrolyte values did not change appreciably in any of the subgroups. NSAID's prohypertensive effects seem to be mostly due to vasoconstriction and, to a minor degree, to volume expansion, since no marked changes in body weight, urinary output, serum creatinine or serum/urinary electrolyte profile were observed.

[A study of comorbidity in patients with chronic obstructive pulmonary disease]. / Ispitivanje komorbiditeta u bolesnika s kronicnom opstrukcijskom plucnom bolesti.

AIMS: The impact of the chronic obstructive pulmonary disease (COPD) severity on the number of exacerbations, and the interdependence of COPD and some concomitant diseases were studied in chronic pulmonary patients. In order to determine the actual influence of some risk factors and comorbidity on the course of COPD, we conducted a study in two family medicine consulting offices, one in the city of Split and the other on the island of Brac. METHODS: This retrospective study included a sample of 64 subjects, mean age 64.43 years, divided into two groups of 32 subjects each (group 1 and group 2). After taking history data and clinical examination, spirometry was performed. The severity of COPD was determined on the basis of lung function tests. RESULTS: There were 15 (46.9%) smokers in group 1, seven of them former smokers, and 20 (65.6%) smokers in group 2, eight of them former smokers. The groups differed significantly according to the mean number of annual exacerbations (1.3 in group 1 and 2.4 in group 2; p < 0.001). The frequency of exacerbations was higher in smokers and depended on the stage of COPD. If COPD was more severe, the exacerbations were more frequent and influenced the progression of irreversible functional changes on the lungs. Productive cough was more frequent in smokers. The correlation of concomitant diseases and degree of COPD was found in group 2 (hypertension, r = 0.305; p = 0.014). In group 1, there was correlation between patient age and concomitant disease (cardiac arrhythmias, r = 0.307; p = 0.013), whereas in group 2 it was significant in case of hypertension (r = 0.474; p < 0.001) and cardiomyopathy (r = 0.301; p = 0.016). DISCUSSION: Cigarette smoke causes chronic inflammatory changes in the lungs. In our study, the number of patients suffering from persistent cough accompanied by sputum was higher in group 2, which also comprised of more smokers, but differences between smokers and non-smokers according to this characteristic were not statistically significant. Study groups differed significantly according to the number of COPD exacerbations per year (with more exacerbations in the group with more smokers). In group 2, there was a correlation between COPD severity and hypertension. CONCLUSIONS: Comorbidity of COPD and cardiovascular diseases was confirmed, along with correlation between age and cardiovascular complications in patients with COPD.

[Merits of paracetamol in osteoarthritic hypertensive patients]. / Prednosti paracetamola u lijecenju osoba s hipertonijom i artrozom.

BACKGROUND: Nonsteroidal anti-inflammatory drug (NSAID) side effects can impair quality of life in patients with osteoarthritis. Due to its particular mechanism of action, paracetamol might bypass these negative effects. OBJECTIVES: To determine both the role of paracetamol in the treatment of osteoarthritis patients and optimal combination of antihypertensives and antirheumatics for these patients. METHODS: A prospective clinical trial in a family practice included 110 treated hypertensives aged over 55 years: 50 controls and 60 also taking NSAIDs for osteoarthritis. This 3-month study compared two antihypertensives, lisinopril/hydrochlorothiazide fixed combination and amlodipine, with two NSAIDs, ibuprofen and piroxicam, and with paracetamol. Following clinical work-up and NSAID discontinuation for at least 3 days (run-in period of only 3-7 days), osteoarthritis subjects were randomized to 1-month periods of ibuprofen (400-600 mg t.i.d.) or piroxicam (10-20 mg o.d.) with one month of paracetamol (1000 mg t.i.d.) in the middle as a "wash-out" interval, continuing the prescribed amlodipine (5-10 mg o.d.) or lisinopril/hydrochlorothiazide fixed drug combination (10/6.25-20/12.5 mg o.d.), while control subjects (hypertensives with no osteoarthritis) were just keeping their antihypertensive therapy. Blood pressure was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting and supine position. The intensity of arthritic pain (on a visual analogue scale from 1 to 10, where 0 means "no pain" and 10 "the worst pain you may imagine") and the patient's quality of life estimate (on a visual analogue scale from 1 to 10, where 0 means "general condition excellent" and 10 "the worst possible") were recorded. RESULTS: Blood pressure control was unchanged in the amiodipine group across the study periods and impaired in the lisinopril/ hydrochlorothiazide group during either ibuprofen or piroxicam, but not during paracetamol. In the amlodipine +/- ibuprofen subgroup, the reduction of the average pain intensity score throughout the study was significant (chi2 = 8.250; df 3; P = 0.037). In the lisinopril/hydrochlorothiazide +/- piroxicam subgroup, the assessed quality of life differed significantly (chi2 = 9.716; df 3; P = 0.018), while in the amlodipine +/- ibuprofen and amlodipine +/- piroxicam subgroups the changes were marginal (chi2 = 6.936; df 3; P = 0.072 and chi2 = 7146; df 3; P = 0.065, respectively).

Shunt in the diagnosis of initial lung lesion in smokers.

Cigarette smoking is an important risk factor for all respiratory tract diseases. Unfortunately, the symptoms develop slowly, thus patients feel the consequences of the slowly developing inflammation too late. The inflammation first develops in the area of respiratory bronchioles. In this stage, the disease is asymptomatic. The study included a sample of 31 smokers, mean age 36.38 years, with normal spirometry indices, acid-base status and arterial blood gases. The mean smoking index was 11.28 smoking/years. All subjects were healthy, without any subjective health problems or disease indicators. The aim was to define dead lung area (V/Q) as an early indicator of changes in smokers. Study results demonstrated the mean shunt value in smokers of 8.25%, which showed positive correlation with smoking. The shunt size yielded negative correlation with the forced expiratory volume in one second and midexpiratory flow in smokers. In conclusion, determination of lung shunt is a simple method that is sensitive enough in the diagnosis of initial lung lesion due to cigarette smoking.