Guía SEPAR para el tratamiento del tabaquismo en la empresa / SEPAR guide for treatment of smoking habit in the work sites

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Los “fumadores de fondo” / No disponible

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Tabaquismo en la infancia / Tobacco use in childhood and adolescence

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[Smoking cessation and bupropion: anxiety and depression as predictors of therapeutic efficacy]. / Deshabituación tabáquica y bupropión: la ansiedad y la depresión como índices de eficacia terapéutica.

UNLABELLED: Smoking and depression are related. Bupropion, the first non-nicotinic drug that is an effective treatment in smoking cessation, is a tricyclic antidepressant that inhibits neuronal uptake of serotonin, dopamine and norepinephrine in the thalamic nuclei. OBJECTIVE: To assess if certain personality factors (anxiety or depression) might predict the efficacy of bupropion for smoking cessation. METHOD: The study was carried out in two smoking cessation clinics in Madrid and Barcelona. Fifty patients (21 men) declaring the desire to quit smoking were enrolled. Their mean age was 43.6 years (SD 8.75). The patients were treated with 300 mg of bupropion per day for one month and expired CO was monitored for 6 months. Personality factors were assessed on a hospital anxiety and depression scale (HADS). We evaluated whether there was a significant difference in HADS scores for patients who were still not smoking after 6 months and those who had not managed to quit. RESULTS: The 50 patients were smokers of a mean 39 packs per year (SD 17.82) and had mean scores of 7.4 (SD 4.15) for anxiety and 5.8 (SD 3.93) for depression. Four patients (8%) were unable to complete the study. After one month, 28% of the patients smoked, after 3 months 56% smoked and after 6 months 58% still smoked. The patients who smoked during the first month had higher depression scores than did the non-smokers (p = 0.03). After 3 and 6 months the patients who had managed to continue not smoking were those who had higher anxiety scores than did those who still smoked (p = 0.0052 at 3 months and p = 0.017 at 6 months). CONCLUSION: Patients who responded better to treatment with bupropion after 6 months of follow-up were those with higher anxiety scores on the HADS. Depression levels influenced outcome only during the first month.

Deshabituación tabáquica y bupropión: la ansiedad y la depresión como índices de eficacia terapéutica / Smoking cessation and bupropion: anxiety and depression as predictors of therapeutic efficacy

Existe una relación entre tabaquismo y enfermedad depresiva. Bupropión es el primer fármaco no nicotínico eficaz en la deshabituación tabáquica. Se trata de un antidepresivo que inhibe la recaptación neuronal de la serotonina, la dopamina y la noradrenalina en los nucleos talámicos. OBJETIVO: Valorar si existen algunas variables dentro del área de la personalidad (ansiedad o depresión) que pudiesen servir como índices predictivos en el tratamiento deshabituador con bupropión. MÉTODO: Estudio realizado en dos consultas de tabaquismo (Madrid y Barcelona). Se incluyó a 50 pacientes (21 varones) con una edad media de 43,6 años (desviación estándar [DE], 8,75) que manifestaban la voluntad en querer dejar de fumar. Fueron tratados con 300 mg/día de bupropión durante un mes y seguidos durante 6 meses con controles de CO espirado. Las variables de personalidad fueron evaluadas con el test de HADS, test psicométrico que puntúa trastornos de personalidad ansiosodepresivos. Se valoró si existía alguna diferencia significativa en los valores de puntuación del HADS entre los pacientes que seguían sin fumar a los 6 meses y los que no. RESULTADOS: Los 50 pacientes incluidos eran fumadores con una media de 39 paquetes/año (DE, 17,82) y con un valor medio de ansiedad de 7,4 (DE, 4,15) y de depresión de 5,8 (DE, 3,93). Un total de 4 pacientes (8 per cent) no pudo completar el estudio. Al primer mes de tratamiento un 28 per cent de los pacientes fumaba, al tercer mes era un 56 per cent de fumadores y a los 6 meses un 58 per cent de los pacientes incluidos seguía fumando. Al analizar las variables de personalidad, observamos que los pacientes que durante el primer mes fumaban tenían unas puntuaciones más elevadas de depresión que los no fumadores (p = 0,03). Al tercero y el sexto mes los pacientes que siguen sin fumar presentan unas puntuaciones más elevadas de ansiedad que la de aquellos pacientes que siguen fumando (p = 0,0052 a los 3 meses y p = 0,017 a los 6 meses). CONCLUSIÓN: Los pacientes que responden mejor al tratamiento con bupropión y después de 6 meses de seguimiento son aquellos que tienen niveles de ansiedad más elevados según el HADS test. Los niveles de depresión sólo influyen negativamente durante el primer mes (AU)

Tratamiento del tabaquismo en personas mayores / The treatment of tobacco use in old people

Los fumadores de 50 años o más son un grupo de pacientes vulnerables, con riesgo de enfermedades complicadas por el hecho de fumar. Pueden obtener beneficios significativos en su salud si abandonan este hábito, aunque probablemente llevan fumando muchos años y sufren una gran adicción. El médico es una pieza fundamental para conseguir que dejen el tabaco. Los médicos pueden mejorar significativamente la salud de sus fumadores ancianos con un plan o intervención mínima de cinco pasos: identificar sistemáticamente a todos los fumadores en cada visita, aconsejar firmemente dejar de fumar, identificar a aquellos fumadores que quieren hacer un intento de cesación, prestar la ayuda y el soporte necesario, realizar seguimiento. Se exponen las diferentes terapias farmacológicas (AU)

Smokers 50 years old or more are a damaged group of patients, with the risk of having complicated illness because of tobacco. If they finish smoking, they can obtain significant benefits in their health, although they smoke many years ago and have a great addition. The doctor is an important element for finishing smoking. Doctors can improve the old smokers health significantly with a five-steps plan: to identify in a systematic way all smokers in each visit, to advise seriously leaving smoking, to identify the smokers who want leaving smoking seriously, to give necessary help, and to do pursuit. The different pharmacologic therapies are exposed (AU)

Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. The EOLO Study Group.

BACKGROUND AND OBJECTIVE: The aim of this study was to develop and validate two models to estimate the probabilities of frequent exacerbations (more than 1 per year) and admissions for chronic obstructive pulmonary disease (COPD) that can be used in a primary care setting. METHODS: Information was obtained in a cross-sectional observational study on ambulatory COPD patients performed in 201 general practices located throughout Spain. The model for admissions included 713 cases, 499 for the developmental sample and 214 in the validation sample; the model for frequent exacerbations included 896 patients, 627 in the developmental sample and 269 in the validation model. Candidate variables to be included in both models were: age, sex, body mass index (BMI), FEV(1) as percent predicted [FEV(1 )(% pred.)], active smoking, chronic mucus hypersecretion (CMH) and significant comorbidity. RESULTS: The admission model contained 2 readily obtainable variables: comorbidity (OR = 1.97; CI 95% = 1. 24-3.14) and FEV(1)(% pred.) (OR = 0.72; 0.58-0.88, for every 10 units), and well calibrated in developmental and validation samples (goodness-of-fit tests: p = 0.989 and p = 0.720, respectively). The model for frequent exacerbations included 3 variables: age (OR = 1. 21; 1.01-1.44; for every 10 years of increasing age), FEV(1 )(% pred. ) (OR = 0.82; 0.70-0.96, for every 10 units) and CMH (OR = 1.54; 1. 11-2.14) and also well calibrated (p = 0.411 and p = 0.340 in the developmental and validation samples, respectively). CONCLUSIONS: Our results suggest that FEV(1) impairment explains part of the risk of frequent exacerbations and hospital admissions. Furthermore, CMH and increasing age are significantly associated with the risk of frequent exacerbations, but severity of exacerbations provoking hospital admissions is associated with the presence of significant comorbidity. These important and easily measurable variables contain valuable information for optimal management of ambulatory patients with COPD.

Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. EOLO Group. Estudio Observacional de la Limitación Obstructiva al Flujo aEreo.

The high prevalence and chronicity of chronic obstructive pulmonary disease (COPD) imply that many of these patients are treated and controlled in primary-care centres, often without contact with specialized pneumologist care. We conducted the present study to evaluate the treatment administered in stable and exacerbated COPD in GP-setting clinics and to investigate which factors could be associated with the different prescriptions. This is a cross-sectional observational study of ambulatory COPD patients. General practitioners (n = 201) were selected throughout Spain by regionally stratified sampling. We recorded the physician-reported prescription drug use in ambulatory treatment of stable COPD and acute exacerbations of COPD through a standard questionnaire. Factors independently associated with the prescription of drugs were ascertained by multiple logistic regression analysis. Of 1078 questionnaires reviewed, 1001 fulfilled quality criteria. There were 878 men (88%) and 123 women (12%); 777 (78%) were smokers or ex-smokers with a mean age of 68 years. Mean FEV1 was 47% predicted (% pred.) (SD = 13%). The median number of exacerbations was two per year (range = 0-16). Regular treatment for COPD was received by 878 (88%): the most commonly used drugs were inhaled beta 2-agonists (71%), theophyllines (53%) and inhaled corticosteroids (ICs) (50%), followed by mucolytics (25%), ipratropium bromide (23%), and oral corticosteroids (OCs) (4%). Treatment for exacerbations included inhaled bronchodilators (90%), antibiotics (89%), ICs (71%) and OCs (43%). Impairment of FEV1 was the factor most strongly associated in multiple regression analysis with increasing drug prescription in stable COPD, except for mucolytics, while the number of previous acute exacerbations was the main factor associated with exacerbation treatment except for OCs, the use of which was associated with more impaired pulmonary function. A significant number of the treatments prescribed in primary care for stable and exacerbated COPD do not follow current recommendations. Impairment in FEV1 is the factor most strongly associated with increasing prescription in stable COPD and the number of previous exacerbations is the main factor associated with exacerbation treatment.

Skin-prick tests for hypersensitivity to alpha-amylase preparations.

Twenty-five asthmatic subjects with suspected alpha-amylase hypersensitivity were studied by skin-prick tests, a capture ELISA, immunoblotting and bronchial provocation tests. At the same time, different amylases were analysed by SDS-PAGE and immunoblotting using a polyclonal rabbit antiserum. Eight patients showed a positive bronchial response to amylase. Seven of them had positive skin-prick tests, with this method being the most sensitive approach for diagnosis. However, in four cases, skin tests were also positive although the patients had a negative provocation test, thus demonstrating that skin tests are not specific. ELISA and blotting showed similar results in terms of sensitivity and specificity. The enzymes used by the workers included several antigens besides alpha-amylase. The rabbit antiserum to alpha-amylase detected a protein in a wheat flour extract. In one case, the IgE antibodies were specific only for a contaminant of lower molecular weight than amylase. These facts suggest that proteins from the culture medium could be responsible for some cases of amylase hypersensitivity, making the diagnosis difficult. The presence of amylase in another enzymatic extract, a protease produced by Aspergillus oryzae, was proved by means of skin tests and immunoblotting, thus demonstrating the allergenic properties of this enzymatic preparation.

[Almitrine bismesylate treatment in chronic respiratory insufficiency]. / Tratamiento con bismesilato de almitrina en la insuficiencia respiratoria crónica.

This study was designed to evaluate the gasometric and functional respiratory responses in chronic bronchitic patients with chronic respiratory insufficiency (CRI) under ambulatory oxygen therapy (AOT) with almitrine bismesylate (AB). It was a double-blind, placebo-controlled, randomized, prospective study which lasted three months and with a dosage regime of 50-100 mg/day of AB. Fiftyfour patients completed the study (28 in AB and 24 in the placebo (P) groups, respectively). All patients were males, with a mean age or 65 +/- 6.1 years. In the study of pulmonary function only airway resistance (Raw) was changed, with a significant decrease at the third month in the AB group compared with the P group (0.83 +/- 0.31 vs. 1.07 +/- 0.46 kpa/L.S), with a p value of 0.05 (mean +/- SD) and PaO2 which improved from 8.15 +/- 0.88 to 8.81 +/- 2.3 kpa (61.17 +/- 6.6 to 66.10 +/- 10 mmHg), with a p value of 0.05. AB therapy was well tolerated.

Tobacco addiction and control in Spain.

In Spain there is a high prevalence of smokers: 39.2% in the general population, 61.9% of the working population, and 35% of doctors. At the same time, health education on smoking is inadequate, and tobacco is cheap. As a result, it is difficult to implement legislation which bans or restricts smoking in some areas. It is clear that more education on smoking and health is needed at every level of the Spanish population.

[Chronic kidney insufficiency and respiratory muscle function. Changes induced by treatment with 1,25(OH)2D3]. / Insuficiencia renal crónica y función muscular respiratoria. Modificaciones inducidas por el tratamiento con 1,25 (OH)2D3.

A myopathy basically involving proximal respiratory muscles can develop in uremia. To evaluate respiratory muscle force in uremia, maximal inspiratory pressure (MIP) was measured in 27 patients with renal failure. MIP was very limited in patients with a creatinine clearance (Crc) lower than 10/ml/min 1.73 m2 not treated with hemodialysis (HD) and in patients on HD who were not treated with 1.25 (OH)2D3 (45 +/- 9 and 43 +/- 5 cm H2O, respectively), moderately reduced in patients on HD treated with 1.25 (OH)2D3 (58 +/- 5 cmH2O) and normal in patients with Crc higher than 10 ml/min 1.73 m2 (86 +/- 6 cmH2O). The treatment with 1.25 (OH)2D3 during 3 months promoted a significant increase in MIP and serum calcium level and a reduction in parathyroid hormone in patients with Crc lower than 10 ml/min. It was concluded that, in uremia, a respiratory muscle weakness partially reversible with vitamin D therapy may be found.