Adherencia al tratamiento farmacológico del tabaquismo y factores predictores en un escenario no financiado / Adherence to pharmacological treatment of smoking and predictive factors in an unfunded scenario

Antecedentes y objetivo. Las intervenciones de des habituación basadas en el asesoramiento psicológicoy tratamiento farmacológico han demostrado ser las más eficaces para abandonar el tabaco. La terapia sustitutiva con nicotina, bupropión y vareniclina son lostratamientos farmacológicos de primera elección que han demostrado una mayor seguridad y eficacia, triplicando las posibilidades de cesación tabáquica. Sinembargo, en un escenario no financiado, el grado de adherencia a estos fármacos es bajo. Por todo ello, el objetivo del estudio es analizar la adherencia a dichosfármacos y los factores predictores de ella.Pacientes y métodos. Estudio transversal de una cohorte de 660 fumadores reclutados entre 2013 y 2017en un área sanitaria de Galicia incluidos en programas de deshabituación tabáquica. Se analizan las características de los pacientes y el porcentaje de adherenciaa los fármacos de cesación tabáquica.Resultados.Un 35% de los fumadores que acuden aconsultas de deshabituación tabáquica en nuestra áreasanitaria no retiran el fármaco previamente prescrito.Son factores predictores de adherencia a fármacos dedeshabituación tabáquica: estar en fase de preparación OR: 4,06 IC95% (1,58-6,39) p=0,003; realizarintentos previos de abandono en el último año OR:5,3 IC95% (1,3-7,1) p=0,016; uso de fármacos pre-viamente OR: 4,16 IC95 (1,7-6,2) p=0,0003; o elnúmero de consultas: OR: 1,6 IC95% (1,26-2,05)p=0,000.Conclusiones.La adherencia al tratamiento del tabaquismo es mejorable en nuestra área sanitaria. Lafase de abandono del fumador, los intentos previoscon tratamientos farmacológicos y la intensidad de la intervención son factores que se asocian a su implementación. (AU)

Backgrounds and objective. The smoking cessation interventions based on psychological advice and drugtreatment have been shown to be the most effectiveto stop smoking. Nicotine replacement therapy, bu-propion and varenicline are the drug treatments of first choice that have demonstrated better safety andefficacy, tripling the possibilities of smoking cessation.However, in an unfinanced setting, the degree of ad-herence to these drugs is low. Therefore, the objectiveof the study is to analyze adherence to said drugs andthe predictive factors of it.Patients and methods.Cross-sectional study of acohort of 660 smokers recruited between 2013 and2017 in a health care area of Galicia enrolled in smo-king cessation programs. The characteristics of thepatients and percentage of adherence to the smokingcessation drugs are analyzed.Results.A total of 35% of smokers who come to thesmoking cessation consultations in our health carearea do not obtain the previously prescribed drug.Predictive factors of adherence to smoking cessationdrugs are: being in the preparation phase: OR: 4.0695% CI (1.58-6.39) p=0.003, having made previousattempts to stop smoking in the last year: OR: 5.395% CI (1.3-7.1) p=0.016, previous use of drug: OR:4.16 95% CI (1.7-6.2) p=0.0003 or number of con-sultations: OR: 1.6 95% CI (1.26-2.05) p=0.000.Conclusions.Adherence to treatment of smoking ces-sation can be improved in our health care area. Thecessation phase of the smoker, previous attempts withdrug treatments and intensity of the intervention arethe factors associated to its implementation. (AU)

The CD14 (-159 C/T) SNP is associated with sCD14 levels and allergic asthma, but not with CD14 expression on monocytes.

LPS-ligation to CD14/TLR-4 on monocytes/macrophages triggers the production of IL-12-family cytokines. IL12/18 promote TH1-differentiation, counteracting the TH2-driven asthma. Therefore, CD14 modulation could alter the TH2-differentiation and should be taken into account when studying asthma. To analyse the alteration in CD14 levels and its association with CD14 (-159 C/T) SNP (rs2569190) in Caucasian adults with stable allergic asthma, we performed a cross-sectional study (277 healthy subjects vs. 277 patients) where clinical parameters, CD14 values and the CD14 (-159 C/T) SNP were studied. Apart from typical biomarkers, we found an increment of neuron-specific enolase (NSE) in allergic asthma, probably linked to monocyte activity. Indeed, we evidenced increased monocyte numbers, but lower CD14 expression and normalised sCD14 values in patients. Moreover, we noticed an association of the T allele (P = 0.0162) and TT genotype (P = 0.0196) of the CD14 SNP with a decreased risk of allergic asthma and augmented sCD14 levels. In conclusion, monocyte CD14 expression and normalized sCD14 values were reduced in stable state asthmatics, and this could be related to the presence of an expanded CD14low monocyte subset. This study also demonstrates that the CD14 (-159 C/T) polymorphism is a risk factor for moderate-severe allergic asthma in adult Caucasians.

Expansion of a CD26low Effector TH Subset and Reduction in Circulating Levels of sCD26 in Stable Allergic Asthma in Adults.

BACKGROUND AND OBJETIVE: The pathogenesis of asthma is dependent on the balance between regulatory and effector T cells, which display differential expression of CD25 and CD26. Therefore, alteration of circulating levels of sCD25 and sCD26 during allergic asthma could be conditioned by changes in leukocyte phenotype. Objectives: To analyze expression of CD25 and CD26 on T lymphocytes and their soluble derivatives (sCD25, sCD26) during stable phases of moderate-severe allergic asthma. METHODS: Cross-sectional study with 2 adult cohorts of allergic asthmatics. Clinical, anthropometric, pulmonary, hematological, and biochemical parameters were measured. Phenotyping was performed with flow cytometry in both circulating and cultured leukocytes. Dipeptidyl peptidase 4 (DPP4) activity was assayed in culture supernatants. RESULTS: In vitro studies revealed upregulation of CD26 on human T lymphocytes upon activation, especially under TH17-favoring conditions, and a correlation with soluble DPP4 activity (rs=0.641; P<.001). CD26 expression on lymphocytes was higher in asthmatics, while serum sCD26 was lower in women and patients. The latter finding could be associated with an expanded CD25low/CD26low/CD127low subset of effector CD4+ T cells in allergic asthma, with no changes in Treg percentages. However, women showed an increased Teff/Treg ratio, which could explain their greater susceptibility to asthma. CONCLUSIONS: Allergic asthma causes an increment in CD25lowCD26low helper T cells detected in stable stages. These changes are mirrored in serum and should be considered in the light of the downmodulating role of CD26 in major chemokines related to the pathogenesis of asthma such as CCL11 (eotaxin), CCL5 (RANTES), and CXCL12a (SDF-1α).

Asthma exacerbations: risk factors for hospital readmissions.

OBJECTIVE: The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase. STUDY DESIGN: We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. METHODS: The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge. RESULTS: This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment. CONCLUSIONS: About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.

Expansion of a CD26 low effector TH subset and reduction in circulating levels of sCD26 in stable allergic asthma in adults

Background: The pathogenesis of asthma is dependent on the balance between regulatory and effector T cells, which display differential expression of CD25 and CD26. Therefore, alteration of circulating levels of sCD25 and sCD26 during allergic asthma could be conditioned by changes in leukocyte phenotype. Objectives: To analyze expression of CD25 and CD26 on T lymphocytes and their soluble derivatives (sCD25, sCD26) during stable phases of moderate-severe allergic asthma. Methods: Cross-sectional study with 2 adult cohorts of allergic asthmatics. Clinical, anthropometric, pulmonary, hematological, and biochemical parameters were measured. Phenotyping was performed with flow cytometry in both circulating and cultured leukocytes. Dipeptidyl peptidase 4 (DPP4) activity was assayed in culture supernatants. Results: In vitro studies revealed upregulation of CD26 on human T lymphocytes upon activation, especially under TH17-favoring conditions, and a correlation with soluble DPP4 activity (rs=0.641; P<.001). CD26 expression on lymphocytes was higher in asthmatics, while serum sCD26 was lower in women and patients. The latter finding could be associated with an expanded CD25 low/CD26 low /CD127 low subset of effector CD4 + T cells in allergic asthma, with no changes in Treg percentages. However, women showed an increased Teff/Treg ratio, which could explain their greater susceptibility to asthma. Conclusions: Allergic asthma causes an increment in CD25 low CD26Low helper T cells detected in stable stages. These changes are mirrored in serum and should be considered in the light of the downmodulating role of CD26 in major chemokines related to the pathogenesis of asthma such as CCL11 (eotaxin), CCL5 (RANTES), and CXCL12a (SDF-1alfa) (AU)

Introducción: La patogénesis del asma depende del equilibrio entre células T reguladoras y T efectoras, las cuales presentan distintos niveles de CD25 y CD26. Por tanto, la alteración de la concentración de sCD25 y sCD26 durante el asma alérgica podría estar condicionada por cambios en el fenotipo de los leucocitos. Objetivos: Analizar la expresión de CD25 y CD26 en linfocitos T y sus derivados solubles (sCD25 y sCD26) durante asma alérgica moderada-severa y en fases estables. Métodos: Estudio transversal con dos cohortes de adultos con asma alérgica. Se han medido parámetros clínicos, antropométricos, de función pulmonar, hematológicos y bioquímicos. Se ha hecho el fenotipado de leucocitos circulantes y en cultivo mediante citometría de flujo. Se ha analizado la actividad Dipeptidil peptidasa 4 (DPP4) en sobrenadantes de cultivo. Resultados: Los estudios in vitro mostraron un aumento de expresión de CD26 en linfocitos T humanos tras activación, especialmente en condiciones favorables para TH 17, y una correlación con la actividad DPP4 soluble (rs=0,641; p < 0,001). La expresión de CD26 en linfocitos fue mayor en asmáticos, mientras que sCD26 estaba reducido en sueros de mujeres y pacientes. Este último hallazgo podría ser relacionado con la expansión de una subpoblación CD25 low/CD26 low/CD127 low de células T CD4 + efectoras en asma alérgica, sin cambios en los porcentajes de Treg. Sin embargo, las mujeres mostraron un incremento del cociente Tef/Treg, lo cual podría explicar su mayor susceptibilidad al asma. Conclusiones: El asma alérgica causa un incremento de células TH CD25 low CD26 low durante fases no activas. Estos cambios se reflejan en suero y deberían tenerse en cuenta a la luz de la función inhibidora de CD26 sobre quimioquinas importantes relacionadas con la patogénesis del asma, como CCL11 (eotaxina), CCL5 (RANTES) o CXCL12a (SDF-1alfa)

¿Podemos defender el uso del cigarrillo electrónico para ayudar a dejar de fumar? / Can we defend the use of the electronic cigarette for help quit smoking?

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Cross-sectional study about impact of parental smoking on rhinitis symptoms in children.

OBJECTIVE: Assess the prevalence of rhinitis and exposure to environmental tobacco smoke (ETS) of children in our community and its relationship with symptoms of rhinitis METHODS (DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES): Cross-sectional study using questionnaire on rhinitis of the International Study of Asthma and Allergies in Childhood, in children (6-7 years) and adolescents (13-14 years). Categories: "rhinitis ever", "recent rhinitis", "recent rhinoconjunctivitis", "severe rhinoconjunctivitis". Parental smoking: (i) neither parent smokes; (ii) only the mother smokes; (iii) only the father smokes; and (iv) both parents smoke. Odds ratio of the prevalence of symptoms of rhinitis according to ETS exposure was calculated using logistic regression. RESULTS: 10 690 children and 10 730 adolescents. The prevalence of "rhinitis ever" in children: 29.4%, "recent rhinitis" 24%, "recent rhinoconjunctivitis" 11.5% and "severe rhinoconjunctivitis" 0.1%. In adolescents: 46.2%, 34.5%, 16.2% and 0.2%, respectively. Environmental tobacco smoke exposure in the home occurred in 51% of cases. Parental smoking was associated with a higher prevalence of forms of rhinitis in adolescents when only the mother was a smoker. In children when both parents were smokers. CONCLUSION: Rhinitis is highly prevalent in our community. Environmental tobacco smoke exposure is still very common. The relationship between ETS and rhinitis symptoms in children of this community is not as robust as that found for asthma.

Retratamiento del tabaquismo con el mismo fármaco / Re-treatment of smoking habit with the same drug

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Obesity and asthma: An association modified by age

Background: Some studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. Methods: A cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6---7 year-old children (n = 7485) and 13-14 year-old adolescents (n = 8496).The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95%confidence intervals. Results: Obesity was associated with an increase in wheezing ever (OR: 1.35) and exercise induced asthma (OR: 1.62) in the 6-7 year-old group. No significant relationship was observed in the adolescent population. Conclusion: Obesity was associated with a higher prevalence of asthma in young children, but not in adolescents (AU)

Influence of pollen level on hospitalizations for asthma.

The effect of pollen level on asthma hospitalizations is still under debate. The aim of this study was to analyze hospital admissions due to asthma and its relation with environmental pollen and meteorological factors. During 13 years, we included every patient admitted with asthma as primary or secondary diagnosis. For this purpose, we used a case-crossover analysis to compare pollen concentrations at the time of admission with values of the same variables 2 to 6 days before admission. We included 6,687 hospital admissions. High maximum temperature and low humidity were associated with lower risk of asthma admissions. High mean pollen levels exerted a moderate effect and high maximum pollen levels led to a dramatic increase of hospital admissions due to asthma, especially among females. In conclusion, environmental pollen level increases the risk of asthma hospital admissions.

Obesity and asthma: an association modified by age.

BACKGROUND: Some studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. METHODS: A cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6-7 year-old children (n=7485) and 13-14 year-old adolescents (n=8496). The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals. RESULTS: Obesity was associated with an increase in wheezing ever (OR: 1.35) and exercise-induced asthma (OR: 1.62) in the 6-7 year-old group. No significant relationship was observed in the adolescent population. CONCLUSION: Obesity was associated with a higher prevalence of asthma in young children, but not in adolescents.

Asthma and risk of lung cancer.

Asthma is a very common chronic disease that occurs in all age groups. Its high prevalence has significant health costs, which are even higher in the most severe disease forms. Lung cancer has the highest incidence of all cancers in the developed world and is an important cause of mortality. Patients with lung cancer are a big economic burden on health services, both in direct and indirect costs. Different authors suggest that atopic constitution, including different manifestations of allergy and asthma, are possible risk factors for lung cancer, above all in never-smokers. Given the high asthma prevalence and lung cancer incidence and mortality in developed countries, this association would have important public health implications. Uncertainties about the association and the underlying physiopathological mechanisms, however, seem to require further studies.

Asthma and risk of lung cancer

Asthma is a very common chronic disease that occurs in all age groups. Its high prevalence has significant health costs, which are even higher in the most severe disease forms. Lung cancer has the highest incidence of all cancers in the developed world and is an important cause of mortality. Patients with lung cancer are a big economic burden on health services, both in direct and indirect costs. Different authors suggest that atopic constitution, including different manifestations of allergy and asthma, are possible risk factors for lung cancer, above all in never-smokers. Given the high asthma prevalence and lung cancer incidence and mortality in developed countries, this association would have important public health implications. Uncertainties about the association and the underlying physiopathological mechanisms, however, seem to require further studies (AU)

Effect of delays on survival in patients with lung cancer

BACKGROUND: The effect on survival of delays in the consultation, diagnostic and treatment processes of lung cancer (LC) is still under debate. The objective of our study was to analyse these time delays and their possible effect on survival. METHODS: A retrospective study has been performed on all patients in our health area diagnosed with LC (confirmed by cytohistology) over 3 years. The delay in specialist consultation (time between start of symptoms and the first consultation with a specialist), hospital delay (time between first consultation and start of treatment) and overall delay (the sum of the previous two delays) were analysed. The influence of each of these delays was calculated using Cox regression, adjusted for other factors. RESULTS: A total of 415 patients were included. Of these, 92.5% were male and 75.4% were in stages III-B or IV. The overall delay gave a mean of 123.6 days, the delay in consulting a specialist 82.1 days and the delay in hospitalisation was 41.4 days. A greater overall delay or greater hospital delay was associated with longer survival. No relationship was observed between the specialist consultation delay and survival. CONCLUSIONS: Globally analysing all the cases and all the stages with LC, it is seen that longer delays are associated with longer survival. This probably reflects the fact that patients with more symptoms are treated more rapidly (AU)

Trends in hospital admissions due to asthma in north-west Spain from 1995 to 2007

Purpose: Asthma is the most common chronic disease in childhood. Hospital admissions in the child population appear to be reducing in different populations. Methods: We have retrospectively analysed admissions into hospitals in our region due to asthma in a 0 to 14 years population, between the years 1995 and 2007. The age, sex, date of admission, and length of hospital stay of each patient was recorded and analysed. Results: A total of 9106 admissions (64% males) have been included. A gradual trend towards a reduction in admissions is observed during the period analysed. There were more admissions in 1996, with 2.91 per thousand inhabitants, gradually reducing to 1.33 per thousand in 2007. There were more admissions in May and between September and December, being less frequent in July and August. The mean stay in this period was 4.18 days, which was stable during the whole period of the study. Older children tended to have a longer hospital stay. Conclusions: Our study shows that admissions due to childhood asthma tend to be decreasing, particularly due to younger males, with no change in the length of hospital stay. Asthma exacerbations seemed to be associated with infections and exposure to allergens

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Pneumonitis caused by silicone gel following breast implant rupture.

INTRODUCTION: There have been reports of pneumonitis associated with subcutaneous injection of liquid silicone, and of other pulmonary conditions due to cohesive silicone gel prostheses, but we know of no previous cases of pneumonitis associated with silicone gel. MATERIALS AND METHODS: We report the case of a patient with a cohesive silicone gel mammary prosthesis in whom silicone-induced pneumonitis was diagnosed following radiological observation of pulmonary infiltrates and tests including transbronchial biopsy, which revealed the presence of silicone in alveolar histiocytes and small blood vessels. CONCLUSION: Following removal of the ruptured prosthesis and a course of systemic corticoids, the patient progressed favourably.

[Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases]. / Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos.

INTRODUCTION: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. AIMS: To know the clinical characteristics in the presentation of the lung cancer in our health care area. MATERIAL AND METHODS: All of the incident lung cancer cases for 3 years (January 1, 1997 to December 31, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. RESULTS: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. CONCLUSIONS: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis.

Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos / Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases

Introducción: El cáncer de pulmón es la causa más frecuente de muerte por cáncer en el mundo. Su presentación clínica corresponde habitualmente a estadios avanzados. Desde hace años persiste la controversia sobre la indicación de programas de cribado para el diagnóstico en fases tempranas. Objetivos: Conocer las características clínicas en la presentación del cáncer de pulmón en nuestra área sanitaria. Material y métodos: Se recogieron retrospectivamente todos los casos incidentes de cancer de pulmón durante 3 años (1 de enero de 1997 a 31 de diciembre de 1999), de pacientes con residencia habitual en el área sanitaria de Santiago de Compostela, a partir de la información disponible en el servicio de codificación. El tipo histológico se clasificó según la clasificación de la Organización Mundial de la Salud. La fecha de fallecimiento se obtuvo de la historia clínica del paciente, el registro de mortalidad o de llamadas telefónicas al domicilio del paciente. El resto de la información se obtuvo de la historia clínica del paciente y del servicio de anatomía patológica. Resultados: Se diagnosticaron 481 casos de cáncer de pulmón (tasa bruta de incidencia de 41,79 por 100.000 habitantes y año). La mediana de edad fue 66,9 años (rango intercuartil 60,5-74,4), siendo el 92,77% varones. El 94,1% correspondía a fumadores o exfumadores. Los síntomas más prevalentes como motivo de consulta fueron el síndrome general (20%), el dolor torácico (19%) y la hemoptisis (17%). Existe un grupo de pacientes (56), fundamentalmente varones, de diagnóstico incidental. Conclusiones: La incidencia de cáncer de pulmón parece elevada en nuestra área sanitaria. El paciente tipo con cáncer de pulmón en esta área sanitaria corresponde a un varón de 67 años, fumador, diagnosticado en estadios avanzados, que consulta por síndrome general y/o dolor torácico. Algunos de los síntomas se presentan con diferencias significativas entre sexos. Asimismo, hay diferencias entre histologías, siendo llamativa la elevada frecuencia de dolor torácico en adenocarcinoma, aunque también es la primera causa de consulta en microcítico. Por el contrario, la hemoptisis es el motivo de consulta más frecuente en epidermoide y el síndrome general en el tipo células grandes o con diagnóstico clínico-radiológico (AU)

Introduction: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. Aims: To know the clinical characteristics in the presentation of the lung cancer in our health care area. Material and methods: All of the incident lung cancer cases for 3 years (January l, 1997 to December 3l, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. Results: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. Conclusions: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis (AU)

Young man with asthma and infertility.

Asthma and male infertility are common diseases that can occur in the same patient. In some cases they could have patho-physiological changes common to both diseases. Our patient was seen as a result of having an irritating cough with wheezing, mainly at night, for more than a month. Asthma was diagnosed, and he responded favourably to the treatment given. Upon being informed that he had been examined for infertility for 5 years, alpha-1 antitrypsin (AAT) levels were requested. These confirmed that he had a phenotype SZ AAT deficiency. These findings, together with some evidence published recently, suggested that there is a need to rule out AAT deficiency in males with asthma and infertility.

Predictors of the persistence of childhood asthma.

BACKGROUND: The factors relevant to the prognosis of childhood asthma differ from one population to another. OBJECTIVES: To characterize the course of childhood asthma in the catchment area of our hospital, and to identify prognostic factors for this population. METHODS: All children given a diagnosis of asthma in the paediatric pulmonology service of a tertiary hospital were followed up for 5 years. RESULTS: Satisfactory control of asthma was achieved in 69 % of cases. The factors identified as associated with poor control were allergy to cats and pollen, a large number of crises in the year prior to diagnosis, and younger age at onset. CONCLUSIONS: In our region, childhood asthma has a relatively favourable prognosis. The subsequent course of the disease appears to be determined in childhood. The persistence of symptoms appears to depend to a significant extent on the degree of atopy.