Gustavo Zabert

Smoke, Biomass Exposure, and COPD Risk in the Primary Care Setting: The PUMA Study

BACKGROUND: The evidence indicates that risk factors other than smoking are important in the development of COPD. It has been postulated that less traditional risk factors (eg, exposure to coal and/or biomass smoke) may interact with smoking to further increase COPD risk. This analysis evaluated the effect of exposure to biomass and smoking on COPD risk in a primary care setting in Latin America. METHODS: Subjects attending routine primary care visits, ≥40 y old, who were current or former smokers or were exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator FEV1/FVC < 0.70 and the lower limit of normal. Smoking was defined by pack-years (≤ 20, 20–30, or > 30), and biomass exposure was defined as an exposure to coal or wood (for heating, cooking, or both) for ≥ 10 y. RESULTS: One thousand seven hundred forty-three individuals completed the questionnaire, and 1,540 performed spirometry. Irrespective of COPD definition, approximately 40% of COPD subjects reported exposure to biomass versus 30% of those without COPD. A higher proportion of COPD subjects (post-bronchodilator FEV1/FVC < 0.70) than those without COPD smoked > 30 pack-years (66% vs 39%); similar results were found with the lower limit of normal definition. Analysis of exposure to biomass > 10 y plus smoking > 20 pack-years (reference was no exposure) found that tobacco smoking (crude odds ratio [OR] 4.50, 95% CI 2.73–7.41; adjusted OR 3.30, 95% CI 1.93–5.63) and biomass exposure (crude OR 3.66, 95% CI 2.00–6.73; adjusted OR 2.28, 95% CI 1.18–4.41) were risk factors for COPD, with smoking a possible confounder for the association between biomass and COPD (post-bronchodilator FEV1/FVC < 0.70); similar results were found with the lower limit of normal definition. CONCLUSIONS: Subjects with COPD from primary care had a higher exposure to biomass and smoking compared with non-COPD subjects. Smoking and biomass are both risk factors for COPD, but they do not appear to have an additive effect.

Reflexiones sobre oportunidades de intervención en tabaquismo en Latinoamérica

The tobacco epidemic is a huge public health problem affecting all Latin American countries. These countries have the characteristic of a wide base of the pyramidal population structure, with many young people who have been natural targets for the tobacco industry. Therefore in this region there is an urgent need to establish prevention and treatment strategies capable to reduce incidence and prevalence of tobacco smoking in the population and as a consequence modify the health effects of tobacco consumption. Treating nicotine addiction requires intervention strategies really effective to reduce the number of current smokers as well as giving them tools to avoid relapse and maintain abstinence. Currently poor and vulnerable groups, which represent 44% of the total population in Latin America, are the most susceptible to suffer the health consequences of smoking since they show the highest prevalence rates and have little or no access to health services. The Framework Convention on Tobacco Control (FCTC) and MPOWER, both strategies proposed by the World Health Organization against tobacco, define clear goals to achieve their purposes, nevertheless they are limited by the economic and human resources assigned by each country. The scientific community involved in the fight against tobacco must think about new ways to place this issue in the political agenda so there will be more opportunities to increase the resources and therefore to reduce tobacco consumption in all the groups of the population. In the fight against tobacco, this is the right time to consider primarily issues related to equity and social justice.

Respiratory medication use in primary care among COPD subjects in four Latin American countries

OBJECTIVES To assess respiratory medications used, factors predicting treatment and patterns of corticosteroid (CS) use in primary care in Latin America among chronic obstructive pulmonary disease (COPD) patients. METHODS COPD was defined as post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) < 0.70 or previous medical diagnosis. To determine factors associated with respiratory medication use, crude and adjusted Poisson regression models were performed. RESULTS Of 1743 patients interviewed, 1540 completed spirometry, 309 had COPD (FEV1/FVC<0.70) and 102 had a prior diagnosis of COPD. Among spirometry-defined COPD patients, 36.6% used respiratory medications: bronchodilators (BD) 24.9%, CS 13.3%, BD+CS 15.2%. In those with a previous diagnosis, 79.4% used respiratory medications: BD 64.7%, CS 37.6%, BD+CS 25.6%. A total of 81/102 (79%) patients with prior diagnosis were using CS despite not having airway obstruction or exacerbation. In spirometry-defined COPD, dyspnoea (OR 2.09, 95%CI 1.13-3.87), severe airway obstruction (OR 3.36, 95%CI 1.40-8.03) and exacerbation in the past year (OR 5.52, 95%CI 2.19-13.89) were associated with increased respiratory medication use. Among those with a previous diagnosis, use of respiratory medications was associated with cough (OR 5.31, 95%CI 1.28-22.12), severe airway obstruction (OR 29.50, 95%CI 3.18-273.30) and fewer years of schooling (OR 0.12, 95%CI 0.03-0.52). CONCLUSIONS In the primary care setting, undertreatment is frequent in spirometry-defined COPD patients, and there is increased use of CS (overtreatment) in patients with a previous diagnosis of COPD.

Patología pulmonar asociada al consumo de marihuana

Marijuana is the most widely usedillegal drug in the world, with a prevalence of 2.5%-5%, and the second most commonly smoked substance after tobacco. The components of smoke from combustion of marijuana are similar to those produced by the combustion of tobacco, but they differ in terms of psychoactive components and use. Inhalation of cannabis smoke affects the respiratory tract, so the available evidence must be updated in order to provide pulmonologists with the latest scientific information. In this article, we review the impact of cannabis consumption on the lungs, taking into account that the respiratory route is the most popular route of cannabis consumption.

Día mundial del pulmón

The Forum of International Respiratory Societies is better known by the acronym FIRS. FIRS is an association of the most important global health institutions dedicated to the advocacy of respiratory health. It was formed in 2001, and brings together more than 70 000 health professionals throughout the world who devote their lives to the prevention, control, diagnosis, and treatment of respiratory diseases.1 On September 25, 2017, the FIRS will celebrate “World Lung Day”. The main aim of this event is to raise awareness among the general public and also managers of public and private health systems of the immense global health problem generated by respiratory diseases: every year more than 4 million people die prematurely due to chronic respiratory diseases.2 Five respiratory diseases are responsible for this high mortality: COPD, asthma, lower respiratory infections, tuberculosis, and lung cancer.2,3 The first and last are caused mainly by the active and passive consumption of tobacco, although other causes have also been described: exposure to biomass fuel, fumes from car engines, radon, asbestos, and other known carcinogens. Although lower respiratory infections and tuberculosis are caused by well-defined etiological agents, the course and prognosis of these diseases are affected by voluntary or involuntary exposure to these contaminants. The disease course of asthma is similarly modulated by exposure to these substances.4 It is important to bear in mind that today, more than 2 billion people are exposed to toxic pollutants in the home, more than 1 billion are exposed to air pollution outside the home, and 1 billion are exposed to tobacco smoke.5 It is imperative to raise awareness of this among all stakeholders, including health and non-health workers, health managers and politicians, journalists, and associations of patients, so that together we can demand that decisions be made to ultimately control exposure to environmental tobacco

Preguntas y respuestas relacionadas con tabaquismo en pacientes con EPOC. Aplicación de metodología con formato PICO

The ALAT and SEPAR Treatment and Control of Smoking Groups have collaborated in the preparation of this document which attempts to answer, by way of PICO methodology, different questions on health interventions for helping COPD patients to stop smoking. The main recommendations are: (i)moderate-quality evidence and strong recommendation for performing spirometry in COPD patients and in smokers with a high risk of developing the disease, as a motivational tool (particularly for showing evidence of lung age), a diagnostic tool, and for active case-finding; (ii)high-quality evidence and strong recommendation for using intensive dedicated behavioral counselling and drug treatment for helping COPD patients to stop smoking; (iii)high-quality evidence and strong recommendation for initiating interventions for helping COPD patients to stop smoking during hospitalization with improvement when the intervention is prolonged after discharge, and (iv)high-quality evidence and strong recommendation for funding treatment of smoking in COPD patients, in view of the impact on health and health economics.

Documento de consenso SEPAR-ALAT sobre vacunación antineumocócica en fumadores

Streptococcus pneumoniae is responsible for several clinical syndromes, such as community-acquired pneumonia, sinusitis, otitis media, and others. The most severe clinical entity caused by this bacteria is undoubtedly invasive pneumococcal disease. Certain factors are known to increase the risk of presenting invasive pneumococcal disease, the most important being smoking habit and underlying concomitant diseases. This article comprises a consensus document on antipneumococcal vaccination in smokers, drawn up by a Smoking Expert Group from the Spanish Society of Pulmonology and Thoracic Surgery and the Latin American Chest Association.