Miguel Barrueco Ferrero

Quadruple Therapy Is Effective for Eradicating Helicobacter pylori After Failure of Triple Proton‐Pump Inhibitor–Based Therapy: A Detailed, Prospective Analysis of 21 Consecutive Cases

Background. Data regarding the effectiveness of second‐line treatment of Helicobacter pylori infection are limited, especially if microbiological studies are considered.

Recomendaciones para el tratamiento farmacológico del tabaquismo. Propuestas de financiación

. Todas estas guias coinciden en considerar que el tra-tamiento del tabaquismo es diferente para cada fuma-dor y depende fundamentalmente de la motivacion queeste tenga para abandonar de forma definitiva el consu-mo del tabaco. Asi, parece claro que los fumadores quese encuentren en fase de preparacion deben recibir 2 ti-pos de intervencion:

Pharmacological Tobacco Cessation Treatments: Proposals for Financing

Tobacco dependence is a recurring and addictive chronic disease and the leading preventable cause of death in the world. All health professionals are obliged to correctly diagnose and treat smokers to enable them to break the habit.1,2 In recent years, a wide range of recommendations and guidelines for treating smokers have been published for health professionals.1,2-5 In 2002 in Spain, a group of scientific societies published the first consensus document on the diagnosis and treatment of tobacco dependence.6 In 2003, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) updated the current guidelines on treatment of tobacco dependence.7,8 All these guidelines agree that treatment of this condition must be on an individual basis and depends essentially on personal motivation for permanent cessation. Therefore, it seems clear that smokers who are preparing to quit should receive 2 types of help: a) behavioral therapy, aimed at combating their psychological dependence and b) pharmacological therapy to relieve their physical dependence on nicotine (level A evidence).1-8 During the last 10 years, there have been important developments in the pharmacological treatment of smoking. New drugs have come onto the market, the modes of use and doses of currently available drugs have been modified, and the indications of the different drugs have even varied slightly. Furthermore, the arrival of new pharmacological options in tobacco cessation has opened an important debate as to whether this option should be financed by the Spanish national health system.9,10 These new guidelines on the pharmacological treatment of smoking have 2 main objectives: to analyze the drugs approved by the Spanish health authorities for use as pharmacological treatment of tobacco dependence and to make reasoned proposals based on scientific evidence for public financing of these treatments. This article sets out the neurophysiological grounding of nicotine dependence and tobacco addiction. It also uses scientific evidence to justify the need for smokers who wish to make a serious attempt at quitting to receive pharmacological therapy when indicated. Similarly, the article reviews the mechanism of action, doses, indications, and contraindications of each of the drugs available in Spain (nicotine gum, tablets, and patches, bupropion, and varenicline) to help smokers quit. The article also examines the results and conclusions of a new approach to the treatment of tobacco dependence: gradual reduction of intake using nicotine gum as a first step towards permanent cessation. Finally, proposals for public financing of pharmacological treatment to help smokers quit are presented.

Program for the Prevention of Smoking in Secondary School Students

Abstract Background and Objective School smoking prevention programs have never yielded the expected results. The aim of this study was to analyze the efficacy of an intensive smoking prevention program created by the educational community in which it was to be applied. Population and Method A 3-year smoking prevention program was carried out among the students of Fuentesauco Secondary School in Zamora, Spain. The Babilafuente Secondary School in Salamanca, Spain was the control group. The program included both prevention and treatment activities. The former were carried out in the school, in out-of-school situations, and in the community. The questionnaire of the European Smoking Prevention Framework Approach was used. Results A total of 417 students aged 12 to 17 years participated in the study. Of these, 54.4% belonged to the intervention group and 45.6% to the control group. Smokers represented 36.7% of the population. After the intervention smokers represented 40.1% of the Fuentesauco students compared with 46.1% of the Babilafuente students, though the difference was not statistically significant. With respect to the cognitive determinants of smoking behavior, after the intervention significant differences in favor of the intervention group were only observed in the subjects’ perception of the behavior of their siblings, peers, and teachers. Conclusions The use of smoking prevention programs in schools should be reconsidered, and their evaluation should be based on educational rather than clinical criteria. Proposed changes in the program include decreasing its intensity, starting with students of an earlier age and seeking greater involvement of parents.

Tratamiento del tabaquismo en fumadores con enfermedad pulmonar obstructiva crónica

Unidad Especializada en Tabaquismo, Comunidad de Madrid, Madrid, España Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, España CAP Drassanes, Barcelona, España Servicio de Neumología, Complejo Hospitalario de Navarra B, Pamplona, España Servicio de Neumología, Hospital San Juan, San Juan de Alicante, Alicante, España Servicio de Neumología, Hospital Universitario Gregorio Marañón, Madrid, España Servicio de Neumología, Hospital Valdemoro, Valdemoro, Madrid, España Servicio de Neumología, Hospital Fundación Alcorcón, Alcorcón, Madrid, España Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, España Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca, España

Deshabituación tabáquica. Valor del resultado en la fase de acción sobre el resultado en la fase de consolidación

Objetivo La escasez de estudios a largo plazo dificulta la valoracion de la abstinencia mantenida en el tiempo de los fumadores que consiguen dejar de fumar. El objetivo de nuestro estudio ha sido determinar en que medida los resultados obtenidos tras la intervencion para dejar de fumar se consolidan en el tiempo, al cabo de 5 anos. Pacientes y metodos Se ha realizado un estudio longitudinal y prospectivo sobre 502 fumadores, cuasi experimental, al considerar el grado de dependencia nicotinica como criterio para la asignacion del tratamiento: intervencion minima sistematizada en los fumadores con dependencia baja o que aun no se encontraban en fase de preparacion, y tratamiento sustitutivo con nicotina en aquellos con dependencia moderada-alta y/o alto consumo de cigarrillos. Resultados De los 267 pacientes que completaron el seguimiento a los 5 anos, el 29,6% dejo de fumar y se mantuvo abstinente al ano de seguimiento, y el 18,0% a los 5 anos. De los que consiguieron dejar de fumar a los 2 meses de la intervencion el 47,4% consolido su abstinencia al cabo de los 5 anos de seguimiento, y de los que no lo consiguieron seguia fumando el 88,1%. Conclusiones LOS resultados observados en la fase de accion pueden considerarse un elemento de ayuda para reorientar la actitud terapeutica, y quiza el planteamiento de controles programados en el tiempo ayude a consolidar la abstinencia tabaquica conseguida durante la intervencion.

Abstinencia puntual y continuada con el tratamiento farmacológico del tabaquismo en la práctica clínica

BACKGROUND AND OBJECTIVE: The objective of the study was to evaluate the effectiveness of the pharmacological treatment of tobacco dependence according to the criteria established by SEPAR.ATIENTS AND METHOD: Longitudinal, prospective and multicentre study. We included smokers aged more than 18 years who attended 5 smokers clinics and received nicotine replacement therapy (NRT), bupropion or both. The punctual and continuous abstinence was studied at the 15, 30, 60, 90 and 180 days with each one of the proposed treatments. Effective results were defined as the intention to treat. RESULTS: There were 904 smokers, 476 males and 428 females, mean age 42.51 (10.09). Of the 904 individuals who started the treatment, 820, 776, 687, 719 and 679 were present at the follow-up sessions at 15, 30, 60, 90 and 180 days, respectively. The punctual global abstinence at 15 and 180 days was 65.6% and 43.1%, while the continuous one was 57.4% and 38.8% at two and six months, respectively. Significant differences were not observed with regard to the punctual or continuous abstinence among patients treated with NRT, bupropion or both.ONCLUSIONS: The pharmacological treatment of tobacco dependence used individually according to the recommendations of the clinical guidelines allows to obtain good results with regard to the momentous and continuous abstinence. The effectiveness of the different first line treatments is similar in all the phases of the therapeutic process.

El cigarrillo electrónico. Declaración oficial de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) sobre la eficacia, seguridad y regulación de los cigarrillos electrónicos

The electronic cigarette (EC) is a device formed by three basic elements: battery, atomizer and cartridge. When assembled, it looks like a cigarette. The cartridge contains different substances: propylene glycol, glycerine and, sometimes, nicotine. When the user “vapes”, the battery is activated, the atomizer is heated and the liquid is drawn in and vaporized. The smoker inhales the mist produced. Various substances have been detected in this mist: formaldehyde, acetaldehyde and acrolein and some heavy metals. Although these are found in lower concentrations than in cigarettes, they may still be harmful for the human body. Several surveys show that 3-10% of smokers regularly use e-cigarettes. A randomized study has shown that the efficacy of e-cigarettes for helping smokers to quit is similar to nicotine patches. Nevertheless, the study has relevant methodological limitations and reliable conclusions cannot be deduced. This report sets down the Position Statement of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on the efficacy and safety of e-cigarettes. This statement declares that e-cigarettes should be regulated as medicinal products.

Resistencia de Helicobacter pylori al metronidazol y a la claritromicina: análisis descriptivo entre 1997 y 2000

Fundamento y objetivo: Revisar, en el area geografica de Aragon, la resistencia de Helicobacter pylori a los antibioticos claritromicina y metronidazol, en pacientes con y sin tratamiento erradicador previo, asi como su evolucion en los ultimos anos y su relacion con el consumo anual de antibioticos. Pacientes y metodo: Estudio retrospectivo en el que se analizo a todos aquellos pacientes con infeccion por H. pylori que presentaron un cultivo positivo entre los meses de enero de 1997 y diciembre de 2000. Se empleo la concentracion minima inhibitoria (CMI) determinada por E-test para definir la resistencia a claritromicina (CMI > 2 mg/l) y metronidazol (CMI > 32 mg/l). Resultados: Se estudiaron 537 cepas de H. pylori procedentes de 389 pacientes sin tratamiento erradicador previo y 148 con tratamiento erradicador previo. En los pacientes sin tratamiento previo se observo un 8,7% (intervalo de confianza [IC] del 95%, 6,1-12) de resistencia a la claritromicina y un 13,8% (IC del 95%, 10,4-17,3) al metronidazol, frente a un 39,2% (IC del 95%, 31,3-47,1) y un 37,8% (IC del 95%, 30-45,7), respectivamente, en los pacientes con tratamiento previo (p < 0,001). La tasa de resistencias primarias mostro una tendencia a la estabilizacion para la claritromicina (1997: 9,7%; 1998: 5,7%; 1999: 11,8%; 2000: 6,2%) y un descenso para el metronidazol (1997: 38,7%; 1998: 15,1%; 1999: 9%; 2000: 6,9%), sin observar una relacion clara con el consumo anual de estos antibioticos. Conclusiones: En nuestra region se observa una estabilizacion en las tasas de resistencia primaria de H. pylori a la claritromicina y un descenso en la resistencia al metronidazol.

RESULTADOS DEL PRIMER PROGRAMA PARA LA REDUCCIÓN DEL TABAQUISMO EN LOS TRABAJADORES DEL AYUNTAMIENTO DE SALAMANCA, ESPAÑA

Fundamento: El tabaquismo es el principal factor de riesgo en salud publica y una de las causas que ocasionan una mayor carga economica para la sociedad. El presente trabajo tiene por objeto conocer los resultados de un programa de deshabituacion tabaquica en el medio laboral. Metodos: Se diseno un programa con dos fases. La primera consistio en la realizacion de una encuesta para conocer la prevalencia y actitudes respecto al tabaco de los trabajadores del Ayuntamiento de Salamanca. La segunda en un programa de tratamiento especializado destinado a todos los trabajadores que deseasen dejar de fumar Resultados: Respondieron a la encuesta 384 trabajadores, de los cuales 135 (35,1%) eran fumadores. El 80,5% de estos (n = 113) deseaban dejar el tabaco y recibir ayuda medica para lograrlo. Iniciaron el programa de tratamiento 73 trabajadores. Al ano de tratamiento se observo una tasa de abandono del tabaco del 41% de los trabajadores que lo iniciaron. El nivel de satisfaccion de los trabajadores con el programa fue de una media de 2,9 sobre 3.