Article

Prevalencia y factores de riesgo de EPOC en fumadores y ex fumadores

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Material y métodos: Se realizó un estudio descriptivo transversal en el ámbito de la atención primaria. En él se incluyo a 444 personas de 40 años de edad o mayores que fumaban o habían fumado. A todos se les realizó una espirometría. Si la relación volumen espiratorio forzado en el primer segundo/porcentaje de la capacidad vital forzada era menor del 70%, se realizaba una prueba de broncodilatación y se repetía la espirometría a los 15-20 min tras dos inhalaciones de terbutalina (500 µg/dosis). Si la relación volumen espiratorio forzado en el primer segundo/porcentaje de la capacidad vital forzada seguía siendo inferior al 70% y el volumen espiratorio forzado en el primer segundo menor del 80% del teórico, se diagnosticaba EPOC. También se recogieron edad, sexo, consumo de tabaco, edad de inicio, índice tabáquico (paquetes/día x años de consumo) e intentos de abandono. Resultados: La edad media de los pacientes era de 53,5 años, y un 65,8% eran varones. En el momento del realizar el estudio fumaban 248 sujetos (55,9%). La mediana de inicio del consumo resultó de 16,5 años, y la del índice tabáquido fue de 26,7. El 72,1% había realizado al menos un intento de abandono. Se diagnosticó de EPOC a 70 personas (24 ya conocidas), lo que supone una prevalencia del 16,4% (intervalo de confianza del 95%, 12,9-19,9). Un 10% eran casos graves. Tras el análisis multifactorial resultaron significativamente asociadas a EPOC la edad y el índice tabáquico. Conclusiones: La prevalencia de EPOC hallada es ligeramente superior a la de otros estudios, si bien puede existir un sesgo en los resultados obtenidos al no haber podido establecer contacto con el 11,9% de la población objeto del estudio. Casi dos tercios de los casos eran desconocidos. Son claros factores de riesgo la edad y el consumo acumulado de tabaco.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Th is study confi rms the high prevalence of COPD in subjects over the age of 45 with a history of smoking, and it may have been underestimated because some active smokers refused to take part in the survey. Th e prevalence of 24.3% found in our population-based study is consistent with the results of other epidemiological studies using the same COPD criteria and involving populations of similar age and smoking habits (4,5,(22)(23)(24)(25). In particular, other studies such as ours, carried out exclusively in smokers have reported a prevalence of COPD that ranges from 22% to 26% (24,25).Th us, the use of spirometry in all individuals at risk will detect one case of COPD out of every four tests performed, most not having been previously diagnosed.We did not exclude the cases considered to be false positives of COPD (see below) from this prevalence in order to compare our result with those of other epidemiological studies that did not carry out any therapeutic intervention to verify the diagnosis of COPD. ...
... In contrast to other countries, most of the COPD cases were men, which refl ects the later introduction of the smoking habit among women in Spain. All Spanish epidemiological studies have confi rmed a 3-to 4-fold higher prevalence of COPD among men compared to women (5,22,23,25). ...
Article
Full-text available
Abstract The prevalence of COPD is high, and most cases remain undiagnosed. In contrast, some patients labeled and treated as COPD do not have spirometric confirmation. Our objective was to determine the prevalence of COPD among smokers aged 45 years or older and investigate the accuracy of diagnosis of COPD in primary care. A population-based, epidemiological study was conducted in a primary care centre among subjects older than 45 years with a history of smoking. The participants underwent a clinical questionnaire and spirometry with bronchodilator test. Additionally, participants with newly diagnosed COPD, defined as postbronchodilator FEV1/FVC<0.7, underwent 4-week treatment with formoterol and budesonide to rule out reversible airflow obstruction. A total of 1,738 individuals (84.4% male) with a mean age of 59.9 years were included. The prevalence of COPD was 24.3% (95%, CI 22.3-26.4), with an overall underdiagnosis of 56.7%. Patients with COPD were older, more frequently male, with a lower body mass index, a longer history of smoking, lower educational level, previous occupational exposure, and more cardiovascular co-morbidity (all p < 0.001). After 4 weeks of treatment, 16% of initially obstructed patients had normal spirometry; in addition, 15.6% of individuals with a diagnosis of COPD did not have airflow obstruction. One out of four smokers 45 years or older presenting in primary care have airflow obstruction, mostly undiagnosed. However, among those with an initial diagnosis of COPD up to 16% will normalise spirometry after 4 weeks of treatment. There is also a significant number of individuals misdiagnosed with COPD.
... En términos generales, opinamos que se trata de un estudio valioso, realizado en un medio apenas estudiado, que cuenta con la ventaja de que es de tipo observacional, de base poblacional y que el tamaño de la muestra es amplio y representativo de la población estudiada. Estamos totalmente de acuerdo con los que opinan que estos estudios de prevalencia locales se erigen como centinelas del impacto de la Atención Primaria para aquellos procesos, indicadores de morbimortalidad evitable, cuya mejora es atribuible a la misma 18 . Sería importante también en este medio mejorar la sensibilidad y percepción general de los médicos frente a las mujeres con síntomas respiratorios y sospecha de EPOC, con el objeto de disminuir sus altos porcentajes de infradiagnóstico. ...
Article
Full-text available
Fundamentos: La enfermedad pulmonar obstructiva crónica es un problema sanitario mundial debido a su elevada prevalencia, alta morbilidad y cuantioso coste económico. En España su prevalencia varía considerablemente entre las diferentes áreas geográficas estudiadas. El objetivo de este estudio fue establecer la prevalencia de enfermedad pulmonar obstructiva crónica en una zona básica de salud de ámbito rural y el análisis según diferentes factores de riesgo. Métodos: Estudio transversal realizado en Yunquera de Henares (Guadalajara) durante 2014. Para la recogida de información se utilizó un cuestionario que recogió datos sociodemográficos, consumo de tabaco, edad y profesión a una muestra de sujetos seleccionada de manera aleatoria y estratificada según edad, sexo y núcleos de población. El tamaño muestral fue de 749 personas. Se realizó análisis estadístico descriptivo con medias y porcentajes, analítico: chi⁽²⁾, t de Student, ANOVA y multivariante por regresión logística. Resultados: La prevalencia de enfermedad pulmonar obstructiva crónica fue del 15,8% (IC 95%: 13,2-18,4). Las personas con enfermedad pulmonar obstructiva crónica tenían una edad media de 64,6±11años vs 58,9±11,7 de quienes no la padecían (p<0,05), eran hombres el 83,2% (IC95%: 85,9-80,5; p<0,001), fue más frecuente en personas con estudios primarios: 66,4% (IC95%: 69,7-63; p<0,01) y entre quienes consumían tabaco: 40,3% (IC 95%: 43,8-36,8 ; p<0,001). De manera no estadísticamente significativa, también presentaban mayor índice de masa corporal:28,2% (IC95%: 29,5-26,9). Trabajababan en el campo el 28,6% (IC95%: 20,5-36,7). Conclusiones: La prevalencia de enfermedad pulmonar obstructiva crónica encontrada fue alta. La exposición laboral puede ser un factor importante en el medio rural.
... Tras el análisis multivariante encontramos como variables relacionadas con el riesgo de presentar EPOC el género, la edad, la tos y el grado de tabaquismo, en concordancia con otros estudios 3,6,18,19 . Según dichos resultados, obtendríamos un mayor rendimiento del cribado seleccionando a hombres de 50 a 59 años, fumadores de más de 40 paquetes/año y que refieran tos. ...
Article
Objective To show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit.
... Tras el análisis multivariante encontramos como variables relacionadas con el riesgo de presentar EPOC el género, la edad, la tos y el grado de tabaquismo, en concordancia con otros estudios 3,6,18,19 . Según dichos resultados, obtendríamos un mayor rendimiento del cribado seleccionando a hombres de 50 a 59 años, fumadores de más de 40 paquetes/año y que refieran tos. ...
Article
To show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit. A cross-sectional and multicentre study. Basic Primary Care Centres representing different rural and urban areas of Lleida. A total of 497 active smokers without COPD from 40 to 70 years selected from the database Primary Care Database (e-CAP). Spirometry was performed on all patients. The spirometry results were reported and brief counselling was given on quitting smoking and the readiness to stop smoking was determined. Age, gender, height, weight, smoking, respiratory symptoms and physical activity. The majority of patients (65.4%) were men, age 51± 7.6 years. They smoked an average of 32 packs/year; 40.4% performed moderate activity and 27.4% referred to some respiratory symptoms. Of the 25% who had an obstructive or mixed pattern, 75.8% of the cases had a moderate level of severity. A decision to quit was made by 38.8%. In the multivariate analysis, gender, age 50 to 59 years and a smoking index>40 were associated with COPD. Moderate or intense physical activity decreased the risk of COPD. To perform spirometry in high-risk smokers, to show the spirometry results and give brief anti-smoking counselling, enables not previously diagnosed cases of COPD to be detected. It also helps to determine the readiness to stop smoking and to establish individualised treatment and follow-up plans.
Article
The article is a thematic review on chronic obstructive pulmonary disease, proposed as a nursing care guide to the nursing professional, to be use in different context. It incorporates a short pathophysiological explanation, followed by the nursing assessment, justification, and the identification of nursing diagnosis of the North American Nursing Diagnosis (NANDA). It includes too the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC)
Article
Introduction: in this century has been an unusual increase of smoking, habit that is the more important risk factor for development of ventilatory limitation, such action has became a problem in the health staff. Objective: to determine the possible repercussion of smoking on the pulmonary function. A cross-sectional and descriptive study was conducted in smokers working in the Dr. Carlos J. Finlay Central and Military Hospital. Sixty smokers underwent a spirometry study. Results: there was predominance of female sex from the 40 and 49 age-groups. The assistant staff was the group with a greater figure of smokers. Cigarette was the more consumed toxic agent. Also, there was predominance of moderate smokers (11-20 cigarettes by day) during more of 21 years with the greater figure of patients with respiratory symptoms. Conclusions: the predominant spirometry pattern was normal, but there was a significant percentage of smokers presenting with an obstructive ventilatory dysfunction, showing the damage to pulmonary function in the smokers staff.
Article
Background and objective: the aim of the study was to describe the palliative care provided to cancer or non-oncologic terminal patients in an acute care hospital. Material and method: we conducted a retrospective study of 297 patients who died from malignant disease, heart failure, and chronic obstructive pulmonary disease. Demographic data, do not resuscitate (DNR) orders, symptoms, reception and duration of palliative care, family participation in therapeutic decisions, and total withdrawal of other drug therapies described in these patients' medical records were obtained. Results: despite the fact that DNR orders were specified only in 32% of cases, 8% of patients were subjected to cardiopulmonary resuscitation. Drug withdrawal was carried out in 31% of patients but 86% died with malignant illness. Conclusion: palliative care for patients with cardiorespiratory terminal illness is less extensive than for oncological patients.
Article
Chronic obstructive pulmonary disease (COPD) is characterized by an insidious and progressive course, and it represents a major health, economic, and social problem. COPD prevalence is greatly underestimated because the disease usually remains undiagnosed until symptomatic airflow obstruction is clinically apparent. Spirometry is fundamental for the diagnosis of COPD because it allows to achieve an accurate diagnosis and also meets all the criteria for early detection of the disease. However, despite the current good price, size, and quality of office spirometers, only a small portion of general practitioners (GPs) regularly use these instruments. There is numerous evidence confirming that well trained GPs can perform good quality spirometries and correctly interpret them. Office spirometry may increase the rate of COPD diagnosis and also impact favourably on the clinical decision making in primary care.
Article
The extensive worldwide disease burden attributable to tobacco smoking [13] has been reviewed, with particular attention to the epidemiologic and clinical aspects, molecular and cellular mechanisms, and pathophysiology of a variety of smoking-related pulmonary diseases (asthma, COPD, community-acquired pneumonia, pulmonary thromboembolism, lung cancer, and interstitial lung diseases), and the epidemiology and clinical presentation of smoking-related atherosclerotic disease as it affects the cardiovascular system cerebral circulation, the aorta, and the peripheral arterial tree. Comprehensive, governmentally coordinated, global tobacco control efforts, as proposed by the American Society of Clinical Oncology in its 2003 policy update statement [97], are focused on the ultimate achievement of a tobacco-free world, with the goal of reducing the incidence of lung cancer. In such a fashion the extensive pulmonary and cardiovascular morbidity and mortality discussed in this article may someday be ameliorated.
Article
Full-text available
Background: Multiple factors can influence the severity of chronic obstructive pulmonary disease (COPD) and the functioning of patients with COPD, such as personal characteristics and systemic manifestations. Objective: To evaluate the different factors that can influence the activity and psychosocial impact domains of the Saint George's Respiratory Questionnaire (SGRQ) in COPD patients. Method: Participants, recruited in a university-based hospital, responded to the SGRQ, and in addition, personal, anthropometric, and clinical data were collected. The study was approved by the Institutional Ethics Committee. Data were analyzed using multiple linear regression models, with the SGRQ activity and psychosocial impact scores as outcome variables, and 10 explanatory variables (age, gender, forced expiratory volume in the first second - FEV1, smoking load, body mass index, oxygen therapy, associated diseases, regular physical activity, participation in a formal rehabilitation program, and SGRQ symptoms score) were considered. Results: The best regression model for predicting the SGRQ activity score (r²=0.477) included gender, FEV1, and SGRQ symptoms. In contrast, the predictive model with the highest proportion of explained variance in psychosocial impact score (r²=0.426) included the variables gender, oxygen therapy, and SGRQ symptoms. Conclusions: The results indicate that the outcomes, while based on functioning parameters in COPD patients, could be partly explained by the personal and clinical factors analyzed, especially by the symptoms assessed by the SGRQ. Thus, it appears that the health conditions of these patients cannot be described by isolated variables, including pulmonary function parameters.
Article
Full-text available
Chronic obstructive pulmonary disease (COPD) is an enormous public health problem and of growing importance due to its high prevalence, elevated morbimortality, and socioeconomic costs. Many Spanish epidemiological studies report a prevalence of 10% of the adult population, with its growth appearing to have stabilised. Nevertheless, over 75% of cases are still underdiagnosed. The diagnosis of mild and moderate obstruction is associated with a higher survival and lower costs (14 years and €9,730) compared to 10 years survival and €43,785 of patients diagnosed in the severe obstruction phase. COPD was the fourth cause of death in Spain in 2011, although the adjusted mortality rates have decreased more than 20% in the last decade, particularly in males. Patients with advanced COPD die from it, but patients with mild or moderate COPD die due to cardiovascular diseases or cancer (mainly of the lung). It is estimated that the annual cost of the disease is around 3,000 million Euros. These increase with the spirometric severity, and is mainly associated with exacerbations (almost 60% of the direct costs). Comorbidity, that is the presence of diseases that coexist with the studied disease, is higher in patients with COPD than in the general population and affects health results.
Article
Chronic obstructive pulmonary disease (COPD) is an enormous public health problem and of growing importance due to its high prevalence, elevated morbimortality, and socioeconomic costs. Many Spanish epidemiological studies report a prevalence of 10% of the adult population, with its growth appearing to have stabilised. Nevertheless, over 75% of cases are still underdiagnosed. The diagnosis of mild and moderate obstruction is associated with a higher survival and lower costs (14 years and €9,730) compared to 10 years survival and €43,785 of patients diagnosed in the severe obstruction phase. COPD was the fourth cause of death in Spain in 2011, although the adjusted mortality rates have decreased more than 20% in the last decade, particularly in males. Patients with advanced COPD die from it, but patients with mild or moderate COPD die due to cardiovascular diseases or cancer (mainly of the lung). It is estimated that the annual cost of the disease is around 3,000 million Euros. These increase with the spirometric severity, and is mainly associated with exacerbations (almost 60% of the direct costs). Comorbidity, that is the presence of diseases that coexist with the studied disease, is higher in patients with COPD than in the general population and affects health results.
Article
Introduction: in this century has been an unusual increase of smoking, habit that is the more important risk factor for development of ventilatory limitation, such action has became a problem in the health staff. Objective: to determine the possible repercussion of smoking on the pulmonary function. A cross-sectional and descriptive study was conducted in smokers working in the "Dr. Carlos J. Finlay" Central and Military Hospital. Sixty smokers underwent a spirometry study. Results: there was predominance of female sex from the 40 and 49 age-groups. The assistant staff was the group with a greater figure of smokers. Cigarette was the more consumed toxic agent. Also, there was predominance of moderate smokers (11-20 cigarettes by day) during more of 21 years with the greater figure of patients with respiratory symptoms. Conclusions: the predominant spirometry pattern was normal, but there was a significant percentage of smokers presenting with an obstructive ventilatory dysfunction, showing the damage to pulmonary function in the smokers staff.
Article
Full-text available
Objective Although the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results. Methods A representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated. Results COPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09). Conclusions There is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk.
Article
Chronic obstructive pulmonary disease (COPD) causes substantial morbidity and mortality. More than 18,000 people die from COPD each year in Spain. This disease is the fifth cause of death among men, with an annual rate of 60 deaths per 100,000 inhabitants, and the seventh among women, with an annual rate of 17 deaths per 100,000 inhabitants. These figures place Spain in an intermediate position within the European Union, in a ranking topped by some Eastern European and English speaking countries. The prevalence of COPD in Spain, as reported by the epidemiological COPD in Spain (IBERPOC), was 9.1% of the adult population, affecting 14.3% of men and 3.9% of women. Among smokers, the prevalence of COPD was 15% in smokers, 12.8% in ex-smokers and 4.1% in non-smokers. The IBERPOC study is perhaps one of the most widely referenced reports in the global literature on the population distribution of COPD and has served as a model for other epidemiological studies, which are discussed in the present chapter.
Article
Full-text available
Smoking is a known cause of the outcomes COPD, chronic bronchitis (CB) and emphysema, but no previous systematic review exists. We summarize evidence for various smoking indices. Based on MEDLINE searches and other sources we obtained papers published to 2006 describing epidemiological studies relating incidence or prevalence of these outcomes to smoking. Studies in children or adolescents, or in populations at high respiratory disease risk or with co-existing diseases were excluded. Study-specific data were extracted on design, exposures and outcomes considered, and confounder adjustment. For each outcome RRs/ORs and 95% CIs were extracted for ever, current and ex smoking and various dose response indices, and meta-analyses and meta-regressions conducted to determine how relationships were modified by various study and RR characteristics. Of 218 studies identified, 133 provide data for COPD, 101 for CB and 28 for emphysema. RR estimates are markedly heterogeneous. Based on random-effects meta-analyses of most-adjusted RR/ORs, estimates are elevated for ever smoking (COPD 2.89, CI 2.63-3.17, n = 129 RRs; CB 2.69, 2.50-2.90, n = 114; emphysema 4.51, 3.38-6.02, n = 28), current smoking (COPD 3.51, 3.08-3.99; CB 3.41, 3.13-3.72; emphysema 4.87, 2.83-8.41) and ex smoking (COPD 2.35, 2.11-2.63; CB 1.63, 1.50-1.78; emphysema 3.52, 2.51-4.94). For COPD, RRs are higher for males, for studies conducted in North America, for cigarette smoking rather than any product smoking, and where the unexposed base is never smoking any product, and are markedly lower when asthma is included in the COPD definition. Variations by sex, continent, smoking product and unexposed group are in the same direction for CB, but less clearly demonstrated. For all outcomes RRs are higher when based on mortality, and for COPD are markedly lower when based on lung function. For all outcomes, risk increases with amount smoked and pack-years. Limited data show risk decreases with increasing starting age for COPD and CB and with increasing quitting duration for COPD. No clear relationship is seen with duration of smoking. The results confirm and quantify the causal relationships with smoking.
Article
La inexistencia de una base de datos traumática nacional hurta el conocimiento de la dimensión del problema en nuestro país. Solo la información de los accidentes de tráfico nos advierte de la dimensión del mismo, pero su descripción se centra en el «accidente», no en los accidentados, ni en sus lesiones. Intentando responder a: ¿qué características tiene el paciente traumático ingresado en una UCI? ¿qué factores pueden actuar como riesgo o protección frente a la mortalidad?, se diseño el presente estudio. El objetivo principal de esta tesis es definir el perfil del paciente traumático grave en una unidad de Medicina Intensiva. En segundo lugar, determinar los factores de riesgo con la mortalidad. Y en tercer lugar, describir las lesiones, antecedentes, complicaciones y evolución durante los 12 años del estudio.
Article
Background and objectives: Chronic obstructive pulmonary disease (COPD) causes considerable morbidity and mortality in Spain. The 1997 IBERPOC study, applying the old criteria of the European Respiratory Society, reported a COPD prevalence of 9.1% in the adult population of Spain. The Epidemiologic Study of COPD in Spain (EPI-SCAN) aims to determine the current prevalence of COPD in residents of Spain aged 40-80 years and to estimate changes over the past 10 years. Secondary objectives are, among others, to describe the current prevalence of smoking and changes in COPD prevalence relative to previous studies; to describe treatments received by patients, quality of life, and the BODE index (body mass index, obstruction of airflow, dyspnea, and exercise tolerance); and to measure inflammatory markers in blood and exhaled-breath condensate. Patients and methods: EPI-SCAN is a population-based, cross-sectional epidemiologic study targeting the general population of Spain aged between 40 and 80 years. Participating centers were located in Barcelona, Burgos, Cordoba, Huesca, Madrid, Oviedo, Seville, Valencia, Vic, and Vigo. All subjects filled in an extensive questionnaire to collect social, demographic, and clinical information. Slow and forced spirometry tests before and after a bronchodilator test were also undertaken. Additionally, selected subjects performed a 6-minute walk test and answered generic and specific quality-of-life questionnaires, as well as an activities-of-daily-living questionnaire. Exhaled-breath condensate and blood samples were also collected from these subjects for measurement of inflammatory and other biomarkers.
Article
Full-text available
The prevalence of asthma and chronic obstructive pulmonary disease (COPD) is high ( approximately 7.4-18%) in the general population, but less than half are diagnosed. Several studies have shown FEV(6) as a good surrogate marker for forced vital capacity (FVC) to detect airflow limitations. The aim of this study was to evaluate if it is possible to simplify and improve the diagnosis of so far undiagnosed asthma or COPD in the primary care setting by measuring FEV(6) with a new simple screening device (PiKo-6). 507 patients were recruited from three general practices from May to June 2005. Patients with any known pulmonary disease were excluded by questionnaire. FEV(1), FEV(6) and FEV(1)/FEV(6) were determined using a PiKo-6 device. Patients with an FEV(1)/FEV(6) <80% (PiKo positive) were invited to a standardized pulmonary function test to confirm or rule out airflow limitation. 401 (79.1%) patients showed FEV(1)/FEV(6) > or =80% (PiKo negative), and 106 (20.9%) patients were PiKo positive. Of the 106 PiKo-positive patients, 74 patients (14.7% of total) agreed to further studies and 18 patients (3.6%) of them suffered from COPD [COPD 0: 5 (1.0%); COPD I: 9 (1.8%); COPD II: 4 (0.8%), and none with COPD III or IV] and 14 patients (2.8%) suffered from bronchial hyperresponsiveness or asthma. In 42 patients (8.3%), the pulmonary function test was normal. Measurement of FEV(6) using a new simple screening device (PiKo-6) may improve the detection rate of undiagnosed airflow limitation in the primary care setting. However, patients should be carefully selected.
Article
According to literature, COPD rates are high in spite of decreasing rates of main risk factors smoking and air pollution in developed countries. general practice is a good place to survey unbiased prevalence rates. Ten studies done in general practice over the last 20 years found prevalence rates among smokers between 13.1% and 92.1%. Prevalence and detection rates of COPD in smokers in German general practice. Twenty-eight of 34 invited and eligible GP surgeries in/around Duesseldorf, Germany, took part in the non-announced 2-day investigation of all smokers (> or =40 years) who visited the surgeries. Lung function test by hand-held spirometer, peak flow, sympton part of St George's Respiratory Questionnaire, and data on smoking habits were used. GOLD criteria for COPD were employed. GPs had to give their diagnosis not knowing the test results. Of 3157 patients attending the 28 surgeries, 538 were smokers. Four hundred and thirty-seven of these agreed to participate, 5 had to be excluded for medical reasons/unacceptable spirometry. Three hundred and ninety-eight patients have not been previously diagnosed with COPD or asthma. Thirty patients were disgnosed with COPD, making a prevalence of 6.9%, of which 15 patients were already known as having COPD. Our result of low prevalence differs strongly from all other studies in general practice. Considering our study design which avoids selection bias found in nearly all other studies (no pre-announcement, no self-selection of patients or GPs, high participation rate and testing all patients), we strongly believe that our findings reflect the current situation of COPD in German general practice.
Article
Full-text available
Life time smoking of ready made cigarettes can be readily quantified as "pack years" smoked, but methods for measuring loose tobacco use are less well established. In this study the frequency of loose tobacco use by 247 hospital in-patients was determined; 64% were current or ex-smokers, 41.3% of whom (25.9% of participants) had smoked loose tobacco. A formula was developed for converting loose tobacco use to pack years smoked, based on the weight of tobacco in ready made cigarettes; 12.5 g or half an ounce of loose tobacco was approximately equivalent to one packet of 20 cigarettes. Using a questionnaire it was found that hospital physicians of all grades were able to convert smoking histories of ready made cigarettes, but not loose tobacco, into number of "pack years" smoked.
Article
Full-text available
Data suggest that women are more susceptible to develop airway obstruction compared to men for the same number of cigarettes smoked. To compare the prevalence of chronic obstructive lung disease (COPD) and the effect of smoking on the risk of developing COPD according to gender, in a population of high-risk smokers. In 795 smokers, spirometry was performed using the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to determine airflow obstruction. COPD prevalence was determined in smokers grouped according to the number of cigarettes smoked per year [<20 (I), 20-40 (II), 40-60 (III) and >60 pack-years (IV)] and age. Men were older, smoked more and for a longer period. Age at smoking initiation and the number of packs smoked per day did not differ. COPD was diagnosed in 26% of the subjects (30.5% men and 22.3% women, p < 0.001) with similar degree of obstruction (forced expiratory volume in 1 s: 78% of predicted in men vs. 75% in women). COPD prevalence was lower in women in all categories irrespective of the pack-year history (I: 9 vs. 19%; II: 16 vs. 28%; III: 28 vs. 39%, and IV: 25 vs. 42%, respectively, p < 0.001). In those older than 50 years, 34% men and 17% women (p < .001) had COPD. Using the GOLD criteria, the prevalence of COPD in smokers was higher than previous reports. In this self-selected sample of high-risk smokers having the same smoking history, prevalence was lower in women than in men, suggesting a lower susceptibility for the development of airway obstruction.
Article
Full-text available
Although the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results. A representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated. COPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09). There is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk.
Article
To assess the association between smoking and respiratory symptoms, lung function and bronchial hyperresponsiveness (BHR) in young adults in Chile. Selected sample of 1232 subjects aged 22-28 years. In this cross-sectional study, the outcome measures were: respiratory symptoms, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow between 25% and 75% (FEF25-75), FEV1/FVC and BHR. Among the 1232 subjects, 67.7% of the men and 49.4% of the women were smokers; the median cigarettes smoked per day was four for men and three for women. Smoking was associated with wheezing, waking up with a cough, breathlessness following exercise and persistent cough, with odds ratios (OR) between 1.94 (95% CI 1.41-2.66) and 3.12 (95% CI 2.21-4.40) among those smoking > or = 5 cigarettes per day, compared to non-smokers. Smoking < 5 cigarettes was significantly associated with wheezing and waking up with a cough. Smokers had a lower FEV1/FVC than non-smokers by approximately 0.8%. Smoking was not associated with FEV1, FEF25-75 or BHR status. This study highlights the early effects of smoking on respiratory symptoms. It could help governments in Latin America take vigorous action to deter young people from starting smoking.
Article
Smoking is the main risk factor for Chronic Obstructive Pulmonary Disease (COPD), an important cause of morbidity and mortality. To estimate smoking attributable risk and population attributable risk in COPD patients attended in Public Health Services of Santiago. A case control study matched by sex and age was carried out. Crude and adjusted attributable risks as well as population attributable risk were estimated, controlled by potential confounders and by interaction variables. Mean ages for cases and controls were 68 and 67 years respectively. When compared to the control group, COPD patients had a higher smoking prevalence (at least 100 cigarettes in their life span: 89.7% vs 60.3%; p <0.01). Among COPD patients, heavy smokers proportion was 4 times higher than in controls, they smoked for more years (43 vs 31; p <0.01) and more cigarettes per day (18 vs 5; p <0.01). Adjusted attributable risk was 87% (95% Confidence Interval (CI): 63.7-94.8). If a patient smoked at least 100 cigarettes in his/her life span and this risk was 92.7% (CI: 82.4-96.9) for heavy smokers. Projecting this index to Santiago inhabitants, about 87,000 individuals older than 40 years would be suffering COPD due to smoking. This article confirms the strong association between smoking and COPD. Attributable risks are high and significant, even when they are adjusted by confounding variables. Women had a higher risk than men, at lower levels of tobacco consumption.
Article
Four hundred sixty-seven patients between 35 and 65 years of age were studied, all taken from a random sample of the population of Health Area 5 of the Valencian Community. Figures for respiratory symptoms, smoking, previous lung disease, professional activity and lung function were obtained through questionnaires and spirometry. The prevalence of asthma found was 2.78% (C.I. 2.76-2.79); chronic bronchitis was 4.07% (C.I. 2.37-5.77) and airflow limitation was 6.4% (C.I. 4.5-8.3). Smokers represented 33.2% of the sample. A significant association was found between the level of intensity of symptoms and lung function. There were no differences between smokers and non smokers with respect to FEV1%. An association between workplace exposure and spirometry was found only for FEV1/FVC%.
Article
El estudio IBERPOC es una iniciativa del Área de Trabajo “Insuficiencia Respiratoria y Trastornos del Sueño” (IRTS) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Ha sido financiado por Boehringer Ingelheim España S.A.
Article
To determine the level of conditions to be found in general medicine in the Basic Health Areas (BHA) of Barcelona and metropolitan area, with respect to the diagnosis and control of asthma and POCD. Also, to determine the level of clinical knowledge of the doctors in terms of diagnosis, control and treatment of these pathologies. Cross-sectional study by questionnaire. The BHA's of Barcelona and metropolitan area. General practitioners (GP's) within the above-mentioned BHA's. Questionnaire consisting of 20 questions and divided into 4 parts: personal information, control and health education, diagnosis and bronchodilatory treatment (BD). 43% of the GP's had a Peak-Flow Metre (PFM), while 21% had never had one. 36% of the doctors required a respiratory functions test (RFT) of all their patients. 15% always prescribed the spacer chamber (SC) when giving inhaled corticoids (IC). 69% had not diagnosed asthma. The B2 agonists are preferred out of all BD for EPOC and asthma. There was no difference between the centres (p < 0.07), nor between the BHA with or without teaching (p < 0.06). There is insufficient use of the PFR, including the PFM. SC with IC is rather infrequent. Asthma is the least diagnosed case, and is most confused with EPOC. A higher level of training is needed for GP doctors in the BHA's, and the setting of minimum criteria for action in the case of asthma and POCD.