ABSTRACT
Tobacco smoke is a proven risk factor for viral and bacterial respiratory infection. In adults without COPD, smoking is associated with a significant increase in the relative risk of pneumonia (OR = 2.0; 95 percent CI 1.24-3.24), invasive pneumococcal disease (OR = 2.6; 95 percent CI 1.9-3.5) and Legionella infection (OR =3.48; 95 percent CI 2.09-5.79). Smoking has clearly been shown to be associated with an increased risk of influenza (OR = 2.4; 95 percent CI 1.5-3.8), tuberculosis (OR = 2.6; 95 percent CI 2.2-3.1) and varicella pneumonia. In young children whose parents smoke, passive exposure to tobacco smoke is associated with an increased relative risk of seasonal infections (bronchitis, pneumonia) (OR = 1.72; CI 95 percent 1.55-1.91) and recurrent otitis media (OR = 1.88; 95 percent CI 1.02-3.49). Passive smoking also increases risk of pneumonia in adults (OR = 2.5; CI 95 percent 1.2-5.1). Plausible explanations of the increased risk of infection in active or passive smokers include increased bacterial adherence, decrease of lung and nasal clearance, and changes in the immune response. Conclusions: Exposure to tobacco smoke approximately doubles the risk of infection. This increased burden of infection has significant healthcare cost implications. Each infectious episode in an individual should prompt an attempt at smoking cessation.
La exposición a humo de tabaco constituye un importante factor de riesgo para adquirir infecciones respiratorias bacterianas y virales. En adultos sin enfermedad pulmonar obstructiva crónica, el tabaquismo está asociado a un aumento significativo del riesgo de neumonía (OR: 2,0; IC95 por ciento: 1,24-3,24), enfermedad neumocócica invasiva (OR: 2,6; IC95 por ciento: 1,9-3,5) e infección por legionella spp. (OR: 3,48; IC95 por ciento: 2,09-5,79). Además, el tabaquismo está asociado a mayor riesgo de influenza (OR: 2,4; IC95 por ciento: 1,5-3,8), tuberculosis (OR: 2,6; IC95 por ciento: 2,2-3,1) y neumonía por virus varicela. En niños pequeños expuestos al humo de tabaco en sus hogares aumenta el riesgo de infecciones respiratorias bajas (bronquitis, neumonía) (OR: 1,72; IC95 por ciento: 1,55-1,91) y otitis media recurrente (OR: 1,88; IC95 por ciento: 1,02-3,49). El tabaquismo pasivo también aumenta el riesgo de neumonía en adultos (OR: 2,5; IC95 por ciento: 1,2-5,1). El aumento del riesgo de infecciones respiratorias en el fumador activo y pasivo puede ser parcialmente atribuido al aumento de la adherencia y colonización bacteriana de la mucosa respiratoria, disminución de la depuración mucociliar nasal y de la vía aérea, y alteraciones específicas de la inmunidad humoral y celular. Conclusión: la exposición a humo de tabaco aumenta al doble el riesgo de infecciones respiratorias en niños y adultos. El aumento de las consultas por infecciones respiratorias constituye una elevada carga para el sistema de salud. En los pacientes que consultan por infecciones respiratorias agudas se debería evaluar el riesgo individual de exposición a humo de tabaco y el equipo de salud debería implementar actividades educativas específicas para intentar controlarlo.
Subject(s)
Humans , Tobacco Smoke Pollution/adverse effects , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/etiology , Tobacco Use Disorder/adverse effects , Risk Factors , Tobacco Use Disorder/physiopathologyABSTRACT
Distinguishing pneumonia from other causes of respiratory illnesses, such as bronchitis, influenza and upper respiratory tract infections, has important therapeutic and prognostic implications. This decision is usually made by clinical assessment alone or by performing a chest x-ray. The reference standard for diagnosing pneumonia is chest radiography, but many physicians rely on history and physical examination to diagnose or exclude this disease. A review of published studies of patients suspected of having pneumonia reveals that there are no individual clinical findings, or combination of findings, that can predict with certainty the diagnosis of pneumonia. Prediction rules have been recommended to guide the order of diagnostic tests, to maximize their clinical utility. Thus, some studies have shown that the absence of any vital sign abnormalities or any abnormalities on chest auscultation substantially reduces the likelihood of pneumonia to a point where further diagnostic evaluation may be unnecessary. This article reviews the literature on the appropriate use of the history and physical examination in diagnose community-acquired pneumonia.