Performance of exhaled carbon monoxide measurement in smoking cessation clinics and its influence on patients' willingness and behavior for smoking cessation / 中华流行病学杂志

Objective: To evaluate the performance of exhaled carbon monoxide measurement in smoking cessation clinics and its influence on patients' willingness and behavior for smoking cessation in China. Methods: Data of 41 566 patients who visited 257 smoking cessation clinics equipped with exhaled carbon monoxide detectors from 2019 to 2021 were selected to study the relationship between exhaled carbon monoxide measurement and patients' willingness to quit smoking as well as smoking cessation rate in those who completed follow up. Results: Only 21 470 (51.7%) of the patients received exhaled carbon monoxide measurement in the first visit. Patients who had exhaled carbon monoxide measurement were 1.87 (95%CI: 1.78-1.96) times more likely to have stronger willingness to quit smoking. The follow up results indicated that the patients with exhaled carbon monoxide measurement in the first visit were 1.10 (95%CI: 1.05-1.16) times more likely to quit smoking one month later than those without the measurement, and 1.22 (95%CI: 1.17-1.29) times more likely to quit smoking three months later than those without measurement. Conclusions: Exhaled carbon monoxide measurement can improve patients' willingness to quit smoking and increase smoking cessation rate. However, the testing rate is low in smoking cessation clinics at present. It's important to promote the equipment and utilization of exhaled carbon monoxide detector in smoking cessation clinics.

Informe especial: Contaminación del aire: CABA 2010-2018 / Special report: Air pollution: CABA 2010-2018

informe realizado por los equipos de trabajo que pertenecen a Salud Ambiental, Agencia de Protección Ambiental y Gerencia Operativa de Epidemiología, del Gobierno de la Ciudad de Buenos Aires. En el presente informe se analizan una serie de indicadores que permiten observar los valores de contaminantes criterio: Material Particulado en suspensión menor a 10 micrones (PM 10), Monóxido de Carbono (CO) y Dióxido de Nitrógeno (NO2), registrados en las estaciones de Monitoreo de Calidad del Aire que posee la Ciudad (La Boca, Parque Centenario y Córdoba), las cuales registran las concentraciones de estos contaminantes en forma continua (durante 24 horas, los 365 días del año), mediante métodos homologados internacionalmente. El periodo registrado abarca los años 2010 hasta el año 2018 completo. (AU)

O impacto dos aditivos do tabaco na toxicidade da fumaça do cigarro: uma avaliação crítica dos estudos patrocinados pela indústria do fumo / El impacto de los aditivos del tabaco en la toxicidad del humo del cigarrillo: una evaluación crítica de los estudios de la industria del tabaco / The impact of tobacco additives on cigarette smoke toxicity: a critical appraisal of tobacco industry studies

Resumo: A produção de cigarros envolve uma série de substâncias e materiais além do próprio tabaco, do papel e do filtro. Os aditivos do tabaco incluem conservantes, flavorizantes, intensificadores, umectantes, açúcares e compostos de amônio. Embora as empresas produtoras de tabaco aleguem que os aditivos não aumentam a toxicidade da fumaça e não tornam os cigarros mais atraentes ou viciantes, tais alegações são contestadas por pesquisadores independentes. Os autores realizaram uma revisão dos estudos sobre os efeitos dos aditivos sobre a composição química e toxicidade da fumaça. Os aditivos elevam os níveis de formaldeído e causam pequenas alterações nos níveis de outros analitos medidos na fumaça. Estudos toxicológicos (testes de mutagenicidade e de citotoxicidade em células de mamíferos, estudos da exposição por 90 dias por via inalatória em ratos e ensaios do micronúcleo em células da medula óssea) indicaram que os aditivos do tabaco não aumentam a toxicidade da fumaça. Entretanto, é conhecido que os estudos em roedores falham em predizer o potencial carcinogênico da fumaça do cigarro, e os testes realizados tiveram poder estatístico insuficiente para detectar diferenças pequenas, porém relevantes do ponto de vista toxicológico, entre cigarros experimentais (com aditivos) e controles (sem aditivos). Em conclusão, esta revisão da literatura mostrou que o impacto dos aditivos na toxicidade da fumaça do tabaco ainda permanece por ser esclarecido.

Resumen: La producción de cigarrillos involucra un número de sustancias y materiales diferentes al tabaco en sí, papel y filtro. Los aditivos del tabaco incluyen aromas artificiales, potenciadores del sabor, humectantes, azúcares, y compuestos de amonio. A pesar de que las compañías sostienen que los aditivos del tabaco no aumentan la toxicidad del humo y no hacen los cigarrillos más atractivos y adictivos, estas afirmaciones son cuestionadas por investigadores independientes. Este trabajo ha revisado los estudios sobre los efectos de los aditivos del tabaco en la química del humo y su toxicidad. Los aditivos del tabaco conllevan niveles más altos de formaldehído y otros cambios menores en los análisis realizados del humo. Estudios toxicológicos (tests de mutagenicidad en bacterias y citotoxicidad en mamíferos, ensayos de inhalación en ratas 90 días y células del micronúcleo de la médula ósea) mostraron que los aditivos del tabaco no aumentaron la toxicidad del humo. Los ensayos de roedores, sin embargo, no predijeron adecuadamente la carcinogenicidad del humo del tabaco, y no eran claramente suficientes para dar a conocer, sin embargo, las pequeñas, pero toxicológicamente relevantes, diferencias entre el test (con/aditivos del tabaco) y control (sin/aditivos del tabaco) en cigarrillos. Esta revisión de la literatura nos lleva a la conclusión de que el impacto dañino de los aditivos del tabaco en el humo continúa estando poco claro.

Abstract: Cigarette production involves a number of substances and materials other than just tobacco, paper and a filter. Tobacco additives include flavorings, enhancers, humectants, sugars, and ammonium compounds. Although companies maintain that tobacco additives do not enhance smoke toxicity and do not make cigarettes more attractive or addictive, these claims are questioned by independent researchers. This study reviewed the studies on the effects of tobacco additives on smoke chemistry and toxicity. Tobacco additives lead to higher levels of formaldehyde and minor changes in other smoke analytes. Toxicological studies (bacterial mutagenicity and mammalian cytoxicity tests, rat 90 days inhalation studies and bone-marrow cell micronucleus assays) found that tobacco additives did not enhance smoke toxicity. Rodent assays, however, poorly predicted carcinogenicity of tobacco smoke, and were clearly underpowered to disclose small albeit toxicologically relevant differences between test (with tobacco additives) and control (without tobacco additives) cigarettes. This literature review led to the conclusion that the impact of tobacco additives on tobacco smoke harmfulness remains unclear.

Situación epidemiológica de intoxicación por monóxido de carbono (CO) / Epidemiological situation of carbon monoxide intoxication (CO)

El monóxido de carbono es un gas tóxico, incoloro, inodoro e insípido que se produce durante la quema de combustible. Las intoxicaciones por monóxido de carbono (CO) constituyen causa de enfermedad y muerte. Además del evento agudo, los cuadros de intoxicación graves pueden dejar secuelas cognitivas. La exposición crónica también es importante dado que puede producir sintomatología neurológica y cognitiva. Se presentan diferentes análisis de la serie histórica que va desde 2005 a la Semana Epidemiológica 38 de 2016, de las intoxicaciones por Monóxido de Carbono asistidas en la Ciudad de Buenos Aires. Los datos para la construcción de indicadores del presente informe provienen del registro de casos individuales de intoxicación por CO, en el módulo C2 de Vigilancia Clínica del Sistema Nacional de Vigilancia de la Salud (SNVS)

The effects of smoking and smoking cessation on nasal mucociliary clearance, mucus properties and inflammation

OBJECTIVE: The aim of the present study was to assess nasal mucociliary clearance, mucus properties and inflammation in smokers and subjects enrolled in a Smoking Cessation Program (referred to as quitters). METHOD: A total of 33 subjects with a median (IQR) smoking history of 34 (20-58) pack years were examined for nasal mucociliary clearance using a saccharine transit test, mucus properties using contact angle and sneeze clearability tests, and quantification of inflammatory and epithelial cells, IL-6 and IL-8 concentrations in nasal lavage fluid. Twenty quitters (mean age: 51 years, 9 male) were assessed at baseline, 1 month, 3 months and 12 months after smoking cessation, and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and after 12 months. Clinicaltrials.gov: NCT02136550. RESULTS: Smokers and quitters showed similar demographic characteristics and morbidities. At baseline, all subjects showed impaired nasal mucociliary clearance (mean 17.6 min), although 63% and 85% of the quitters demonstrated significant nasal mucociliary clearance improvement at 1 month and 12 months, respectively. At 12 months, quitters also showed mucus sneeze clearability improvement (∼26%), an increased number of macrophages (2-fold) and no changes in mucus contact angle or cytokine concentrations. CONCLUSION: This study showed that smoking cessation induced early improvements in nasal mucociliary clearance independent of mucus properties and inflammation. Changes in mucus properties were observed after only 12 months of smoking cessation.

Predictors of smoking cessation in smokers with chronic periodontitis: a 24-month study

Abstract The purpose of this 24-month study was to identify predictors of smoking cessation in a cohort of smokers with chronic periodontitis, attending a multidisciplinary smoking cessation program. Of the 286 subjects screened, 116 were included and received non-surgical periodontal treatment and smoking cessation therapy, which consisted of lectures, cognitive behavioral therapy, and pharmacotherapy, according to their individual needs. During initial periodontal treatment, dentists actively motivated the study subjects to stop smoking, using motivational interviewing techniques. Further smoking cessation counseling and support were also provided by the dentists, during periodontal maintenance sessions at 3, 6, 12 and 24 months of follow-up. Smoking status was assessed by means of a structured questionnaire, and was validated by exhaled carbon monoxide (CO) measurements. The Fagerström Test for Cigarette Dependence was used to assess smoking dependence. Of the 61 individuals that remained up to the 24-month examination, 31, 21 and 18 declared that they were not smoking at 3, 12 and 24 months, respectively. Smoking cessation after 24 months was associated with the male gender (OR = 3.77, 95%CI = 1.16-12.30), baseline CO levels less than 10ppm (OR = 5.81, 95%CI 1.76-19.23), not living or working with another smoker (OR = 7.38, 95%CI 1.76-30.98) and a lower mean Fagerström test score (OR = 5.63, 95%CI 1.55-20.43). We concluded that smoking cessation was associated with demographic, smoking history and cigarette dependence variables.

Air pollutants and hospitalization due to pneumonia among children. An ecological time series study / Poluentes atmosféricos e internações por pneumonia em crianças. Estudo ecológico de série temporal

ABSTRACT CONTEXT AND OBJECTIVE: Exposure to air pollutants is one of the factors responsible for hospitalizations due to pneumonia among children. This has considerable financial cost, along with social cost. A study to identify the role of this exposure in relation to hospital admissions due to pneumonia among children up to 10 years of age was conducted. DESIGN AND SETTING: Ecological time series study using data from São José dos Campos, Brazil. METHODS: Daily data on hospitalizations due to pneumonia and on the pollutants CO, O3, PM10 and SO2, temperature and humidity in São José dos Campos, in 2012, were analyzed. A generalized additive model of Poisson's regression was used. Relative risks for hospitalizations due to pneumonia, according to lags of 0-5 days, were estimated. The population-attributable fraction, number of avoidable hospitalizations and cost savings from avoidable hospitalizations were calculated. RESULTS: There were 539 admissions. Exposure to CO and O3 was seen to be associated with hospitalizations, with risks of 1.10 and 1.15 on the third day after exposure to increased CO concentration of 200 ppb and ozone concentration of 20 µg/m3. Exposure to the pollutants of particulate matter and sulfur dioxide were not shown to be associated with hospitalizations. Decreases in CO and ozone concentrations could lead to 49 fewer hospitalizations and cost reductions of R$ 39,000.00. CONCLUSION: Exposure to certain air pollutants produces harmful effects on children's health, even in a medium-sized city. Public policies to reduce emissions of these pollutants need to be implemented.

RESUMO CONTEXTO E OBJETIVOS: A exposição a poluentes do ar é um dos fatores responsáveis pelas internações por pneumonias em crianças. Esse desfecho tem custo financeiro considerável, além do custo social. Estudo para identificar o papel dessa exposição nas internações em crianças com até 10 anos de idade foi desenvolvido. TIPO DE ESTUDO E LOCAL: Estudo ecológico de séries temporais com dados de São José dos Campos, Brasil. MÉTODOS: Dados diários de internações por pneumonia, dos poluentes CO, O3, PM10, SO2 além de temperatura e umidade de São José dos Campos, em 2012, foram analisados. Utilizou-se modelo aditivo generalizado da regressão de Poisson e foram estimados os riscos relativos para internações por pneumonia segundo defasagens de 0 a 5 dias. Foram calculadas a fração atribuível populacional, as internações evitáveis e a economia nos custos das internações evitáveis. RESULTADOS: Foram 539 internações. Exposição ao CO e O3 se mostraram associadas às internações, com riscos de 1,10 e 1,15 no terceiro dia após a exposição decorrentes de aumento nas concentrações do CO em 200 ppb e nas concentrações de ozônio em 20 µg/m3. Exposições aos poluentes material particulado e dióxido de enxofre não se mostraram associados às internações. Diminuição nas concentrações de CO e O3 poderiam reduzir em 49 internações e de R$ 39 mil nos custos. CONCLUSÃO: Mesmo em uma cidade de médio porte, exposição a determinados poluentes do ar causa efeito danoso à saúde da criança, sendo necessária a implantação de políticas públicas para redução da emissão desses poluentes.

Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth? / Comparação entre medidas objetivas do tabagismo e tabagismo autodeclarado em pacientes com asma ou DPOC: será que nossos pacientes dizem a verdade?

OBJECTIVE: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. METHODS: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. RESULTS: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. CONCLUSIONS: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management ...

OBJETIVO: O tabagismo autodeclarado é usado frequentemente para estimar a prevalência dessa condição. As taxas de tabagismo podem ser subestimadas por esse método. O objetivo deste estudo foi avaliar a diferença entre o tabagismo autodeclarado e o tabagismo determinado pelo uso de medidas objetivas em um ambulatório de doenças respiratórias. MÉTODOS: Estudo transversal realizado em 144 indivíduos: 51 pacientes com asma, 53 pacientes com DPOC, 20 fumantes e 20 não fumantes. O tabagismo foi determinado por meio de autorrelato em entrevistas e medição de monóxido de carbono no ar exalado (COex) e de cotinina urinária. RESULTADOS: Todos os pacientes com asma e DPOC declararam não ser fumantes. Nos pacientes com DPOC e asma, a mediana de concentração de cotinina urinária foi de 167 ng/ml (variação, 2-5.348) e de 47 ng/ml (variação, 5-2.735 ppm), respectivamente (p < 0,0001), enquanto . a mediana de COex foi de 8 ppm (variação, 0-31) e 5,0 ppm (variação, 2-45 ppm), respectivamente (p < 0,05). Em 40 (38%) dos pacientes com asma ou DPOC (n = 104), houve discordâncias entre o tabagismo autodeclarado e a concentração de cotinina urinária (> 200 ng/mL). Em 48 (46%) desses 104 pacientes, o não tabagismo autodeclarado foi refutado por um nível de COex > 6 ppm, considerado indicativo de fumo atual. Em 30 (29%) dos pacientes com asma ou DPOC, a concentração de cotinina urinária e o nível de COex contradisseram o autorrelato desses como não fumantes. CONCLUSÕES: Nossos achados sugerem que altas proporções de pacientes fumantes com doenças respiratórias declaram ser não fumantes. A classificação correta do tabagismo é fundamental no tratamento dessas doenças. Medidas objetivas do tabagismo podem ser úteis na melhora do manejo clínico e no aconselhamento. .

Combined pulmonary fibrosis and emphysema with pulmonary arterial hypertension: A Rare Case Report.

Combined pulmonary fi brosis and emphysema (CPFE) is a recently recognized radiologically defi ned syndrome characterized by simultaneous coexistence of both upper lobe emphysema and lower lobe pulmonary fi brosis. We present a case of CPFE in a 57-year-old male smoker who presented with dry cough, progressive breathlessness, and swelling of feet. His chest X-ray revealed bilateral lower Zone reticulonodular opacities with hyperlucent upper Zones. Pulmonary function tests showed wellpreserved lung volumes and reduced diff using capacity of the lung for carbon monoxide. High-resolution computed tomogram showed bilateral lower lobe subpleural honeycombing along with fi brosis and traction bronchiectasis with bilateral upper lobe emphysema predominantly paraseptal type. His 2D echo was suggestive of moderate pulmonary arterial hypertension.

Estandarización de la prueba de capacidad de difusión de monóxido de carbono: Chilean Society of Respiratory Diseases guidelines / Standardization of the single-breath diffusing capacity

Since its introduction in clinical practice carbon monoxide diffusing capacity (DLCO), has been widely used in respiratory diseases, being the most common test utilized after spirometry in pulmonary function laboratories. It represents the entire diffusion process including transport through the alveolar-capillary barrier and hemoglobin binding. Its high affinity with hemoglobin and its near zero partial pressure in plasma determines that CO transfer depends specifically on diffusion. Common respiratory and cardiac diseases such as emphysema, interstitial lung diseases, lung damage by drugs, arterial pulmonary hypertension and cardiac failure, among others show a reduced DLCO. Recent theories considering red blood cells as the main factor involved in resistance to diffusion, suggest that DLCO may reflect the status of lung microcirculation. For example, in cardiac failure, DLCO does not improve in parallel with lung volume, even with cardiac stabilization or cardiac transplantation. Despite its wide utilization, DLCO measurement presents standardization and reproducibility difficulties. International guidelines and task forces recommend using representative values of the target population. After analyzing the available information a group of experts from the Pulmonary Function Commission of the Chilean Society of Respiratory Diseases has proposed guidelines for measurement techniques, quality control, equipment calibration and interpretation of results.

Desde la introducción en la práctica clínica de la prueba de difusión con monóxido de carbono (CO) a mediados del siglo pasado, su utilización ha sido ampliamente difundida en la evaluación de diversas enfermedades respiratorias, de hecho se le considera la prueba más utilizada luego de la espirometría. Desde el punto de vista conceptual aporta información global de todo el proceso de difusión, que incluye el paso a través de la barrera alvéolo capilar y su unión con la hemoglobina. Gracias a la elevada afinidad del CO por la hemoglobina y a la particularidad de que la presión parcial de CO en el plasma es prácticamente cero, la transferencia del CO depende sólo de su difusión. Patologías respiratorias y cardíacas habituales como el enfisema pulmonar, las enfermedades pulmonares intersticiales, el compromiso pulmonar por drogas neumotóxicas, la hipertensión arterial pulmonar y la insuficiencia cardíaca congestiva, entre otras, cursan con disminución de la capacidad de difusión de CO (DLCO). Un nuevo desafío plantean las hipótesis recientes que postulan que la resistencia a la difusión del monóxido de carbono depende principalmente del glóbulo rojo, por lo que ésta podría consistir en una representación de la microcirculación. Como ejemplo, en la insuficiencia cardíaca congestiva, el deterioro de la DLCO no mejora en conjunto con los volúmenes pulmonares, ni cuando estos pacientes se estabilizan o se trasplantan. Si bien se trata de una técnica de laboratorio ampliamente utilizada, aún presenta problemas de estandarización y reproducibilidad. En este documento de consenso, un grupo de estudio de la Comisión de Función Pulmonar de la Sociedad Chilena de Enfermedades Respiratorias, ha efectuado una revisión de este método, con las correspondientes proposiciones de técnicas de medición, control de calidad, calibración e interpretación.

Estudo exploratorio da qualidade do ar em escolas de educacao basica, Coimbra, Portugal / Estudio exploratorio de la calidad del aire en escuelas de educacion basica, Coimbra, Portugal / Exploratory study of air quality in elementary schools, Coimbra, Portugal

OBJETIVO : Analisar a qualidade do ar em escolas de educação básica e suas condições estruturais e funcionais. MÉTODOS : Foi avaliada a qualidade do ar de 51 escolas (81 salas de aula) de educação básica da cidade de Coimbra, Portugal, tanto na parte interior das salas como na exterior, durante as quatro estações do ano, de 2010 a 2011. Foram avaliadas a temperatura (Tº), umidade relativa (Hr), concentrações de monóxido de carbono (CO), dióxido de carbono (CO 2 ), ozona (O 3 ), dióxido de nitrogênio (NO 2 ), dióxido de enxofre (SO 2 ), compostos orgânicos voláteis (COV), formaldeído e material particulado (PM 10 ), de novembro de 2010 a fevereiro de 2011 (outono/inverno) e de março de 2011 a junho de 2011 (primavera/verão). Procedeu-se ao preenchimento de uma grelha de caracterização das condições estruturais e funcionais das escolas. Aplicaram-se os testes estatísticos t- Student para amostras emparelhadas e o teste t de Wilcoxon. RESULTADOS : Em 47 escolas, as concentrações médias de CO 2 encontravam-se acima da concentração máxima de referência (984 ppm) mencionada na legislação portuguesa. Os valores máximos de concentração encontrados no interior das salas foram críticos, principalmente no outono/inverno (5.320 ppm). As concentrações médias de COV e de PM 10 no interior ultrapassaram a concentração máxima de referência legislada em algumas escolas. Não foram detetados valores relevantes (risco) de CO, formaldeído, NO 2 , SO 2 e O 3 . CONCLUSÕES : Houve maior concentração de poluentes no interior das salas, comparativamente com o exterior. A inadequada ventilação está associada à elevada concentração de CO 2 nas salas de aula. .

OBJETIVO : Analizar la calidad del aire en escuelas de educación básica y sus condiciones estructurales y funcionales. MÉTODOS : Se evaluó la calidad del aire de 51 escuelas (81 salas de aula) de educación básica de la ciudad de Coimbra, Portugal, tanto en el interior de las salas como en el exterior, durante las cuatro estaciones del año, de 2010 a 2011. Se evaluaron la temperatura (T°), humedad relativa (Hr), concentraciones de monóxido de carbono (CO), dióxido de carbono (CO2), ozono (O3), dióxido de nitrógeno (NO2), dióxido de azufre (SO2), compuestos orgánicos volátiles (COV), formaldehido (HCHO) y material particulado (PM10), de noviembre de 2010 a febrero de 2011 (otoño/invierno) y de marzo de 2011 a junio de 2011 (primavera/verano). Se procedió a llenar una tabla de caracterización de las condiciones estructurales y funcionales de las escuelas. Se aplicaron las pruebas estadísticas t-Student para muestras pareadas y la prueba t de Wilcoxon. RESULTADOS : En 47 escuelas, las concentraciones promedio de CO2 estaban por encima de la concentración máxima de referencia (984 ppm) mencionada en la legislación portuguesa. Los valores máximos de concentración encontrados en el interior de las salas fueron críticos, principalmente en el otoño/invierno (5.320 ppm). Las concentraciones promedio de COV y de PM10 en el interior sobrepasaron la concentración máxima de referencia legislada en algunas escuelas. No fueron detectados valores relevantes (riesgo) de CO, HCHO, NO2, SO2 y O3. CONCLUSIONES : Hubo mayor concentración de contaminantes en el interior de las salas, en comparación con el exterior. La inadecuada ventilación está asociada con la elevada concentración de CO2 en las salas de aula. .

OBJECTIVE : To analyze the air quality in elementary schools and their structural and functional conditions. METHODS : Air quality in 51 elementary schools (81 classrooms) in the city of Coimbra, Portugal, both inside and outside of the rooms was evaluated during the four seasons, from 2010 to 2011. Temperature (T°), relative humidity (Hr), concentrations of carbon monoxide (CO), carbon dioxide (CO2), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), compounds were evaluated, as were volatile organics (VOC), formaldehyde and particulate matter (PM10), from November 2010 to February 2011 (autumn/winter) and March 2011 to June 2011 (spring/summer). A grid characterizing the structural and functional conditions of the schools was created. The statistical Student t test for paired samples and the Wilcoxon t test were applied. RESULTS : In 47 schools, the average CO2concentrations were above the maximum reference concentration (984 ppm) mentioned in Portuguese legislation. The maximum concentration values found inside the rooms were critical, especially in the fall/winter (5,320 ppm). In some schools the average concentrations of VOC and PM10within the maximum concentration exceeded the reference legislated. The values (risk) of CO, formaldehyde, NO2, SO2and O3detected were not relevant. CONCLUSIONS : There was a higher concentration of pollutants inside the rooms compared with outside. Inadequate ventilation is associated with high CO2concentration in the classroom. .

pH in exhaled breath condensate and nasal lavage as a biomarker of air pollution-related inflammation in street traffic-controllers and office-workers

OBJECTIVE: To utilize low-cost and simple methods to assess airway and lung inflammation biomarkers related to air pollution. METHODS: A total of 87 male, non-smoking, healthy subjects working as street traffic-controllers or office-workers were examined to determine carbon monoxide in exhaled breath and to measure the pH in nasal lavage fluid and exhaled breath condensate. Air pollution exposure was measured by particulate matter concentration, and data were obtained from fixed monitoring stations (8-h work intervals per day, during the 5 consecutive days prior to the study). RESULTS: Exhaled carbon monoxide was two-fold greater in traffic-controllers than in office-workers. The mean pH values were 8.12 in exhaled breath condensate and 7.99 in nasal lavage fluid in office-workers; these values were lower in traffic-controllers (7.80 and 7.30, respectively). Both groups presented similar cytokines concentrations in both substrates, however, IL-1β and IL-8 were elevated in nasal lavage fluid compared with exhaled breath condensate. The particulate matter concentration was greater at the workplace of traffic-controllers compared with that of office-workers. CONCLUSION: The pH values of nasal lavage fluid and exhaled breath condensate are important, robust, easy to measure and reproducible biomarkers that can be used to monitor occupational exposure to air pollution. Additionally, traffic-controllers are at an increased risk of airway and lung inflammation during their occupational activities compared with office-workers. .

Effects of a Smoking Cessation Program including Telephone Counseling and Text Messaging using Stages of Change for Outpatients after a Myocardial Infarction

PURPOSE: This study was done to identify effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients who have had a myocardial infarction (MI). METHODS: This research was a quasi-experimental design with a nonequivalent control group pretest-posttest. The participants were 48 outpatients (experimental group=24, control group=24) recruited from one university hospital. They were randomly assigned to one of two groups: (a) an experimental group with telephone counseling (once a week) and text messaging (five times a week) using stages of change, and (b) a control group with traditional telephone counseling (once a month). Efficacy of the intervention was measured by comparing the two groups on smoking-related variables at 3 weeks and 12 weeks. RESULTS: At the 3-week and 12-week measurements, there were significant differences between the experimental and control groups on smoking cessation self-efficacy (p<.001), nicotine dependence (p<.001), CO levels (p<.001), and smoking cessation rates (p<.001). CONCLUSION: The results indicate that the smoking cessation program including telephone counseling and text messaging using stages of change is effective for outpatients after a MI. Further attention should be paid to the intensity of the smoking cessation program and periods for long-term follow-up.

Avaliação da concentração de monóxido de carbono em estudantes universitários da área da saúde / Evaluation of the carbon monoxide concentration in university students of health area

Objetivo - Avaliar o nível de monóxido de carbono exalado em estudantes universitários da área da saúde fumantes, não fumantes, fumantes passivos e ex-fumantes. Método - Participaram do estudo estudantes universitários da área da saúde, maiores de 18 anos, de ambos os sexos, fumantes, não fumantes, fumantes passivos e ex-fumantes. Foram excluídos do estudo estudantes em processo de cessação de tabagismo. Foram coletadas medidas de monóxido de carbono no ar exalado (COex) e nível de dependência de tabagismo através do teste de Fagerstrõm. Resultados - Foram estudados 100 universitários, sendo 65% não fumantes, 11% fumantes, 16% fumantes passivos e 8% ex-fumantes.Houve predomínio do sexo feminino para os estudantes não fumantes (55,48%) e para os fumantes passivos (68,75%). Os fumantes apresentaram grau de dependência do tabagismo de leve a moderada. A média de COex em não fumantes foi de 8,4±7,6 ppm, nos fumantes foi de 32,1±20,1 ppm, nos fumantes passivos de 14,6±8,3 ppm e nos ex-fumantes de 14,4±6,6 ppm. Os cursos que tiveram menos fumantes foram Fisioterapia (9,09%) e Enfermagem (9,09%) e o curso com mais fumante foi o de Medicina (36,36%). Conclusão - Há um percentual considerável de indivíduos fumantes entre os cursos da área da saúde e os níveis de monóxido de carbono no ar exalado destes estudantes fumantes, ex-fumantes, fumantes passivos e não fumantes foram altos.

Objective - To evaluate the level of exhaled carbon monoxide in university students in the health area smokers, nonsmokers, passive smokers and former smokers. Method - Participants were college students in the health area, over 18 years, of both sexes, smokers, nonsmokers, passive smokers and former smokers. The study excluded students in the process of smoking cessation. We collected measurements of carbon monoxide in exhaled air and level of dependence on smoking by the Fagerstrõm test. Results - There were 100 students, 65% nonsmokers,11% smokers, passive smokers 16% and 8% former smokers. There were more female students to nonsmokers (55.48%) and passive smokers (68.75%). Smokers had the degree of tobacco dependence treatment of mild to moderate. The mean expired CO in nonsmokers was 8.4 ±7.6 ppm, in smokers was 32.1 ± 20.1 ppm, in passive smokers, and 14.6 ± 8.3 ppm and in former smokers, 14.4 ± 6.6 ppm. The courses had fewer smokers were physiotherapy (9.09%) and nurses (9.09%) and the course was more smoking medicine (36.36%). Conclusion - There is a considerable percentage of smokers among the courses in the area of health and levels of carbon monoxide in exhaled air of student smokers, former smokers, passive smokers and nonsmokers were high.

Políticas de etiquetado en los paquetes de cigarrillos: situación actual en América Latina y el Caribe / Cigarette labeling policies: current situation in Latin America and the Caribbean

En 2002, Brasil se convirtió en el primer país de la región en implementar etiquetas de advertencias sanitarias con pictogramas en los paquetes de cigarrillos. Desde la adopción del CMCT de la OMS en 2005, otros nueve países adoptaron advertencias con pictogramas y seis más aprobaron legislación cuya implementación está pendiente. El contenido del mensaje y el estilo del pictograma varían entre los países. Diecisiete países prohibieron descriptores de marca y nueve requieren una advertencia cualitativa con información de constituyentes y emisiones. Un importante progreso se ha alcanzado en la región desde 2005. Sin embargo, los países ratificantes del CMCT aún no han implementado todas las recomendaciones de las Directrices del Artículo 11.

In 2002, Brazil became the first country in the region to implement pictorial health warning labels on cigarette packages. Since the adoption of the FCTC/WHO in 2005, nine more countries adopted pictorial labels and six passed legislation that is pending of implementation. The message content and the picture style vary across countries. Seventeen countries have banned brand descriptors and nine require a qualitative label with information on constituents and emissions. Since 2005, important progress has been achieved in the region. However, countries that have ratified the FCTC have not yet implemented all the recommendations of Article 11 Guidelines.

Sarcoidosis: Presentación clínica y pronóstico / Sarcoidosis: Clinical presentation and prognosis

Se analizaron las características clínicas de 26 pacientes con cuadro clínico compatible y diagnóstico histopatológico de sarcoidosis, y se identificaron variables asociadas a mortalidad en el seguimiento. Se examinaron datos clínicos y de diversos estudios complementarios. El seguimiento se realizó mediante consulta médica y encuesta telefónica. La edad media fue 42.6 ± 12.7 años. El 53.8% eran mujeres. El 88.4% presentó afección pulmonar y el 30.7% tuvo manifestaciones extratorácicas. Predominó el estadio radiológico II (34.7%). La alteración espirométrica más frecuente fue la capacidad de difusión de monóxido de carbono (DLCO) < 80% del predicho (56.5%). Se constató hipertensión pulmonar en el 34.7%. Recibieron tratamiento corticoideo el 69.2% de los pacientes. El seguimiento se realizó en el 96.1% de los casos durante 98 ± 73 meses (rango: 3 a 228). Se constató una mortalidad del 23% (n = 6). Los factores asociados en forma significativa a mayor mortalidad fueron: gasometría arterial con menor presión parcial de oxígeno (41.5 mm Hg vs. 73.3 mm Hg; p = 0.041); mayor presión parcial de dióxido de carbono (59.5 mm Hg vs. 39.6 mm Hg; p = 0.0008); presencia de hipertensión pulmonar (83.3% vs. 16.6%; p = 0.001) y mayor presión pulmonar wedge (12.5 mm Hg vs. 9.5 mm Hg; p = 0.041). Hubo una tendencia a mayor mortalidad en pacientes con estadio radiológico III/IV (66% vs. 27%; p = 0.082) y menor DLCO (33.5% vs. 51.4%; p = 0.087). Las características clínicas y evolutivas encontradas en nuestra serie difirieron en algunos aspectos con las publicadas en la literatura internacional. Los factores asociados a mortalidad estuvieron relacionados a la gravedad de la enfermedad.

We analyzed clinical characteristics of 26 patients with suggesting clinical picture and histopatological diagnosis of sarcoidosis. We identified mortality-related variables in the follow-up. We examined clinical data and several complementary tests. Follow-up was performed by clinical consultation and telephonic interview. The patients mean age was 42.6 ± 12.7 years old, and 53.8% were female. Pulmonary affection was present in 88.4% of patients and extrapulmonary manifestation were seen in 30.7%. Radiological stage II was the most frequent (34.7%). The predominant spirometric abnormality was a low carbon monoxide diffusing capacity (DLCO) in 56.5% of cases. Pulmonary hypertension was found in 34.7% of cases. Steroid therapy was performed in 69.2%. The follow-up was completed in 96.1% of patients with a mean of 98 ± 73 months (range 3 to 228). The mortality rate was 23% (n = 6). The factors significantly associated with mortality were: blood arterial gases with lower partial oxygen pressure (41.5 mm Hg vs. 73.3 mm Hg; p = 0.041); higher partial carbon dioxide pressure (59.5 mm Hg vs. 39.6 mm Hg; p = 0.0008); presence of pulmonary hypertension (83.3% vs. 16.6%; p = 0.001) and higher pulmonary capillary wedge pressure (12.5 mm Hg vs. 9.5 mm Hg; p = 0.041). There was a tendency to higher mortality in patients with radiological stage III/IV (66% vs. 27%; p = 0.082) and lower DLCO (33.5% vs. 51.4%; p = 0.087). Clinical characteristics and long-term prognosis in our serie differed from others publications in international literature. Mortality-related factors were associated with severity of disease.

Avaliação da concentração de monóxido de carbono no ar exalado em tabagistas com DPOC / Evaluation of the exhaled carbon monoxide levels in smokers with COPD

OBJETIVO: Medir os níveis de monóxido de carbono no ar exalado (COex) em tabagistas com e sem DPOC. MÉTODOS: Tabagistas frequentadores dos ambulatórios do Hospital São Lucas em Porto Alegre (RS) entre setembro de 2007 e março de 2009 foram convidados a participar do estudo. Os participantes responderam a um questionário com características demográficas e epidemiológicas e realizaram espirometria, medição de cotinina urinária e de COex. Os participantes foram agrupados conforme a presença de DPOC. RESULTADOS: Foram incluídos 294 tabagistas, 174 (59,18 por cento) diagnosticados com DPOC. Todos os participantes apresentavam níveis de cotinina urinária > 50 ng/mL. Os fumantes com DPOC apresentaram medianas significativamente superiores as do grupo sem DPOC para as variáveis idade e maços-ano (p < 0,001 e p = 0,026, respectivamente). Não houve diferença significativa nas demais variáveis. Quando ajustados para sexo, início do tabagismo, cigarros/dia e cotinina urinária, os valores médios de COex foram mais altos no grupo DPOC que no grupo sem DPOC, mas sem significância estatística (17,8 ± 0,6 ppm e 16,6 ± 0,7 ppm, respectivamente; p = 0,200). As diferenças permaneceram não significativas quando o método de base logarítmica foi usado. Uma ampla dispersão dos valores de COex foi encontrada quando os participantes foram classificados conforme os valores de VEF1 (r = -0,06; p = 0,53) ou o sistema de classificação de Global Initiative for Chronic Obstructive Lung Disease (r = 0,08; p = 0,34). As proporções de resultados falso-negativos para tabagismo foram de 18,4 por cento e 6,7 por cento, respectivamente, nos grupos com e sem DPOC (p = 0,007). CONCLUÕES: Esse estudo mostrou que os valores de COex não apresentaram diferenças significativas em fumantes com ou sem DPOC. Desse modo, parece não haver nenhuma restrição relevante para a sua aplicabilidade em fumantes com DPOC.

OBJECTIVE: To measure exhaled carbon monoxide (COex) levels in smokers with and without COPD. METHODS: Smokers treated at outpatient clinics of São Lucas Hospital in the city of Porto Alegre, Brazil, between September of 2007 and March of 2009 were invited to participate in this study. The participants completed a questionnaire regarding demographic and epidemiologic characteristics and were submitted to spirometry, as well as to determination of COex and urinary cotinine levels. The participants were divided into two groups: those with COPD and those without COPD. RESULTS: The study involved 294 smokers, of whom 174 (59.18 percent) had been diagnosed with COPD. All of the participants presented with urinary cotinine levels > 50 ng/mL. Smokers with COPD presented significantly higher median values for age and pack-years than did those without COPD (p < 0.001 and p = 0.026, respectively). No other statistically significant differences were found. When adjusted for gender, age at smoking onset, number of cigarettes/day and urinary cotinine level, the mean values of COex were higher, but not statistically so, in the COPD group than in the non-COPD group (17.8 ± 0.6 ppm and 16.6 ± 0.7 ppm, respectively; p = 0.200). The differences remained nonsignificant when plotted logarithmically. A wide dispersion of COex values was found when the participants were classified by FEV1 level (r = -0.06; p = 0.53) or by Global Initiative for Chronic Obstructive Lung Disease classification (r = 0.08; p = 0.34). The proportions of false-negative results for smoking were 18.4 percent and 6.7 percent, respectively, in the COPD and non-COPD groups (p = 0.007). CONCLUSIONS: Since COex values did not differ significantly between smokers with COPD and those without, there seem to be no major contraindications to their use in smokers with COPD.

Breath carbon monoxide concentration in Cigarette and Bidi smokers in India.

Objective. To measure and compare the breath carbon monoxide (CO) levels in cigarette and bidi smokers in India. Methods. Breath CO was measured in 389 smokers (241 cigarette smokers,148 bidi smokers) using portable breath CO analyser (Bedfont-England, Smokelyzer). Tobacco contents and length of single stick of different brands of cigarette and bidi were also measured. Results. Their mean age was 38.7±13.4 years. The average duration of smoking was 18.2±13.0 years. Average breath CO levels were 15.6±7.0 ppm in smokers and 4.07±1.16 ppm in non-smokers. Average breath CO level was significantly higher in bidi smokers (18.9±7.7 ppm) compared to cigarette smokers (13.6±5.8 ppm) when total consumption of cigarette/bidi was more than five pack-years (p=0.002). Average tobacco weight of bidi (216.8mg) was significantly less than cigarette (696mg). Conclusions. Bidi is equally or more harmful than cigarette smoking. One bidi may be considered to one cigarette for calculating “pack-years” of smoking.