ABSTRACT
To inform the clinical practice guidelines' recommendations developed by the European Academy of Allergy and Clinical Immunology systematic reviews (SR) assessed using GRADE on the impact of environmental tobacco smoke (ETS) and active smoking on the risk of new-onset asthma/recurrent wheezing (RW)/low lung function (LF), and on asthma-related outcomes. Only longitudinal studies were included, almost all on combustion cigarettes, only one assessing e-cigarettes and LF. According to the first SR (67 studies), prenatal ETS increases the risk of RW (moderate certainty evidence) and may increase the risk of new-onset asthma and of low LF (low certainty evidence). Postnatal ETS increases the risk of new-onset asthma and of RW (moderate certainty evidence) and may impact LF (low certainty evidence). Combined in utero and postnatal ETS may increase the risk of new-onset asthma (low certainty evidence) and increases the risk of RW (moderate certainty evidence). According to the second SR (24 studies), ETS increases the risk of severe asthma exacerbations and impairs asthma control and LF (moderate certainty evidence). According to the third SR (25 studies), active smoking increases the risk of severe asthma exacerbations and of suboptimal asthma control (moderate certainty evidence) and may impact asthma-related quality-of-life and LF (low certainty evidence).
ABSTRACT
INTRODUCTION: Our aim was to ascertain how the anti-smoking legislation of 2005/2010 has affected the behavior of primary healthcare center (PHC) personnel (medical and nonmedical) with respect to their attitudes towards tobacco, its consumption and the legislative changes. METHODS: We conducted a multi-center descriptive study of a randomized conglomerate sample of PHC personnel from each Autonomous Community in Spain. The questionnaire covered tobacco consumption, and knowledge/attitudes towards smoking and legislation. The statistical analysis used SPSS software. RESULTS: The sample consisted of 2040 PHC employees (1578 women, 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5% of the sample, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the antismoking legislation, a decrease in consumption was observed. Most of the participants considered that tobacco consumption affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. CONCLUSIONS: Spanish primary healthcare professionals have a relatively low prevalence of smoking compared to the general population. It is necessary to implement more legislative measures to improve and maintain this outcome.
ABSTRACT
Introducción: Importantes estudios como el EPISCAN ha puesto de manifiesto en España, el retraso diagnóstico de la EPOC y una elevada tasa de infradiagnóstico, encontrando que el 73% de los pacientes estaba sin diagnosticar y en la mayoría de los que se diagnosticaban ya se encontraban en estadios III y IV. Este retraso en el diagnóstico provoca una elevada morbilidad, así como un elevado coste asistencial. Por todo esto es necesario un diagnóstico precoz. Objetivos: Identificar pacientes de EPOC no diagnosticados, mediante un servicio de cribado de EPOC ofrecido por farmacias comunitarias. Material y métodos: Población de estudio: mayores de 40 años de ambos sexos, fumadores, exfumadores, y fumadores pasivos, que presentan signos o síntomas crónicos, y que en el cuestionario COPD-PS obtengan una puntuación ≥4. A los pacientes se les realizó la prueba de espiración forzada mediante el dispositivo portátil Vitalograph COPD-6. Si presentaba valores del cociente FEV1/FEV6 <0,75 se derivaba el paciente a su médico de familia para que se le realizase la espirometría convencional de confirmación. Resultados: Se encuestaron un total de 198 pacientes, 154 de ellos presentaban COPD-PS ≥4,38 (24,7%) de ellos presentaron resultados del cociente FEV1/FEV6 <0,75. La prevalencia de posible EPOC en este estudio se ha estimado en un 19,2% de los pacientes encuestados. Conclusiones: El significativo porcentaje de pacientes a los se les ha detectado una posible EPOC, nos demuestra la utilidad de implantar servicios de cribado y detección precoz de EPOC en las farmacias comunitarias (AU)
Introduction: Important studies, as EPISCAN, have revealed in Spain a delay in diagnosis of COPD and a high rate of underdiagnosis, finding that 73% of patients were undiagnosed and most of those who were already diagnosed were in III and IV stages of COPD. This delay in diagnosis causes high morbidity and high health care costs. For all that, early diagnosis is necessary. Objectives: To identify undiagnosed COPD patients, using a COPD screening service offered by community pharmacies. Material and methods: Study Population: current, former and passive smokers, aged 40 or older who have signs or chronic symptoms were recruited. Those who obtained a score ≥ 4 in COPD-PS questionnaire underwent a forced expiratory test by using Vitalograph COPD-6 portable device. If the FEV1 / FEV6 value was <0.75, the patient was referred to the general practitioner (GP) in order to confirm COPD diagnosis with conventional spirometry. Results: A total of 198 patients were recruited, 154 of them had a COPD-PS score ≥ 4, of whom 38 (24.67%) presented results of FEV1 /FEV6 <0.75. The prevalence of COPD in this study may have been estimated at 19.2% of patients enrolled. Discussion and conclusions: The significant proportion of patients detected with a possible diagnosis of COPD demonstrates the utility to implement services of screening and early detection of COPD in community pharmacies (AU)
Subject(s)
Adult , Aged, 80 and over , Aged , Female , Humans , Male , Middle Aged , Pharmacies/organization & administration , Pharmacy Service, Hospital/methods , Pharmacy Service, Hospital/organization & administration , Community Pharmacy Services/organization & administration , Community Pharmacy Services/standards , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Early Diagnosis , Spirometry/methods , Spirometry/trends , Pulmonary Disease, Chronic Obstructive/prevention & control , Surveys and Questionnaires , Mass Screening , Primary Health Care/organization & administration , Forced Expiratory Volume/immunologyABSTRACT
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