Prevalence of bronchial obstruction in a tobacco smoke exposed population - the PNEUMOBIL project.

The use of spirometry is not yet widespread enough in chronic respiratory or at -risk patients whose diagnosis is incomplete. There is scarce knowledge and inadequate management of the burden of these diseases, particularly chronic obstructive pulmonary disease (COPD). Pneumobil, an initiative aimed at raising awareness among smokers and ex -smokers, was reactivated 10 years after its launch in Portugal. It found a large prevalence of bronchial obstruction as measured by spirometry (30% and 25% in men and women respectively) in a sample of 5324 smoke -exposed individuals, 50% current smokers, screened at state or business (private company group) health institutions. This risk is neither mainly attributable to occupational exposure nor mainly related to respiratory symptoms, which were very common in our population. Only dyspnoea (OR=1.28; p=0.02) and frequent episodes of sputum production (OR=1.21; p=0.008) or acute bronchitis (OR=1.31; p=0.05) were somewhat related to bronchial obstruction. Prior knowledge of COPD is rare and bronchial obstruction is not correlated (p=0.204) to a possible diagnosis of COPD.

[Lung function tests: the pneumologist and ambulatory care]. / O estudo funcional respiratório: o pneumologista e o ambulatório.

Lung function testing (LFT) has been standardized and greatly improved in the last three decades, but its relative complexity has driven to recent sistematization and standardization of its applicability in the office and in primary care. In memorian of Prof António Couto, and of his outstanding role in the promotion of LFT in Potyugal, this conference deals with the definition of office spirometry, its application range, and the essential steps for the performance, in acceptable quality and reproducibility conditioms. The role of the specialist in promoting this method, and his support to possible spirometry performers, is aimed as an important request in the success of the practical and used technique in family practice and primary health care.

Airway flow limitation in patients with vibroacoustic disease.

INTRODUCTION: Vibroacoustic disease (VAD) is a pathology caused by occupational exposure to large pressure amplitude and low frequency (LPALF) noise (> or =90 dB SPL, < or =500 Hz), and has been the object of study by this group for the past 20 yr. In a group of 140 VAD-diagnosed patients, 7 non-smoker aircraft technicians developed clinical signs of respiratory insufficiency at an early age. Previously, multi-focal fibrosis had been observed in the lung of Wistar rats exposed to occupationally simulated LPALF noise and with no possibility of contamination by fumes, dust or other chemical agents. The goal of this study is to compare pulmonary imaging and/or functional changes in two age- and exposure-time matched groups of VAD-diagnosed aircraft technicians, with and without airflow limitation symptoms. METHODS: In a population of 140 individuals occupationally exposed to LPALF noise and diagnosed with VAD, we excluded the smokers (45 cases) and selected 7 individuals with complaints of airway flow limitations, average age 42.3 yr (SD = 2.3). From the remaining non-smokers without respiratory complaints, we selected a group of 15, age-matched patients (average age 36 yr, SD = 6.5). All subjects received a high-resolution CT scan of the chest and respiratory function tests consisting of body plethysmography, spirometry and metacholine airway provocation. RESULTS: There is a significant relationship between the presence of symptoms and imaging of lung fibrosis through high-resolution CT scan (p = 0.03624). There are no significant differences when both groups are compared with respect to the percentage of predicted values of lung function: Vital Capacity (VC), Total Lung Capacity, Forced Expiratory Volume during the first second of expiration, Maximal Expiratory Flow at 50% VC, Total Airway Resistance, and Airway Reactivity after 25 mg of metacholine. CONCLUSION: High resolution CT scan is a valuable tool for diagnosis of lung fibrosis in VAD patients who have symptoms of airway flow limitations. The fact that lung ventilation tests did not present significant changes between both groups is in agreement with findings in Wistar rats. This strongly suggests that a process of focal pulmonary fibrosis may be induced by occupational noise exposure, and is a feature of VAD.