Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study.

OBJECTIVES: To investigate the association of early snus use initiation (≤15 years of age) with asthma and asthma symptoms. DESIGN: Cross-sectional analysis of a population-based cohort. SETTING: Study centres in Norway, Sweden, Iceland, Denmark and Estonia, from 2016 to 2019. PARTICIPANTS: 9002 male and female participants above 15 years of age of the Respiratory Health in Northern Europe, Spain and Australia study. MAIN OUTCOME MEASURES: Current asthma and asthma symptoms. RESULTS: The median age of study participants was 28 years (range 15-53) and 58% were women. 20% had used snus, 29% men and 14% women. Overall, 26% of males and 14% of females using snus started ≤15 years of age. Early snus use initiation was associated with having three or more asthma symptoms (OR 2.70; 95% CI 1.46 to 5.00) and a higher asthma symptom score (ß-coefficient (ß) 0.35; 95% CI 0.07 to 0.63) in women. These associations were weak in men (OR 1.23; 95% CI 0.78 to 1.94; ß 0.16; 95% CI -0.06 to 0.38, respectively). There was evidence for an association of early snus initiation with current asthma (OR 1.72; 95% CI 0.88 to 3.37 in women; OR 1.31; 95% CI 0.84 to 2.06 in men). A sensitivity analysis among participants without smoking history showed stronger estimates for all three outcomes, in both men and women, statistically significant for three or more asthma symptoms in women (OR 3.28; 95% CI 1.18 to 9.10). Finally, no consistent associations with asthma outcomes were found for starting snus after age 15 years. CONCLUSIONS: Snus initiation in puberty was associated with higher likelihood of asthma and asthma symptoms, with the highest estimates in females and those without smoking history. These results raise concerns about the health adversities of early snus initiation and emphasise the need for public health initiatives to protect young people from this tobacco product.

Validación pronóstica según los criterios de la GesEPOC 2017 / Prognostic Validation Using GesEPOC 2017 Severity Criteria

Introducción: La Guía española de la EPOC (GesEPOC) ha sido recientemente modificada. El objetivo de este trabajo es valorar la clasificación y el pronóstico de los enfermos según la nueva clasificación de la gravedad. Métodos: Se siguió a 700 enfermos con EPOC (83,9% varones) durante un periodo medio de 5 años en hospitales españoles y de EE. UU. Se midieron datos antropométricos, función pulmonar, disnea medida con la escala mMRC, así como exacerbaciones y los índices de BODE y Charlson. Se clasificaron según el riesgo proporcionado por GesEPOC y se valoró el pronóstico a 5 años. Resultados: Los pacientes tenían una edad media de 66 ± 9,6 años y un FEV1% de 59,7 ± 20,2. El 40,43% de la muestra se encontraba en bajo riesgo. Los sujetos del grupo de alto riesgo presentaban un índice de BODE significativamente mayor que los de bajo riesgo (2,92 ± 0,66 vs. 0,52 ± 1,91, p < 0,001). El índice de Charlson fue similar entre ambos grupos. La mortalidad a 60 meses en el grupo de alto riesgo fue significativamente mayor que en el de bajo riesgo (31,7% vs. 15.5%, p < 0,001). Tanto la disnea como el FEV1% fueron también predictores independientes de mortalidad (p < 0,001), siendo cada uno de ellos no inferior prediciendo mortalidad que el conjunto de los criterios del grupo de alto riesgo de GesEPOC. Conclusiones: La nueva clasificación de la gravedad de GesEPOC predice la mortalidad de forma adecuada. No obstante, tanto el FEV1% como la disnea tienen la misma potencia para predecir mortalidad

Introduction: The Spanish COPD guidelines (GesEPOC) have been recently modified. The aim of this study is to assess this revision and evaluate the prognosis of patients according to the new classification of severity. Methods: A total of 700 COPD patients (83.9% men) were prospectively followed up for a mean period of 5 years in tertiary hospitals in Spain and the USA. Anthropometric data, lung function tests, dyspnea (according to the mMRC scale), BODE and Charlson index were collected. We calculated mortality at 5 years following the risk criteria proposed by the new GesEPOC. Results: Mean age was 66 ± 9.6 years and mean FEV1% was 59.7 ± 20.2. The proportion of patients in the low-risk group was 40.43%. Patients in the high-risk group had a significantly higher BODE index than those in the low-risk group (2.92 ± 0,66 vs. 0.52 ± 1.91, p < 0.001), while the Charlson index score was similar in both groups. Mortality at 60 months was significantly higher in the high-risk group (31.7% vs. 15.5%, p < 0.001). Dyspnea and FEV1% were also independent predictors of mortality (p < 0.001), and neither was inferior to the risk classification proposed by GesEPOC. Conclusions: The new severity index proposed by GesEPOC accurately predicts 5-year mortality. However, dyspnea and FEV1% have the same strength in predicting mortality

Prognostic Validation Using GesEPOC 2017 Severity Criteria. / Validación pronóstica según los criterios de la GesEPOC 2017.

INTRODUCTION: The Spanish COPD guidelines (GesEPOC) have been recently modified. The aim of this study is to assess this revision and evaluate the prognosis of patients according to the new classification of severity. METHODS: A total of 700 COPD patients (83.9% men) were prospectively followed up for a mean period of 5 years in tertiary hospitals in Spain and the USA. Anthropometric data, lung function tests, dyspnea (according to the mMRC scale), BODE and Charlson index were collected. We calculated mortality at 5 years following the risk criteria proposed by the new GesEPOC. RESULTS: Mean age was 66±9.6 years and mean FEV1% was 59.7±20.2. The proportion of patients in the low-risk group was 40.43%. Patients in the high-risk group had a significantly higher BODE index than those in the low-risk group (2.92±0,66 vs. 0.52±1.91, p<0.001), while the Charlson index score was similar in both groups. Mortality at 60 months was significantly higher in the high-risk group (31.7% vs. 15.5%, p<0.001). Dyspnea and FEV1% were also independent predictors of mortality (p<0.001), and neither was inferior to the risk classification proposed by GesEPOC. CONCLUSIONS: The new severity index proposed by GesEPOC accurately predicts 5-year mortality. However, dyspnea and FEV1% have the same strength in predicting mortality.