Exercise capacity in idiopathic pulmonary fibrosis: the effect of pulmonary hypertension.

BACKGROUND AND OBJECTIVE: Increased pulmonary arterial pressure (PAP) usually coexists with impaired lung function in IPF. Data on the effect of pulmonary hypertension (PH) on cardiopulmonary responses during exercise in IPF patients is very limited. We sought to investigate the impact of PH on exercise capacity and the correlation between systolic PAP (sPAP) and pulmonary function testing, as well as cardiopulmonary exercise parameters, in patients with IPF and PH. METHODS: Eighty-one consecutive patients with IPF, who were evaluated over a 6-year period, were retrospectively studied. Patients underwent pulmonary function testing, Doppler echocardiography and maximal cardiopulmonary exercise testing. PH was defined as sPAP > 35 mm Hg. RESULTS: PH was diagnosed in 57% of the patients. Categorization of patients according to severity of PH indicated a significant reduction in maximum work rate, peak O(2) uptake, anaerobic threshold and peak O(2) pulse in those with sPAP > 50 mm Hg. In IPF patients with PH, estimated sPAP correlated with peak O(2) uptake, anaerobic threshold, peak O(2) pulse and end-tidal CO(2) at anaerobic threshold, while the strongest correlation was between sPAP and ventilatory equivalent for CO(2) at anaerobic threshold (r = 0.611, P < 0.001). There were no differences in pulmonary function or exercise parameters indicative of lung volume reduction, across the patient categories, and none of these parameters correlated with sPAP. CONCLUSIONS: PH has a negative impact on exercise capacity in IPF patients. In IPF patients with PH, resting sPAP correlated with exercise parameters indicative of gas exchange and circulatory impairment, but not with defective lung mechanics.

Smoking cessation in clinical practice: predictors of six-month continuous abstinence in a sample of Greek smokers.

AIM: To identify the predictors of six-month continuous abstinence among Greek smokers treated in a Smoking Cessation Clinic, emphasising the role of sleep disturbance on the outcome. METHODS: A nested case-control design was used. Patients who attended the Smoking Cessation Clinic between November 2004 and October 2005, and who completed six months of follow-up, constituted the final study population (N=285). The patients were separated into two groups - those who managed to quit smoking and those who didn't. The cessation method included pharmacotherapy, one-to- one behavioral counselling, and follow-up by telephone communication. RESULTS: Among various baseline characteristics examined, multivariate regression analysis indicated that the time to first cigarette after awakening, and use of bupropion, independently predicted abstinence, while awakening during the night was negatively associated with abstinence. CONCLUSION: These multivariate factors, which can positively or negatively affect the outcome, should be taken into account so that smoking cessation treatment can be individualised.