Intervención para cesación tabáquica en pacientes con enfermedad pulmonar obstructiva crónica en 6 Centros de Salud / Intervention for smoking cessation in patients with chronic obstructive pulmonary disease in 6 municipal health care centers in Santiago de Chile

Entre un 30 y un 70% de los pacientes con EPOC determinado por tabaquismo continúan fumando a pesar del consejo médico. En estos casos la única medida que puede impedir el deterioro de la función pulmonar y alargar la vida es detener el consumo de tabaco. En este artículo se comunican los resultados de un Proyecto Piloto realizado durante 2012 por los profesionales del programa EPOC de 6 consultorios de Atención Primaria de Salud (APS). Se identificaron los pacientes fumadores y se ofreció consejería intensiva y medicamentos a los que fumaban >=10 cigarrillos día. Ingresaron a estudio pacientes con diagnóstico clínico y/o espirométrico de EPOC y se excluyeron aquellos con condiciones médicas o psicológicas inestables y/o consumo actual de alcohol. En 3 centros se usó vareniclina 2 mg/día y en 3 bupropión 300 mg/día más chicle de nicotina de 4 mg. Duración del tratamiento: 3 meses. Ingresaron a terapia 50 pacientes. Edad promedio 58,8, rango 37- 80, sexo femenino 60%. Los pacientes mostraron alto grado de adicción, 47,7% fumaban >=20 cpd y 64% lo hacían antes de 30 min luego de despertar. El promedio de sesiones de terapia fueron de 8,9. Los efectos secundarios de los fármacos se presentaron leves en 17 pacientes (34%) e intensos en 3 (6%), determinando la suspensión del tratamiento. El coste de fármacos por paciente tratado fue de US$ 138. Dejaron de fumar a los 6 meses 19 pacientes (38%). Conclusiones. El paciente con EPOC se caracteriza por alto grado de adicción. El tratamiento intensivo con terapia psicosocial y medicamento realizado en consultorio por los mismos profesionales que los controlan puede obtener resultados aceptables (AU)

Between 30-70% of patients with COPD caused by tobacco consume remain smoking despite medical advice. In these cases the only measure that can prevent deterioration of pulmonary function and to prolong life is to stop tobacco use. Here are the results of a pilot project done in 2012 by professionals of the COPD control program of six Primary Health Care Centers (PHCC). The strategy was to identify patients, who smoke, provide intensive treatment though counseling and medications. The patients that entered the study, were previously diagnosed COPD clinically and/or by spirometry and were excluded those with unstable medical or psychological conditions and/or current use of alcohol. Six counseling sessions were planned. Drugs were administered to those who smoked >= 10 cigarettes daily. At three PHCCs Varenicline 2 mg was used daily. At three other PHCCs Bupropion 300mg plus Nicotine Gum 4 mg were used daily. The duration of treatment was 3 months. 50 patients average 58.8 years of age range 37-80, 60% being female. Patients showed high degree of addiction 47.7% smoked >= 20 cpd and 64% did so within 30 min after awakening. Average therapy sessions were 8.9 and side effects were 34%, severe in 6%. 3 patients discontinued treatment due to intolerance. 19 patients quit smoking after 6 months (38%). Conclusions. COPD patients are characterized by high degree of addiction. Intensive treatment with medication and psychosocial therapy performed in PCCs by the same professionals whom perform routine check-ups can achieve acceptable results (AU)

Tratamiento de tabaquismo en funcionarios de la salud en 11 centros de Atención Primaria / Treatment of smoking habit in public health officials in 11 Primary Care Centers

Es importante implementar tratamiento de tabaquismo en la Atención Primaria de la Salud (APS). Por esta razón, en el año 2010 iniciamos en 11 consultorios de Servicios de Salud Metropolitano Suroriente (SSMSO) y Viña-Quillota (SSVQ), en Chile, un programa de tratamiento antitabáquico dirigido a funcionarios en esta etapa. La intervención estuvo basada en profesionales de programas de enfermedades respiratorias, capacitados mediante un curso internet-presencial de 106 h. Se encuestaron a los integrantes del centro de salud, se analizó tabaquismo mediante talleres, especialmente las contradicciones entre fumar y trabajar en la salud y se les ofreció tratamiento psicosocial y farmacológico. Un total de 796 funcionarios fueron encuestados. Varones, 229 (28,8%). Fumadores, 332 (41,7%). Fumadores diarios, 223 (28,0). Alto grado de adicción, 25 (7,5%). Ingresaron a tratamiento 81 funcionarios, reciben fármacos 76. El número de sesiones de terapia fue 6,6, promedio. Los fármacos se emplearon en 3 esquemas: bupropión 150 mg c/12, chicle de nicotina (2 mg) según demanda y vareniclina 1 mg c/12. Cada centro utilizó un solo tipo de esquema (al azar) por 3 meses. Efectos secundarios de fármacos fueron leves 5,6% y no determinaron suspensión de tratamiento. A los 6 meses, 29 funcionarios (34,1%) se mantenían sin fumar. La cesación fue comprobada por cooximetría e información de testigos. El costo del tratamiento promedio por persona fue US$92. Conclusión. Es posible realizar tratamiento de tabaquismo a los funcionarios de la salud, basado en profesionales de los centros APS con costo y rendimiento aceptable. El proyecto fue financiado por Laboratorios GlaxoSmithkline, PfizerChile, Johnson y Johnson y los Servicios de Salud (AU)

It is important to implement smoking cessation treatment in Primary Health Care (PHC). Thus, in the year 2010, we initiated a smoking cessation treatment program aimed at health care staff workers in this stage in 11 South-Eastern Metropolitan Health Services (SSMSO) and Viña-Quillota Health Services (SSVQ) out-patient clinics, in Chile. The intervention was based on professionals of respiratory disease programs, trained by a 106 hour internet and on-site course. The members of the health care site were interviewed. Smoking habit was analyzed by workshops, especially the contradictions between smoking and working in health care and psychosocial and pharmacological treatment was offered. A total of 796 health care workers were surveyed: Males-229 (28.8%). Smokers-332 (41.7%). Daily smokers-223 (28.0). High grade of addiction-25 (7.5%). A total of 81 staff workers received treatment, 76 receiving drugs. There was an average of 6.6 therapy sessions. The drugs were used in 3 regimens: bupropion 150 mg c/12, nicotine gum (2 mg) on demand and varenicline 1 mg c/12. Each center used only one regimen (at random) for 3 months. Secondary effects of the drugs were mild, 5.6%, and did not lead to treatment cessation. At 6 months, 29 staff workers (34.1%) continued without smoking. The cessation was verified by co-oximetry and witness information. Average treatment cost per person was $92 (USA). Conclusions. Treatment for smoking cessation in health care workers is possible, based on the staff workers of the PHC sites and with acceptable cost and performance. The project was funded by GlaxoSmithkline, PfizerChile, Johnson and Johnson Laboratories and the Health Care Services (AU)

Aging-induced alterations in female rat colon smooth muscle: the protective effects of hormonal therapy

Aging is associated to oxidative damage and alterations in inflammatory and apoptotic pathways. Aging impairs secretion of several hormones, including melatonin and estrogens. However, the mechanisms involved in aging of smooth muscle are poorly known. We have studied the changes induced by aging in the colonic smooth muscle layer of female rats and the protective effect of hormonal therapy. We used young, aged, and ovariectomized aged female rats. Two groups of ovariectomized rats (22 months old) were treated either with melatonin or with estrogen for 10 weeks before sacrifice. Aging induced oxidative imbalance, evidenced by H2O2 accumulation, lipid peroxidation, and decreased catalase activity. The oxidative damage was enhanced by ovariectomy. In addition, aged colonic muscle showed enhanced expression of the pro-inflammatory enzyme cyclooxygenase 2. Expression of the activated forms of caspases 3 and 9 was also enhanced in aged colon. Melatonin and estrogen treatment prevented the oxidative damage and the activation of caspases. In conclusion, aging of colonic smooth muscle induces oxidative imbalance and activation of apoptotic and pro-inflammatory pathways. Hormonal therapy has beneficial effects on the oxidative and apoptotic changes associated to aging in this model (AU)