Revista de Patologia Respiratoria最新文献

Background

To quit smoking is the most effective and most cost-efficient way to reduce risk of causing chronic obstructive pulmonary disease (COPD). Furthermore, to quit smoking is the only treatment that has been demonstrated to stop the development of the disease as it prevents the progressive deterioration of pulmonary function. Our study has aimed to evaluate the efficacy and safety of the pharmacological treatment associated with psychological counseling to quit smoking in patients with COPD and to determine which drug obtains the best results.

Methods

An analytic, longitudinal and prospective study was conducted. A total of 378 smokers with COPD who came seeking help to quit smoking were included. A clinical history of smoking habit was obtained in every case. In all, 7 visits were conducted (Baseline, 2nd and 4th weeks; 2nd, 3rd and 6th month, and finally at week 52). There were also telephone calls in between. All subjects received psychological support, drug therapy and were given written self-help material. Pharmacological interventions included treatment with Varenicline (VNC), Bupropion (BP) and nicotine patches (TSN), with a duration of 8 to 12 weeks. Verbal statement of abstinence was confirmed by expired air (<10 ppm) CO (carbon monoxide) physiological validation.

Results

Mean age was 56.7 (±9.3) years, and 67.6% were males. Mean age of onset of smoking was 15.5 (±4.7) years. Mean cigarettes consumed per day were 27.9 (±12.5). Analysis of physical dependence on nicotine using the Fagerström test showed a mean of 7.2 (±2.8) and motivation by the Richmond test a mean of 8.6 (±1.4). The first cigarette was lit up in less than 30 minutes by 90% of the participants. Abstinence rates with different drugs were the following at the 12th week (VNC 51%; BP 46%; TSN 41%), at week 24 of follow-up (VNC 47%; BP 38%; TSN 34%) and at the end of the study at week 52 (VNC 36%; BP 29%; TSN 27%). The three drugs used in our study were well-tolerated and safe. TSN was the drug causing the least and mildest adverse effects. Nausea and headache were the most frequent in subjects using Varenicline. Insomnia and mouth dryness were the most frequent among Bupropion users. In most of the cases, the adverse effects were mild. Withdrawal of the medications was only necessary in 6% of the participants.

Conclusions

Participants had elevated daily cigarette consumption and severe dependence. The 1st cigarette was lit up in less than half an hour. They had high motivation and 71% had made more than one attempt to quit smoking. First line pharmacological therapy has been demonstrated to be effective, safe and well tolerated in this subgroup of patients. Higher rates of abstinence were obtained with Varenicline compared to Bupropion and nicotine patches.

Objective

Roflumilast is a selective phosphodiesterase type 4 inhibitor that represents a novel pharmacological class approved for the treatment of chronic obstructive pulmonary disease (COPD). Data about its use in clinical practice is still very scarce. We sought to determine the profile of patients that are receiving roflumilast for the treatment of COPD and the specialists’ perceptions of the impact of roflumilast on patients’ health.

Material and methods

A cross-sectional web-based survey was conducted among Spanish pulmonary specialists assessing their perceptions and opinion in the use of roflumilast.

Results

Sixty-one out of the 106 invited specialists started the survey and 50 had enough experience with roflumilast to be finally selected. Most physicians use roflumilast for the treatment of severe COPD associated with chronic bronchitis in patients with a history of frequent exacerbations. This treatment is usually added to bronchodilator treatments but frequently replaces the use of theopylline. Most physicians perceived an improvement of symptoms, mainly in expectoration, coughing and dyspnea. After an average of two months of treatment, an improvement in patients’ quality of life in many ways was also reported. Diarrhoea and loss of weight were the side effects most frequently perceived. The ability to decrease exacerbations and the anti-inflammatory effect were considered the main strengths of roflumilast.

Conclusions

Roflumilast is included in the clinical practice of most pulmonary medicine specialists for the treatment of COPD. It is used in accordance with established recommendations. Most physicians perceive a positive impact of roflumilast on patients’ quality of life and symptoms.

Objective

The smoking habit increases the C reactive protein in the serum. Values are studied in different populations: healthy (exsmokers, smokers and nonsmokers), chronic bronchitis and chronic obstructive pulmonary disease (COPD) in different stages; in addition the influence according to the time of abandonment of the tobacco and the associate comorbidities.

Material and methods

Descriptive-transversal analysis. 401 persons we studied: 106 healthy not smokers (HNS), 104 healthy smokers (HS), 95 healthy nonsmoker (HN), 30 with chronic bronchitis, 30 with incipient COPD (COPDi) and 36 with advanced COPD (COPDa), with ages included between 45 and 80 years old, being detrmined CRP and the associate comorbidities.

Results

CRP's values were: 1.98 (2.1) mg/l in HN; 3.35 (4.39) mg/l in HS; 2 (2.2) mg/l in HE; 3 (3.8) mg/l in chronic bronchitis; 3.40 (2.23) in COPDi and 5.94 (1.76) in COPDa. The CRP in chronic bronchitis and COPD falls to 2.7 (6.8) after five years of abandonment of the tobacco, remaining constant after. There exist significant differences between the HS and HN populations, and between chronic bronchitis and COPD after five years of abstinence with the population HN (p=0.003). There are not significant differences between HE and HN (p > 0.05); between population HS and the population with chronic bronchitis and COPDi (p > 0.05), and between COPD's different stages and the indexes of comorbiditie.

Conclusions

The value of the CRP in the HS population is similar to that on the chronic bronchitis and COPDi population, but higher to that of the HN. After the abandon of the smoking habit, in HS the CRP returns to the value of the HN population. In the populations with pathologies is significantly elevated as compared to HN and not return to the HN level after five years of abstinence. Their level is independent of comorbidity index. The detection level of inflammatory disease is at a value of PCR: 3 mg/l.

Endobronchial ultrasound is highly accurate procedure for the examination and staging of lung carcinoma. Its usefulness in other diseases like granulomatous and linfoproliferative illness is less clear. We show our initial experience in the diagnosis of these type of diseases and a short review of the recent articles published.