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Aaron SD, Montes de Oca M, Celli B, Bhatt SP, Bourbeau J, Criner GJ, DeMeo DL, Halpin DMG, Han MK, Hurst JR, Krishnan JK, Mannino D, van Boven JFM, Vogelmeier CF, Wedzicha JA, Yawn BP, Martinez FJ. Early Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease: The Costs and Benefits of Case Finding. Am J Respir Crit Care Med 2024; 209:928-937. [PMID: 38358788 DOI: 10.1164/rccm.202311-2120pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/14/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Shawn D Aaron
- The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Montes de Oca
- Universidad Central de Venezuela, Caracas, Venezuela
- Hospital Centro Médico de Caracas, Caracas, Venezuela
| | | | - Surya P Bhatt
- Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David M G Halpin
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - MeiLan K Han
- Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan
| | - John R Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Jamuna K Krishnan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
| | - David Mannino
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Claus F Vogelmeier
- Philipps-Universität Marburg, German Center for Lung Research, Marburg, Germany
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Barbara P Yawn
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; and
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Spicuzza L, Morjaria JB, Polosa R. Clinical relevance of endothelial function, oxidative stress and inflammation after smoking cessation. Eur J Clin Invest 2024; 54:e14126. [PMID: 37942567 DOI: 10.1111/eci.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Respiratory Unit, University Hospital "Policlinico-San Marco", University of Catania, Catania, Italy
| | - Jaymin B Morjaria
- Department of Respiratory Medicine, Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, Harefield, UK
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Hospital "Policlinico-S.Marco", University of Catania, Harefield, Italy
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Perisse A, Dao MC, Butty D, Derkenne C, Charton F, Fabre N, Grosset-Janin A, Lutringer M, Chanet A, Diop E, Attia C, Coudert A, Courson A, Maillot G, Augen AS, Bagary P, Sahuguet E, Remond O, Paleiron N, Bylicki O. Long-Term Consequences of Spirometry During Military Routine Medical Examinations on Smoking Cessation Compared to Minimal Advice. Mil Med 2023:usad473. [PMID: 38109715 DOI: 10.1093/milmed/usad473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/21/2023] [Accepted: 12/02/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Smoking kills 8 million people a year worldwide. It is the most prevalent cause of death in France by cancer, cardiovascular, or respiratory diseases. Minimal advice consists in asking patients who smoke if they are interested in quitting. It is effective in reducing smoking. The French High Health Authority recommends its systematic use with patients, whatever their reason for seeking treatment. The beneficial effect of spirometry on smoking cessation is controversial. The objective of our study was to measure the consequences of spirometry associated with minimal advice, compared with only minimal advice in soldiers seen during a routine medical examination. METHODS Our prospective, longitudinal, open, multicenter, controlled, randomized study was conducted among French military smokers presenting for an occupational medicine visit. Each participant received, depending on their group (intervention or control), either minimal advice associated with an evaluation of lung function by mini-spirometer, or only minimal advice. Follow-up visits were performed at 6 and 12 months. The primary objective was self-reported tobacco use cessation at 6 months. RESULTS A total of 267 participants (126 in the intervention group and 141 for the control arm) were included in 10 centers between June 2019 and June 2020. The response rate was 75.6% at 6 months. The cessation rates were 17% and 18% in the intervention and control groups, respectively, with no significant difference between the two groups (P = 0.9). The cessation rate in the general population was 13% at 6 months. CONCLUSIONS Spirometry does not seem to influence smoke cessation on a military population at 6 months. The overall cessation rate in our study was well in excess of the 3-6% expected from only providing minimal which is underused in general practice and should be encouraged.
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Affiliation(s)
- Anne Perisse
- 9th Military Medical Center, Service de Santé des Armées, Toulon Cedex 9 83800, France
| | - Marie-Cécile Dao
- 13th Military Medical Center, Service de Santé des Armées, Rochefort Air 17133, France
| | - Damien Butty
- 3rd Military Medical Center, Service de Santé des Armées, Lille Cedex 59001, France
| | | | - France Charton
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Nathalie Fabre
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Anais Grosset-Janin
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Manon Lutringer
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Aurore Chanet
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Elie Diop
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Claire Attia
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Anne Coudert
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Audrey Courson
- 9th Military Medical Center, Service de Santé des Armées, Toulon Cedex 9 83800, France
| | - Gaelle Maillot
- 9th Military Medical Center, Service de Santé des Armées, Toulon Cedex 9 83800, France
| | - Anne-Sophie Augen
- 9th Military Medical Center, Service de Santé des Armées, Toulon Cedex 9 83800, France
| | - Pierre Bagary
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Emilie Sahuguet
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Odile Remond
- 1st Military medical center, Service de Santé des Armées, PARIS Cedex 12 75614, France
| | - Nicolas Paleiron
- Department of Pneumology, Military hospital Sainte-Anne, Toulon 83800, France
| | - Olivier Bylicki
- Department of Pneumology, Military hospital Sainte-Anne, Toulon 83800, France
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Martín-Luján F, Santigosa-Ayala A, Pallejà-Millán M, Rey-Reñones C, Villalobos F, Solà R. Effectiveness of the spirometry-based motivational intervention to quit smoking: RESET randomised trial. Eur J Gen Pract 2023; 29:2276764. [PMID: 37933978 PMCID: PMC10631381 DOI: 10.1080/13814788.2023.2276764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND The effectiveness of providing feedback on spirometry results for smoking cessation remains inconclusive according to the current evidence. OBJECTIVES To assess the effectiveness of a motivational intervention based on spirometry results in achieving prolonged smoking abstinence (12 months post-intervention). DESIGN AND SETTING A randomised, controlled, observer-blinded, multicentre clinical trial was conducted (from January 2012 to December 2015) in 20 primary healthcare centres in the Tarragona province, Spain. METHODS Participants, active smokers aged 35-70 without known respiratory disease, were recruited from primary healthcare centres by family doctors and nurses. They were randomly assigned to either the intervention group (IG = 308) or the control group (CG = 306). Both groups received brief smoking cessation counselling. Additionally, the IG underwent spirometry and received detailed information about the results, including lung age. The primary outcome was prolonged abstinence, defined as lasting at least 12 months and validated through cotinine measurement in urine. RESULTS The prolonged abstinence rate was 7.8% in the IG, compared to 2.6% in the CG (p = 0.004). At 12 months, in the multivariate analysis, the intervention was identified as an independent factor for smoking cessation (OR 2.8; 95%CI 1.2 to 7.7), a trend maintained throughout the follow-up (HR 2.74; 95%CI 1.13 to 6.62). Moreover, according to the Prochaska and DiClemente model, the preparation or action phase to quit was also associated with smoking cessation (HR 2.55, 95%CI 1.07 to 6.09). CONCLUSION A primary care-delivered intervention involving brief counselling and detailed spirometry information proves effective in increasing abstinence rates among active smokers without known respiratory disease. Additionally, smoking cessation is also influenced by the individual's stage of change. TRIAL REGISTRATION ClinicatTrials.gov NCT02153047.
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Affiliation(s)
- Francisco Martín-Luján
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Antoni Santigosa-Ayala
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Meritxell Pallejà-Millán
- Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Cristina Rey-Reñones
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
- Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Felipe Villalobos
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Reus, Spain
| | - Rosa Solà
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - the researchers of the RESET study
- CONTACT Antoni Santigosa-Ayala Primary Healthcare Research Support Unit Camp de Tarragona. C/Cami de Riudoms, 53-55, Reus-43203, Tarragona, Spain
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Montes de Oca M, Laucho-Contreras ME. Smoking cessation and vaccination. Eur Respir Rev 2023; 32:32/167/220187. [PMID: 36948500 PMCID: PMC10032588 DOI: 10.1183/16000617.0187-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/08/2022] [Indexed: 03/24/2023] Open
Abstract
A significant proportion of COPD patients (∼40%) continue smoking despite knowing that they have the disease. Smokers with COPD exhibit higher levels of nicotine dependence, and have lower self-efficacy and self-esteem, which affects their ability to quit smoking. Treatment should be adapted to the needs of individual patients with different levels of tobacco dependence. The combination of counselling plus pharmacotherapy is the most effective cessation treatment for COPD. In patients with severe COPD, varenicline and bupropion have been shown to have the highest abstinence rates compared with nicotine replacement therapy. There is a lack of evidence to support that smoking cessation reduction or harm reduction strategies have benefits in COPD patients. The long-term efficacy and safety of electronic cigarettes for smoking cessation need to be evaluated in high-risk populations; therefore, it is not possible to recommend their use for smoking cessation in COPD. Future studies with the new generation of nicotine vaccines are necessary to determine their effectiveness in smokers in general and in COPD patients.
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Affiliation(s)
- Maria Montes de Oca
- School of Medicine, Universidad Central de Venezuela and Hospital Centro Médico de Caracas, Caracas, Venezuela
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Siegel SD, Tindle HA, Bergen AW, Tyndale RF, Schnoll R. The Use of Biomarkers to Guide Precision Treatment for Tobacco Use. ADDICTION NEUROSCIENCE 2023; 6. [PMID: 37089247 PMCID: PMC10121195 DOI: 10.1016/j.addicn.2023.100076] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This review summarizes the evidence to date on the development of biomarkers for personalizing the pharmacological treatment of combustible tobacco use. First, the latest evidence on FDA-approved medications is considered, demonstrating that, while these medications offer real benefits, they do not contribute to smoking cessation in approximately two-thirds of cases. Second, the case for using biomarkers to guide tobacco treatment is made based on the potential to increase medication effectiveness and uptake and reduce side effects. Next, the FDA framework of biomarker development is presented along with the state of science on biomarkers for tobacco treatment, including a review of the nicotine metabolite ratio, electroencephalographic event-related potentials, and other biomarkers utilized for risk feedback. We conclude with a discussion of the challenges and opportunities for the translation of biomarkers to guide tobacco treatment and propose priorities for future research.
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Rodriguez-Alvarez MDM, Roca-Antonio J, Martínez-González S, Vilà-Palau V, Chacón C, Ortega-Roca A, Borrell-Thiò E, Erazo S, Almirall-Pujol J, Torán-Monserrat P. Spirometry and Smoking Cessation in Primary Care: The ESPIROTAB STUDY, A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14557. [PMID: 36361437 PMCID: PMC9658367 DOI: 10.3390/ijerph192114557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED This study aims to evaluate the effect of regularly reporting spirometry results during smoking cessation counseling from a primary care physician on the quit rate in adult smokers. METHODS A randomized, two-arm intervention study was conducted at six primary care centers. A total of 350 smokers, ≥18 years of age, who consulted their primary care physician, participated in the study. At the selection visit, smokers who gave their consent to participate underwent spirometry. Subsequently, an appointment (visit 0) was scheduled to complete a nicotine dependence test, a smoking cessation motivation questionnaire, and a sociodemographic questionnaire. Participants were also offered brief, structured advice on how to quit smoking, as well as detailed information on spirometry results. Patients were then randomized and scheduled for follow-up visits at 3, 6, 12, and 24 months. Both arms received brief, structured advice and detailed information on spirometry results at visit 0. At consecutive follow-up visits, the control group only received brief, structured smoking cessation advice, while the intervention group also received information on initial spirometry results at visits 3 and 6, and a spirometry retest at visit 12. Exhaled carbon monoxide testing was used to check smoking cessation. RESULTS The study included 350 smokers; 179 were assigned to the control group and 171 to the intervention group. Smoking cessation at one year was 24.0% in the intervention group compared to 16.2% in the control group. At two years, it was 25.2% in the intervention group and 18.4% in the control group. Overall, the adjusted odds of quitting smoking in the intervention group were 42% higher than in the control group (p = 0.018). CONCLUSIONS Regular and detailed feedback of spirometry results with smokers increases smoking cessation. Specifically, the likelihood of quitting smoking in the intervention group is 1.42 times higher than in the control group (p = 0.018).
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Affiliation(s)
- María del Mar Rodriguez-Alvarez
- Canet de Mar Primary Care Centre, Catalan Institute of Health (ICS), 08360 Canet de Mar, Spain
- Unitat de Suport a la Recerca Girona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), 17002 Girona, Spain
- Department of Medicine, Faculty of Medicine, University of Girona, 17004 Girona, Spain
| | - Josep Roca-Antonio
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), 08303 Mataro, Spain
| | | | - Victoria Vilà-Palau
- Santa Coloma De Farners Primary Care Center, Catalan Institute of Health (ICS), 17007 Girona, Spain
| | - Carla Chacón
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), 08303 Mataro, Spain
| | - Alexandre Ortega-Roca
- Mataro 6 (Gatassa) Primary Care Center, Catalan Institute of Health (ICS), 08302 Mataro, Spain
| | - Eulàlia Borrell-Thiò
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), 08303 Mataro, Spain
- Sant Roc Primary Care Center, Catalan Institute of Health (ICS), 08916 Badalona, Spain
| | - Susana Erazo
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), 08303 Mataro, Spain
- Cardedeu Primary Care Center, Catalan Institute of Health (ICS), 08440 Cardedeu, Spain
| | | | - Pere Torán-Monserrat
- Department of Medicine, Faculty of Medicine, University of Girona, 17004 Girona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), 08303 Mataro, Spain
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- Multidisciplinary Research Group in Health and Society, GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
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Sajid A, Radhi AA, Al-Hashimi AH. Pulmonary Function Tests of Workers at the State Company of Petrochemicals Factory in Basrah City, South of Iraq. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Workers who are exposed to chemical and physical elements at work on a regular or continuous basis are more likely to acquire various occupational diseases, particularly respiratory problems.
AIM: This observational study was carried out to determine the impact of exposure to specific industrial pollutants, such as petroleum products, on the pulmonary function tests of workers at a facility in Iraq’s south.
METHODS: The study involved two groups of people: Exposed workers (G1) and non-exposed workers (G2) (G2). Asthmatics, healthy smokers, and healthy nonsmokers were split into three subgroups. All individuals had their pulmonary function tests (PFTs) performed using a medical spirometer.
RESULTS: There were substantial decreases (p0.05) in PFTs of exposed workers, as well as a significant rise in estimated lung age. The effects of exposure were most noticeable in asthmatics and healthy smokers, while healthy nonsmokers were unaffected. In addition, the exposed group had a considerably higher percentage of obstructive and mixed respiratory illnesses.
CONCLUSION: Workplace exposure to some industrial compounds, such as petrochemical products, may impair PFTs, with the impairment being more pronounced in the presence of other risk factors such as smoking or asthma. Asthmatics and smokers should be cautioned against working in industrial settings for more than five years. In general, all workers should be aware of the risks of working at such a location for more than 5 years, and all workers should adhere to occupational safety regulations.
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Spirometry as a motivator for smoking cessation among patients attending the smoking cessation clinic of Monastir. BMC Public Health 2022; 22:1164. [PMID: 35689178 PMCID: PMC9185973 DOI: 10.1186/s12889-022-13583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The choice of spirometry, a biomarker of lung health, as a motivator for smoking cessation is based on its fidelity in emphasizing tobacco adverse effects. Yet, there is a paucity of evidence on its efficacy, and the findings are currently inconclusive. The aim of this study was to determine whether a spirometry and lung age communication has an effect on smoking cessation rates. METHODOLOGY We conducted a randomized controlled trial among patients who attended the smoking cessation clinic (SCC) at Fattouma Bourguiba University Hospital in Monastir, from June 2017 to February 2020. Participants were assigned into two groups, a control arm receiving standard program and intervention arm receiving a spirometry and lung age announcement along with usual care. The primary outcomes were the smoking cessation rates after one year of follow-up between the intervention arm and the control arm. RESULTS At one-year endpoint, a total of 456 were reachable for assessment, 236 in control group and 220 in spirometry group, which leads to a loss rate equal to 8.8%. One-year smoking cessation rate was higher among the intervention group than among control group (25.5% versus 16.5%), with a considerable statistical significance (p = 0.019). Lung age was significantly higher at paired comparison with chronological age. CONCLUSION Smoking cessation is still a challenging procedure with a high risk of relapse, making very valuable any approach that may increase motivation in both unmotivated and motivated smokers. This study is an additional evidence for spirometry and lung age announcement as motivators for smoking cessation. TRIAL REGISTRATION Pan African Clinical Trial Registry database ( PACTR202110595729653 ), 06/10/ 2021.
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Yee N, Markovic D, Buhr RG, Fortis S, Arjomandi M, Couper D, Anderson WH, Paine R, Woodruff PG, Han MK, Martinez FJ, Barr RG, Wells JM, Ortega VE, Hoffman EA, Kim V, Drummond MB, Bowler RP, Curtis JL, Cooper CB, Tashkin DP, Barjaktarevic IZ. Significance of FEV 3/FEV 6 in recognition of early airway disease in smokers at risk of development of COPD: Analysis of the SPIROMICS cohort. Chest 2021; 161:949-959. [PMID: 34767825 DOI: 10.1016/j.chest.2021.10.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Small airways are known to be affected early in the course of chronic obstructive pulmonary disease (COPD); however, traditional spirometric indices may not accurately identify small airways disease. RESEARCH QUESTION Can FEV3/FEV6 identify early airflow abnormalities and predict future clinically important respiratory-related outcomes, including development of COPD? STUDY DESIGN AND METHODS We included eight hundred thirty-two current and former smokers with post-bronchodilator FEV1/FVC ≥0.7 from the SPIROMICS cohort. Participants were classified as having a reduced pre-bronchodilator FEV3/FEV6 based on lower limit of normal (LLN) values. Repeatability analysis was performed for FEV3 and FEV6. Regression modeling was used to evaluate the relationship between baseline FEV3/FEV6 and outcome measures including functional small airways disease on thoracic imaging and respiratory exacerbations. Interval censored analysis was used to assess progression to COPD. RESULTS FEV3/FEV6 <LLN at baseline, defined as reduced compared to FEV3/FEV6 ≥LLN, was associated with lower FEV1, poorer health status (St. George's Respiratory Questionnaire score), more emphysema, and more functional small airways disease on quantitative imaging. FEV3 and FEV6 showed excellent agreement between repeat measurements. A reduced FEV3/FEV6 was associated with increased odds of a severe respiratory exacerbation within the first year of follow-up and decreased time to first exacerbation. A low FEV3/FEV6 was also associated with development of COPD by spirometry (post-bronchodilator FEV1/FVC <0.7) during study follow-up. INTERPRETATION FEV3/FEV6 is a routinely available and repeatable spirometric index which can be useful in the evaluation of early airflow obstruction in current and former smokers without COPD. A reduced FEV3/FEV6 can identify those at risk for future development of COPD and respiratory exacerbations.
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Affiliation(s)
- Nathan Yee
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Daniela Markovic
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Russell G Buhr
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA
| | - Spyridon Fortis
- Center for Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, IA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | | | - David Couper
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wayne H Anderson
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert Paine
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT; Department of Veterans Affairs Medical Center, Salt Lake City, UT
| | | | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - James M Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Victor E Ortega
- Section on Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eric A Hoffman
- Department of Radiology, Division of Physiologic Imaging, University of Iowa, Carver College of Medicine, Iowa City, IA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - M Bradley Drummond
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Russell P Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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11
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Valentino AS, Eddy E, Woods Z, Wilken L. Pharmacist Provided Spirometry Services: A Scoping Review. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:93-111. [PMID: 34485107 PMCID: PMC8409516 DOI: 10.2147/iprp.s248705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Despite international guidelines' recommendations, spirometry is underutilized in the diagnosis and management of asthma and COPD. Spirometry may be an opportunity for trained pharmacists to meet the needs of patients with suspected or diagnosed lung conditions. The aim of this scoping review is to describe the literature including pharmacist provided spirometry services, specifically to identify: 1) the models of pharmacist provided spirometry services, and additional services commonly offered alongside spirometry, 2) pharmacist training and capability to obtain quality results, and (3) pharmacist, physician, and patient perspectives. Methods In September 2020, a comprehensive literature search in PubMed and EMBASE was conducted to identify all relevant literature on the topic of pharmacist provided spirometry services using the search term: "pharmacist or pharmacy" and "spirometry or pulmonary function test or lung function test." Literature was screened using inclusion/exclusion criteria and selected articles were charted and analyzed using the themes above. Results A total of 27 records were included. The scoping review found that pharmacist provided spirometry has been conducted around the world in community pharmacies and clinic settings. Community pharmacists may increase access to spirometry screening; the lack of communication with primary care providers and remuneration are barriers that need to be overcome to optimize the utility of the service. Clinic-based services are interprofessional and collaborative, allowing a patient to receive the test, results, diagnosis, and medication changes in one visit. Following comprehensive training, pharmacists felt confident in their ability to perform spirometry and met quality standards at acceptable rates. Conclusion Spirometry is an opportunity for pharmacists to improve evidence-based practice for screening and diagnosing lung conditions along with providing comprehensive services to complement testing. Data around provider and patient perspectives is limited and should be further investigated to determine if providers and patients would value and collaborate with pharmacists providing spirometry services.
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Affiliation(s)
- Alexa Sevin Valentino
- Pharmacy Practice and Science, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Emily Eddy
- Pharmacy Practice, Ohio Northern University, Ada, OH, USA
| | - Zachary Woods
- Pharmacy Education and Innovation, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Lori Wilken
- Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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12
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Martin-Lujan F, Basora-Gallisa J, Villalobos F, Martin-Vergara N, Aparicio-Llopis E, Pascual-Palacios I, Santigosa-Ayala A, Catalin RE, Rey-Reñones C, Solà R. Effectiveness of a motivational intervention based on spirometry results to achieve smoking cessation in primary healthcare patients: randomised, parallel, controlled multicentre study. J Epidemiol Community Health 2021; 75:1001-1009. [PMID: 33883199 PMCID: PMC8458052 DOI: 10.1136/jech-2020-216219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/10/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
Objective This 12-month study in a primary healthcare network aimed to assess the effectiveness of usual smoking cessation advice compared with personalised information about the spirometry results. Design Randomised, parallel, controlled, multicentre clinical trial. Setting This study involved 12 primary healthcare centres (Tarragona, Spain). Participants Active smokers aged 35–70 years, without known respiratory disease. Each participant received brief smoking cessation advice along with a spirometry assessment. Participants with normal results were randomised to the intervention group (IG), including detailed spirometry information at baseline and 6-month follow-up or control group (CG), which was simply informed that their spirometry values were within normal parameters. Main outcome Prolonged abstinence (12 months) validated by expired-CO testing. Results Spirometry was normal in 571 patients in 571 patients (45.9% male), 286 allocated to IG and 285 to CG. Baseline characteristics were comparable between the groups. Mean age was 49.8 (SD ±7.78) years and mean cumulative smoking exposure was 29.2 (±18.7) pack-years. Prolonged abstinence was 5.6% (16/286) in the IG, compared with 2.1% (6/285) in the CG (p=0.03); the cumulative abstinence curve was favourable in the IG (HR 1.98; 95% CI 1.29 to 3.04). Conclusions In active smokers without known respiratory disease, brief advice plus detailed spirometry information doubled prolonged abstinence rates, compared with brief advice alone, in 12-month follow-up, suggesting a more effective intervention to achieve smoking cessation in primary healthcare. Trial registration number NCT01194596.
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Affiliation(s)
- Francisco Martin-Lujan
- Direcció d'Atenció Primària, Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain .,Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain.,School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Josep Basora-Gallisa
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain.,School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Felipe Villalobos
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain
| | - Nuria Martin-Vergara
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain
| | | | | | - Antoni Santigosa-Ayala
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain.,School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain.,Institut Català de la Salut, Sant Salvador Primary Health-Care Centre, Tarragona, Spain
| | - Roxana-Elena Catalin
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain.,Institut Català de la Salut, Bonavista-La Canonja Primary Health-Care Centre, Tarragona, Spain
| | - Cristina Rey-Reñones
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain.,School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Rosa Solà
- Hospital Universitari Sant Joan de Reus, Reus, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.,Functional Nutrition, Oxidation and Cardiovascular Disease (NFOC-SALUT) group, Universitat Rovira i Virgili, Reus, Spain
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