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Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life

Publicado a 21/07/2018, 01:14 por Jaime Correia de Sousa

The authors used six waves of the Tasmanian Longitudinal Health Study (TAHS) to model lung function trajectories measured at 7, 13, 18, 45, 50, and 53 years. Pre-bronchodilator FEV1 z-scores at the six time points using group-based trajectory modelling to identify distinct subgroups of individuals whose measurements followed a similar pattern over time were analysed. The trajectories identified were related to childhood factors and risk of chronic obstructive pulmonary disease (COPD) using logistic regression, and estimated population-attributable fractions of COPD.

Six potential FEV1 trajectories were identified, two of which were novel. Three trajectories contributed 75% of COPD burden and were associated with modifiable early-life exposures hose impact was aggravated by adult factors. The authors postulate that reducing maternal smoking, encouraging immunisation, and avoiding personal smoking, especially in those with smoking parents or low childhood lung function, might minimise COPD risk. Clinicians and patients with asthma should be made aware of the potential long-term implications of non-optimal asthma control for lung function trajectory throughout life, and the role and benefit of optimal asthma control on improving lung function should be investigated in future intervention trials.


Combined Analysis of Asthma Safety Trials of Long-Acting β2-Agonists

Publicado a 09/07/2018, 22:10 por Jaime Correia de Sousa

Safety concerns regarding long-acting β2-agonists (LABAs) in asthma management were initially identified in a large postmarketing trial in which the risk of death was increased. In 2010, the Food and Drug Administration (FDA) mandated that the four companies marketing LABAs for asthma perform prospective, randomized, controlled trials comparing the safety of combination therapy with a LABA plus an inhaled glucocorticoid with that of an inhaled glucocorticoid alone in adolescents (12 to 17 years of age) and adults. In conjunction with the FDA, the manufacturers harmonized their trial methods to allow an independent joint oversight committee to provide a final combined analysis of the four trials.

The authors performed a combined analysis of the four trials comparing an inhaled glucocorticoid plus a LABA (combination therapy) with an inhaled glucocorticoid alone. The primary outcome was a composite of asthma-related intubation or death. Post hoc secondary outcomes included serious asthma-related events and asthma exacerbations.

CONCLUSIONS

Combination therapy with a LABA plus an inhaled glucocorticoid did not result in a significantly higher risk of serious asthma-related events than treatment with an inhaled glucocorticoid alone but resulted in significantly fewer asthma exacerbations.

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Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies

Publicado a 17/06/2018, 02:55 por Jaime Correia de Sousa

There is growing evidence that electronic cigarettes in children and adolescents serve as a gateway to cigarette smoking. There can be no argument for harm reduction in children. To protect this vulnerable population from electronic cigarettes and other nicotine delivery devices, the Forum of International Respiratory Societies recommends that electronic cigarettes be regulated as tobacco products and included in smoke-free policies. Sale of electronic cigarettes should be barred to youths worldwide. Flavouring should be prohibited in electronic cigarettes, and advertising accessible by youths and young adults be banned. Finally, they recommend greater research on the health effects of electronic cigarettes and surveillance of use across different countries.

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Case-finding for COPD in primary care: a qualitative study of patients’ perspectives

Publicado a 21/05/2018, 06:47 por Jaime Correia de Sousa

COPD remains largely underdiagnosed. Case-finding is encouraged by many professionals, but there is a lack of information on the patients’ views and perspectives.

Semistructured interviews were conducted with adults, aged 40 years or older with a history of smoking, who were eligible and invited for case-finding for COPD as a part of a large UK primary care trial.

Patient engagement with case-finding may be limited by denial or lack of recognition of symptoms and physical barriers to attendance. Increasing public awareness of COPD risk factors and early symptoms may enhance case-finding.

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Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study.

Publicado a 30/03/2018, 22:33 por Jaime Correia de Sousa

Many smokers report using e-cigarettes to help them quit smoking, but whether e-cigarettes aid cessation efforts is uncertain. The objective of the study was to determine whether e-cigarette use after hospital discharge is associated with subsequent tobacco abstinence among smokers who plan to quit and are advised to use evidence-based treatment.

During 3 months after hospital discharge, more than a quarter of smokers attempting to quit used e-cigarettes, mostly to aid cessation, but few used them regularly. This pattern of use was associated with less tobacco abstinence at 6 months than among smokers who did not use e-cigarettes. Additional study is needed to determine whether regular use of e-cigarettes aids or hinders smoking cessation.

Reference: Rigotti NA, Chang Y, Tindle HA, Kalkhoran SM, Levy DE, Regan S, Kelley JHK, Davis EM, Singer DE. Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study. Ann. Intern. Med.2018 Mar 27 [Epub ahead of print]. doi: 10.7326/M17-2048. PMID: 29582077

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Agreement between hospital and primary care on diagnostic labeling for COPD and heart failure in Toronto, Canada: a cross-sectional observational study

Publicado a 10/03/2018, 02:57 por Jaime Correia de Sousa

The authors studied labeling agreement for COPD and HF for patients seen in both settings in Toronto, Canada.

Agreement levels for COPD and HF were low and labeling was incomplete. Further research is needed to improve labeling for these conditions.

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Fostering the exchange of real world data across different countries to answer primary care research questions: an UNLOCK study from the IPCRG

Publicado a 10/03/2018, 02:53 por Jaime Correia de Sousa

The study identified lessons for future studies and collaborations that require data sharing across borders. It also explored specific challenges to fostering the exchange of primary care data in comparison to other datasets such as public health, prescribing or hospital data and mechanisms that may be used to overcome these.

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Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity A Randomized Clinical Trial

Publicado a 18/02/2018, 00:17 por Jaime Correia de Sousa

The objective of the trial was to evaluate the effect of the SB-TEAM program on asthma morbidity among urban children with persistent asthma.

The intervention consisted of supervised administration of preventive asthma medication at school as well as 3 school-based telemedicine visits to ensure appropriate assessment, preventive medication prescription, and follow-up care.

The SB-TEAM intervention significantly improved symptoms and reduced health care utilization among urban children with persistent asthma. This program could serve as a model for sustainable asthma care among school-aged children.

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Sputum colour can identify patients with neutrophilic inflammation in asthma

Publicado a 13/02/2018, 08:42 por Jaime Correia de Sousa

Visual gradation of sputum colour in asthma relates to high total cell count and neutrophilic inflammation. Assessment of sputum colour can identify adults with asthma who are likely to have NB without the need for sputum processing and differential cell count, which may facilitate asthma management.

Programa Nacional para Prevenção e Controlo do Tabagismo 2017

Publicado a 14/01/2018, 10:50 por Jaime Correia de Sousa

Este documento faz um ponto de situação sobre a prevenção e o controlo do tabagismo em Portugal.

Apresenta um resumo das atividades feitas em 2016/2017, uma previsão do que está a ser feito em 2017/2018, e o que se prevê atingir até 2020.

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