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The importance of nutrition in smoking cessation in women

26 de março de 2013 Comentários desligados

 

blue-lung

The importance of nutrition in smoking cessation in women

                                                                  

                                                                                                                     Marcia M.T.LOBO1

                                                                                                                                                        MARCOS HS NASCIMENTO 2

  1. Masters Degree in Nutritional Safety at Federal University of Paraná – UFPR – Brazil
  2. Medical Editor of PULMAOSA Website

The strategy in stimulating smoking cessation in women should be priorized ahead of the growing exposure to tobacco promotional campaigns associated with the tobacco industry for this population group.

Smoking nowadays is the leading cause of preventable death in the world, and is considered a disease with its own ICD (International Classification of Diseases) to designate it: the F17.2. Smoking by itself, is capable of generating 50 other diseases, being the huge star among the non communicating diseases, as it is responsible by 30%  of all cancer deaths, including lung cancer that presents a clear link with smoking and is the current leader of deaths from this disease in both men and women in the United States and  also in Brazil (1).

Data obtained from the World Health Organization (WHO), attributed approximately 5.4 million deaths per year to tobacco, with Brazil accounting for 200,000 of these deaths (2,3).

Although the prevalence of smoking in Brazil have declined over the past years (17.5% of adults (over 15 years), 22% male and 13% female), however, in  the main cities  of the Southern region of the country presented high prevalence of smoking among women, with 17.5% in Porto Alegre (Rio Grande do Sul State); 15.5% in Curitiba (Paraná); and Florianópolis (Santa Catarina) 15.3%. This may indicate a need to prioritize health promotion and tobacco control focuses primarily on women (4.5).

The control and reduction of smoking prevalence are of fundamental importance since it can provide gains in both health and in financial resources (6). About this context, the Brazilian Thorax Society guidelines for smoking cessation (BTS) suggested that the presence of a dietitian in the multidisciplinary team is of great importance (7).

Regarding specifically to women and their body image, this fact represents a significant issue in this group’s behave, where the fear of weight gain is the great factor relationed with  women’s noncompliance about smoking cessation treatment, even when the health benefits are known,  and also combined with other factors such as stress relief and anxiety (8).

It is crucial that the frequent eating habits or acquired ones be rating after such treatment, as well as monitoring body weight, ir order to be establish behaviors that contribute for the  real success of smoking quit process. The weight gain factor is responsible by non-adherence for the treatment to quit tobacco derivatives and cigarettes, just because the large variation in weight gain and its mechanism constitute the major cause for the increased caloric intake and decreased resting metabolic rate (9).

There is evidence that nicotine causes an increase in energy expenditure. This is explained by the fact that consumption of a single cigarette induce about 3% increase in energy expenditure of the organism of in a period of 30 minutes. Concomitantly nicotine promotes an apetite decrease, caused by the rapid arrival of smoke nicotine in the brain (about 6 to 10 seconds). It allows some increase in the concentration of neurotransmitters, such as dopamine and serotonin, which are inhibitors intake food. It would explain the fact that smokers tend to have lower body weight when compared to nonsmokers, instituting a belief that smoking is an efficient way to control body weight (10,11).

Therefore obtain better results in tobacco control policies, aimed at women, duty would consider the influence of body weight control appropriate and compulsory through nutritional intervention assertive. The objectives of this strategy is to achieve higher success rates in smoking cessation, justifying the control of food intake, that more than an addendum to the treatment, it must be presented as a condition “si ne qua non” in the process of smoking cessation treatment for women.

REFERENCES

 

  1. NASCIMENTO, M.H.S. Doenças Crônicas: Pedágio caro para o Brasil, os USA e o Mundo. Available from: https://pulmaosarss.wordpress.com/2012/03/16/doencas-cronicas pedágio-caro-para-o-brasil-os-usa-e-o-mundo/.Acesso em 12/03/2012.

 

  1. World Health Organization (WHO). The World Health Report 2002: Reducing risks, promoting healthy lifestyles. Geneva: WHO, 2002.

 

  1. Instituto Nacional do Câncer (INCA). Tabagismo no Brasil:

Dados e Numéricos. Brasilia: Ministério da Saúde, INCA. Available from: http://www.inca.gov.br/tabagismo/index.as.Acesso em 20/03/2012.

 

  1. Instituto Brasileiro de Geografia e Estatística (IBGE).Global Adult Tobacco Survey(GATS):Brasil,2008.IBGE;2009.

 

  1. Ministério da Saúde. Secretaria de Vigilância em Saúde; Secretaria de Atenção à Saúde. Diretrizes e Recomendações para o Cuidado Integral de Doenças Crônicas Não-Transmissíveis: Promoção da Saúde, Vigilância, Prevenção e Assistência. Brasília,2008.

 

  1. PISINGER, C.; GODTFREDSEN,N.S. Is there a health benefit of reduced tobacco consumption? A systematic review. Nicotine To Res.9(6):631-46, 2007.

 

  1. REICHERT,J.et al ,Diretrizes para cessação do tabagismo, Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). J Bras Pneumol. 34(10):845-880, 2008.

 

  1. SCARINCI,I.C.et al.Sociocultural factors associated with cigarette smoking among women in Brazilian worksites:a qualitative study.Health Promotion international,v.22,n.2,p.146-154,2007.

 

  1. FILOZOF,C.;FERNANDEZ,P.M.C.;FERNANDEZ,C.A. Smoking cessation and weight gain. Obes Rev,5:95-103, 2004.

 

  1.  CHIOLERO,A., FAETH.D., PACAUD, F., CORNUZ, J. Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr ;87:801–9,2008.
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In terms of public health and tobacco prevention: Enough is just enough!

19 de março de 2012 Comentários desligados

Enough is enough

Marcos Nascimento, MD.

In addressing the tobacco control policies that promote smoking cessation, we can separate them into two groups:

a) Public Health Approaches: are increasing attempts to stop smoking:

  • Increased taxation;
  • Regulations to restrict smoking in public places and workplaces;
  • The Campaign of mass media.

b) Approach in Healthcare: increased rates of smoking cessation:

  • Help / Treatment Smokers.

Evidently tobacco addiction is a multidimensional phenomenon. Thus a proper treatment should include dimensions beyond pharmacological while also addressing the issues of psychological and behavioral addiction. Tell that to treat smokers just put drugs in the pharmacy is a popular reductionism overwhelming.

From the perspective of public health strategies we have to be more cost-effective. If a country have little money, it naturally must to select priorities within the priorities and see which option expense is the best. Of all the strategies listed the most cost-effective policies are smoke free environments.

The countries who are enrolling in a upward trend in the prevalence of tobacco related diseases like lung cancer, cardio vascular diseases and COPD, etc, can not afford to lose the way in terms of tobacco control. Some countries like Australia, Canada, Uruguay and Brazil are giving good examples about tobacco control and Pulbic Health issues.

In order to draw the attention of managers of public and private health for the cause, I have recently published in this website an article titled “The Smoking math formula: ” Smoking = COPD + P
ie., smoking is a generator of Cardiac, Oncologic, Pulmonary Diseases + Pediatric and calls attention to COPD, a disease underdiagnosed with high personal and economic impacts which are now the 3rd death cause in US.

Thus didactical formula Indicates the need for an early & all-embracing approach to smoking because it generates 52 other diseses and produces a huge financial resources scrap, including reducing the productivity of businesses – And just like the tobacco disease, the finance costs are also preventable. Thus the necessity to  early involve children and young people in prevention education with the creation of aplications (Apps), games and cartoons, as proposed in the “children’s story Zoo Logic?”

We can justify, rationalize, and pontificate about individual freedom all we want, but in the tobacco prevention there is “the role of nicotine,” that imposes a high and uncontrolled addiction, and if we go for this process, we will stick our heads in the sand.

The reality is cruel because millions of people are suffering and dying unnecessarily every day. We have the collective means to do something about it with minimal personal sacrifice. Thus, we can keep walking and trying to solve the problem accepting the necessity of public smoke free environments.

In fact, we achieved some important gains in preventing smoking-related diseases in the latest years.  But in terms of public health: Enough can be just enough!

Mainly, because the Life is in the game!

So, Enough is enough. It’s time to step up!

With All Respect,
Marcos Nascimento,MD
Medicine Professor
http://twitter.com/PulmaoSA

Ethics Must Be Global, Not Local

11 de março de 2012 Comentários desligados

ANVISA

Ethics Must Be Global, Not Local

Marcos Nascimento, MD.


This week will be a board meeting of the Brazil’s regulatory agency ANVISA- in that will address the issue of prohibition / restriction of added sugars, and other substances that give flavor to tobacco and its derivative-products such as cigarettes.
Briefly there are three spots to be discussed at this meeting:
1. The Smoking and its consequences for public health:

→ The Smoking to be associated with more than 50 diseases, is considered the biggest concern of the World Health Organization, causing personal ruin and death on a global scale of the order of 200,000 per year in Brazil and six million people worldwide. 1
→ The addition of sugars and any additives or based mint and other flavors, both known to increase the power of addition of nicotine, by the release of various toxins such as alcetaldeído 2, thereby stimulating the initiation of young and adolescents to tobacco products, especially cigarettes, but also used to smoke cigars, pipes and Narguilé water pipe for example.

2. The version of the Smoking Cessation Industry:

→ The international tobacco industry acts as expected for a company that owns shares in the stock market justifying the profit of your business before their shareholders. For this reason, denies the scientific evidence that sugar increases the addictive power of nicotine.
Moreover, the tobacco industry tries to turn the discussion focus only the economic question about an international commodity and the resulting consequences in the local and international tobacco, haggling over how much the ban on flavorings and sugar can affect Brazilian exports, and concomitantly … The Tobacco Industry’s profit!

3. The Role of the Brazil’s National Sanitary Surveillance Agency-ANVISA:

→ By definition, the regulatory agency was created to defend the interest of the population, ie. the interest of all citizens who pay their taxes and trust that the matters will be always discussed through the ethical stances, taken in the interests of public health, as described in virtual page on the Internet’s own ANVISA (The image below).

ANVISA Mission/ Missão da ANVISA

By involving the damage caused by smoking, the discussion of the Next Tuesday, March 13 address an issue of worldwide concern about human life, and will be mainly on Ethics. But the question here are: what is Ethics?  Can the Ethics of business be adapted according to local rules or should be globally the same ?
Evaluating the arguments of the tobacco industry, it can not figure out how leaders of business organizations can act with a set of principles in their homeland and a different one overseas. In terms of principles, ethics MUST be global and not local!

So what we are discussing here, and what will be discussed in Brasilia next Tuesday (March 13), is whether or not ethics works in the real world.

Ethics in a simple definition of Paulo Coelho: “It is the concern for your neighbor, It’s about how you must to think twice before acting on your own benefit.”


And especially when we are called upon to defend the ethics and rebuild the ruins of the system, we can replace the Human Health values close to the heart and not next to the money.
In short, it is expected that the Ethics attend  at the board meeting of the Brazilian Regulatory Agency -ANVISA, and not just summarize a virtual setting in its’ web page, but that is actually aligned with the real world.

SOURCES:
1. WHO – World Health Organization
2. Talhout et al, 2007: sugars in tobacco
3. ANVISA – Web Page
4. Paulo Coelho, free YouTube Video

Has anyone ever explained why you have COPD?

22 de fevereiro de 2012 Comentários desligados

Has anyone ever explained why you have COPD?

Classic COPD appearences as pulmonary enphisema & Chronic bronchitis

Make the following experiment: Inhale as much as you can, fill your lungs with air and hold your breath. Now, exhale a little, and soon after hold your breath. From this point (even with lungs full of air), to breathe again, but based on this interval.
It is exactly this way that a COPD patient breathes with lungs full of air, but with an ability to Exhale (put the air out) Limited.

This is because COPD, an acronym for Chronic Obstructive Pulmonary Disease (more commonly known as emphysema or chronic bronchitis), causes an inflammation in the bronchi of the lungs that obstruct the air passage. As the air out of the lung must be “pushed” by a positive pressure generated by the muscles, he finds difficulty and became trapped, leads to hyperinflation, one of the reasons for the lack of air or oxygen.

COPD
COPD is a disease still largely unknown by most people, including their holders.
The profile of the person with COPD is generally a person smoking, about 40 years and that has as its main symptoms are cough and shortness of breath.
Smokers think the cough is a natural product that comes “free” with the cigarette and that one day will pass … Big mistake! The cough does not cease, by contrast, tends to worsen and the smoker becomes accustomed to thinking that the cough is normal!

Diagnosis of COPD
The vast majority of people who smoke because they think they made a chest x-ray recently, and this is with the report “normal.” Unfortunately the picture is not all! The chest radiograph may be normal, even though the patient may have COPD.
The lab exam that diagnoses COPD is spirometry or pulmonary function test (also known as “blow test”). The spirometry assesses lung function data that may indicate to be a smoker with COPD.

But remember: Smoking causes 52 different diseases and COPD is one of them!

Tobacco Industry & COPD smoker

For the “happiness” of tobacco industry, as cigarettes industries, smokers think they can quit at any time. This, for the vast majority of people do not happen, for one simple reason:

Cigarettes contain nicotine that is an addiction substance, provokes quimic dependency and makes very difficult to quit smoking!
Accordind to PULMAOSA Medical Editor, Dr. Marcos Nascimento: “Quit smoking without medical supervision is extremely difficult, only 3-5 people among 100 do. Hence the need to search for medical and psychological help to start a cognitive behavioral treatment, complement Dr. Nascimento. And if you need to use medication to alleviate withdrawal symptoms – which is that irrepressible desire to return to smoking, there are some medicines available today. Thus, the treatment of smokers have a greater chance of success and you can prevent the progression of COPD.

Tobacco Industries and its Marketing Policy

Like any commercial enterprise, tobacco industries target PROFIT, and just want to be able to pay their shareholders. Tobacco Industries obviously know that the customer can get sick! In fact, it’s just knowing that your customers will get sick and may die or cease to be customers, they have developed a highly focused marketing on young people and women to feed back their customer base and therefore continue their lucrative business.

There is a Chinese saying that someone asks when is the best time to plant a tree. And the answer says that the best time was twenty years ago. The second best time is now!
Therefore, so it is with COPD and smoking: The Best, would be no smoking at any time, but will ALWAYS be an excellent time to STOP SMOKING. Therefore, seek the help of a pulmonologist to informs you about the dangers of smoking and lead the best treatment for COPD.

Sources:

PULMAOSA- Lungs: Your Atmosphere, Your Life!

Nicotine dependence retreated in “Poetry from 1915”

11 de setembro de 2011 Comentários desligados

Nicotine dependence retreated in Poetry from 1915

 Nicotine dependence retreated in poetry from 1915

There is a quote that say that wisdom is popular. Note that pearl of poetry from 1915 mentioning about the addictive effects of nicotine in brain, reflecting a disease known today as smoking ( ICD 17.2). This permit to say “Quit smoking Since 1915!”

” Tobacco is a dirty weed. I like it.
It satisfies no normal need. I like it.
It makes you thin, it makes you lean,
It takes the hair right off your bean.
It’s the worst darn stuff I’ve ever seen.
I like it.”

Graham Lee Hemminger, Penn State Froth, Tobacco, 1915

O Retorno Positivo do Parar de Fumar -Positive Return on Investment in Quitting Smoking

27 de outubro de 2010 Comentários desligados

O Retorno dos investimentos de Nova York em promover Tratamento do Tabagismo

(PULMAOSANEWS) Estudo da Penn State University revela que promover a cessação do  tabagismo, não apenas salva vidas,mastambém é capaz de gerar recursos econômicos as cidades que desenvolvem um programa de tratamento conjugado a medidas de banimento do tabaco de ambientes públicos. O Custo do Tabagismo no Estado de Nova York, segundo este estudo, é de US$ 20 Bilhões de dólares por ano com saúde, perda de horas de trabalho pelas empresas e mortes prematuras.

O mesmo estudo concluiu que ao fornecer tratamento para o tabagismo, o Estado poderia economizar US$ 58 milões de dólares por ano, obtendo um retorno de US$ 1,34 dólar para cada US$ 1,oo dólar investido.

Este Estudo claramente provou que o dinheiro investido na cessação do tabagismo não apenas beneficia a Saúde Pública, mas que também apresenta uma relação custo beneficio altamente eficaz.

ACHADOS CHAVES DO ESTUDO DA PENN UNIVERSITY:

  • Para cada maço vendido no Estado de NY o custo para gastos médicos mais perda de produtividade é de US$36 dólars/por maço (US$ 18,97 por perda de produtividade + 17,28 em gastos médicos diretos);
  • O custo do tabagismo no Estado é de US$ 20 bilhões/ano, sendo US$ 3,9 bilhões em perda de produtividade, US$ 6,8 bilhões em perda de vidas prematuramente e US$ 9,8 bilhões em gastos com o serviço médico;
  • Para cada US$ 1,o dólar investido há retorno de US$ 1,34 dólar.

A PULMÃO S.A. chama a atenção para a grande importancia deste tema e que já foi alvo de vários artigos publicados como a Fórmula Matemática do TabagismoCigarros são Prejudiciais a Saúde Financeira, Por que o GOLD deveria ser considerado Moeda Corrente?

Este estudo da Penn University na opinião do Editor Médico da PULMÃO S.A. Dr. Marcos Nascimento,” tem evidência e impacto ciêntífico suficiente para entrar no rol dos exemplos a serem seguidos por outras cidades no mundo como as demais americanas e  brasileiras, com destaque para aquelas em que já há uma legislação vigente antifumo para os ambientes públicos como Curitiba, Rio de Janeiro, São Paulo, Etc. Constitui, por tanto um excelente estímulo a criação e a expansão dos programas de tratamento já existentes para o tabagismo não apenas nas cidades mas também nos Estados brasileiros.”

Veja os dados de Nova York na íntegra :NY Smoking Cessation: the Economic Benefits

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PULMAOSANEWS – PULMÃO S.A. – Sua Atmosfera, Sua Vida!®

American Lung Association

 

ENGLISH

 

The New York Positive Investment in Quitting Smoking

NY State Quit Smoking Positive Investiment

(PULMAOSANEWS) A New York Penn State University study shows that promote smoking cessation, not only saves lives, mastambém is able to generate financial resources that cities develop a treatment program in conjunction with measures to ban tobacco in public places. The Cost of Smoking in New York state, according to this study is U.S. $ 20 Billion dollars a year on health, loss of working hours by companies and premature deaths.

The same study concluded that by providing treatment for smoking, the state could save $ 58 Milo of dollars a year, getting a return of $ $ 1.34 for every $ 1 dollar invested oo.

This study clearly proved that the money invested in smoking cessation not only benefits the public health, but it also presents a cost benefit altamanete effective.

KEY FINDINGS FROM PENN UNIVERSITY STUDY:

  • For every pack sold in NY State the cost for medical expenses more lost productivity is $ 36 dolars / per pack (U.S. $ 18.97 for lost productivity, direct medical expenditures in 17.28);
  • The cost of smoking in the state’s $ 20 billion per year, with $ 3.9 billion in lost productivity, $ 6.8 billion in lost lives prematurely and $ 9.8 billion in spending on medical service;
  • For every $ 1 dollar invested for the return of  US$ 1.34.

The PULMAOSA draws attention to the great importance of this issue and that was the target of several published articles as Smoking Mathematical Formula Cigarettes are harmful to Financial Health, Why  GOLD should be considered  Currency?

In the opinion of the Medical Editor- in- chief of PULMAOSA, Dr. Marcos Nascimento:  ” The Penn University Study has sufficient scientific evidence and impact to get on the list of examples to be emulated by other cities in the world as Orlando- Florida ( Which could beguin a Example Quit Smoking program with its sisters cities as Curitiba) and Brazilian Cities, with emphasis on those who already have a legislation for smokefree public places such as Curitiba, Rio de Janeiro, Sao Paulo, etc. It is by far a great stimulus to the creation and expansion of existing treatment programs for smoking not only in cities but also in the Brazilian states. ”

See full New York data: NY Smoking Cessation: the Economic Benefits

SOURCES:

PULMAOSANEWS – PULMAOSA – Your atmosphere, Your Life! ®

Vacinas: Uma das chaves da DPOC! Vaccines: One of the COPD’s Keys!

6 de outubro de 2010 Comentários desligados

Dia Mundial da DPOC

Vacinas: Uma das chaves da DPOC!

Marcos Henrique Sant’Ana do Nascimento, MD. 1

1. Professor de Medicina PUCPR

COPD ELETRONIC MARATHON 2011

Apesar de Doença Pulmonar Obstrutiva Crônica (DPOC) ser uma doença muito comum no mundo e mesmo nos Estados Unidos, onde cerca de 24 milhões de americanos são portadores, chamo a atenção para um fato alarmante: pelo menos metade dos pacientes com DPOC não sabem que têm a doença (1, 2)!
Portanto, se  um portador de DPOC não tem diagnóstico, não pode tratar, impedir a progressão e ter uma vida melhor …

Em 2005, aproximadamente um em cada 20 mortes nos Estados Unidos tinham DPOC como causa básica. Tabagismo é a principal causa de DPOC (3).

Este artigo visa colaborar na tentativa de popularizar o conhecimento sobre a DPOC, proporcionando melhor controle e uma melhor qualidade de vida.

Em primeiro lugar vamos lembrar: O que é DPOC?

Bronquite e Enfisema - Bronchitis and Enphysema

A DPOC é uma doença pulmonar comum entre fumantes e ex-fumantes, ocasionando dificuldade para respirar, tosse crônica com ou sem escarro. (4)
A DPOC é caracterizada como uma doença pulmonar inflamatória, caracterizada pela limitação do fluxo aéreo que não é totalmente reversível.
O termo DPOC engloba:
• A bronquite crônica;
• enfisema pulmonar.

Prevenção da progressão da DPOC e das complicações:
A diminuição da função pulmonar é o evento associado com morbidade e mortalidade por DPOC. E esta é desencadeada pelo tabagismo e pela a exacerbação da DPOC, levando as infecções. Portanto, para evitar a queda excessiva da função pulmonar devemos ampliar o conhecimento para os pacientes e este deve ser o objetivo principal para os médicos que cuidam de pacientes com DPOC, com vista a um melhor prognóstico.
Prevenir o declínio da função pulmonar é o objetivo, como abordar esse objetivo?

É necessário, segundo a literatura médica obedecer a um tripé de medidas:

(1) Pare de Fumar!

É preciso compreender que hoje temos um grande arsenal farmacológico como os adesivos de reposição de nicotina, a Bupropiona e a Vareniclina, além de encaminhamento para grupos de cessação do tabagismo, que podem ser oferecidos aos pacientes, e tornar o parar de fumar uma meta realista e exequível.
Parar de fumar é a coisa mais importante que você pode fazer em termos de proporcionar uma vida melhor. Tanto sob o aspecto da saúde quanto em relação a auto-estima. Procure ajuda médica para se livrar da dependência da nicotina. Faça isso por você. Você vai se sentir melhor!
(2) Tome os medicamentos de maneira correta:
Algumas evidências sugerem o uso de bronco dilatador como a terapia farmacológica primária para prevenir e controlar os sintomas, reduzir a freqüência e a gravidade das exacerbações agudas e melhorar a qualidade de vida. (5)

(3) Profilaxia Vacinal
A causa mais freqüente de exacerbação da DPOC está associada com infecções respiratórias virais e bacterianas adquiridas na comunidade. Infecção viral como causa de exacerbações são particularmente comuns quando há grandes variações na temperatura atingindo o seu pico no inverno, mas também são comuns na primavera e no outono. Além disso, desde 2009, a Organização Mundial da Saúde (OMS) declarou uma pandemia de influenza H1N1, uma condição que coloca as mulheres grávidas e pessoas com doenças respiratórias crônicas como asma e DPOC, entre outras condições, na linha de maior risco para a morbidade e mortalidade, com ambas as doenças respiratórias listadas como causas de internações nos EUA para a gripe suína. (6)
Pacientes com DPOC são de alto risco para complicações da gripe por causa da própria doença, o que diminui a reserva pulmonar e por algumas outras razões, tais como: uso de corticosteróide, que poderiam afetar e diminuir a resposta do sistema imunológico, o mau funcionamento dos cílios causados pelo cigarro, que resulta em colonização dos brônquios por bactérias como o pneumococos e o Haemophilus influenzae.
Assim, a prevenção das exacerbações é reconhecida como um objetivo chave na DPOC gerenciamento de estado da doença. (7)

Vacina contra a gripe:

Estar vacinado é a melhor maneira de se prevenir contra a gripe. Todas as pessoas com DPOC ou de qualquer outra doença crônica pulmonar devem receber a vacina contra a gripe sazonal e suína (H1N1):
• Pessoas com DPOC devem começar a “vacina contra a gripe sazonal”, uma vacina feita com vírus inativados (mortos). A vacina contra a gripe é dada com uma agulha, geralmente no braço. (8) A vacina contra a gripe H1N1 de 2009 contém o vírus “morto”, então você não pode ficar gripado por causa da vacina. (8)
• Pessoas com DPOC não deve receber a vacina de spray nasal, que é uma vacina com vírus vivo, e não é recomendado pelo CDC_ Centro de Doenças e Controle dos Estados Unidos ( Esta vacina não encontra-se disponível no Brasil)
• A vacina contra a gripe H1N1 de 2009, pode ser administradas na mesma visita como qualquer outra vacina, incluindo a vacina pneumocócica.

** Por determinação da Organização Mundial de Saúde (OMS) em 2011 a vacina contra a gripe comum (influenza sazonal) conterá 3 vírus da gripe: o H1N1 pandêmico tipo A; Um H3N2 tipo A, e um vírus influenza tipo B

Vacina pneumocócica:
Durante as pandemias anteriores de gripe, a pneumonia bacteriana secundária era uma causa importante de doença e morte. O Streptococcus pneumoniae foi o agente etiológico mais comum. De acordo com orientações provisórias emitidas pelo CDC, todas as pessoas com indicações existentes para vacina Pneumo-23(PPSV23) devem ser vacinadas seguindo recomendações atuais,por ser útil na prevenção de infecções secundárias e reduzir as complicações da doença e minorar o risco de óbito. (9)

REFERÊNCIAS:

(1)  Han MK et al. Chest. 2007;132:403-409.

(2) Lee TA et al. Chest. 2006;129:1509-1515.

(3)CDC. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001. MMWR 2005;54:625–8.

(4)Rennard SI. COPD: overview of definitions, epidemiology, and factors influencing its development. Chest 1998;113(Suppl 4):235–41s.

(5) O’Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2007 update. Can Respir J 2007;14(Suppl B):5–32B.

(6) CDC.2009 H1N1 Flu:Underlying Heath Conditions among Hospitalized Adults and Children: -Acessed in Março 30,2010.

(7) Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.

(8) Cives – Center for Health Information for Travelers of UFRJ:  http://www.cva.ufrj.br/informacao/vacinas/gripe-pr.html Accessed  Março 30,2010.

(9) Centers for Disease Control and Prevention. Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak. July 9, 2009. http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm.  Accessado em 30 Março 2010.

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