Artigo Original/Original Article
Casuística de quatro anos de uma consulta de apoio ao fumador
Four years’ follow up at a smoking cessation clinic
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Caeiro, R. Sotto-Mayor, A. Bugalho de Almeida" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Aguiar" "email" => array:1 [ 0 => "m_aguiar@netcabo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Todo-Bom" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Felizardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Macedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 4 => array:3 [ "nombre" => "F." 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"apellidos" => "Bugalho de Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "af0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Interna do Complementar de Pneumologia / Resident, Pulmonology" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Assistente Hospitalar de Pneumologia / Specialist, Pulmonology" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Chefe de Serviço de Pneumologia / Unit Head, Pulmonology" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Director de Serviço do Serviço de Pneumologia I / Unit Director, Pulmonology I" "etiqueta" => "4" "identificador" => "af0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência/<span class="elsevierStyleItalic">Correspondence to:</span></span> Margarida Aguiar, Hospital de Santa Maria, CHLN, Av. Egas Moniz, 1500 Lisboa" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Four years’ follow up at a smoking cessation clinic" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-10-20" "fechaAceptado" => "2008-12-15" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavra-chave" "identificador" => "xpalclavsec570429" "palabras" => array:3 [ 0 => "Desabituação tabágica" 1 => "fumador" 2 => "consulta" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570430" "palabras" => array:2 [ 0 => "Smoking cessation" 1 => "outpatient smokers" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">O tabagismo é uma importante causa de patologia pulmonar e a sua dependência poderá ser considerada uma doença crónica e recorrente. Os benefícios da cessação tabágica são inquestionáveis e todos os médicos têm responsabilidade na sua recomendação.</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivo:</span> Caracterização da população que recorre à consulta de apoio ao fumador (CAF) do nosso hospital e procurar entender as razões do sucesso</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Materiais e métodos:</span> Análise retrospectiva dos processos clínicos de todos os doentes que foram seguidos na CAF entre Janeiro de 2003 e Junho de 2006. Foram avaliados os seguintes parâmetros: idade, sexo, idade de início, carga tabágica (unidades maço ano-UMA), patologias associadas, grau de dependência (teste de Fargerström), tentativas prévias, motivações para cessação tabágica, necessidade de apoio cognitivo-comportamental e taxas de sucesso e abandono.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados:</span> Foram avaliados 526 doentes, 50% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>263) do sexo masculino. A média de idades situava-se nos 45,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11,4 anos. Iniciaram o consumo antes dos 15 anos 43,1% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>227). A carga tabágica foi de 35,8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20 UMA, observando-se em 21,4% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>113) dos doentes um consumo superior a 50 UMA. Patologia pulmonar esteve presente em 52,1% (DPOC – 39,9%; outras – 12,2%) e a cardiovascular em 14,6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>77) dos doentes. Em 46% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>242) foi identificada uma patologia psiquiátrica importante: perturbações depressivas (21,4%), transtorno de ansiedade (19,4%), outra toxicodependência (2,1%), doença bipolar (1,5%) e esquizofrenia (0,6%). Trezentos e sessenta e sete doentes (69,7%) obtiveram pontuação máxima no teste de Fagerström. Em 72,2% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>380) dos casos foram mencionadas tentativas prévias de abandono do tabagismo. Os motivos actuais evocados para a cessação tabágica relacionaram-se com: saúde (83,5%); factores económicos 8,2%; qualidade de vida (5,7%). Foram submetidos a terapêutica de substituição nicotínica 81,7% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>430) dos doentes, sendo a via de administração: sistema transdérmicos (53,3%), nicotina oral (1,1%) ou ambos (45,6%). O suporte psicofarmacológico utilizado foi: ansiolítico (86,5%); cloridrato bupropiona (2,3%); antidepressivo (0,6%). Foi solicitado apoio cognitivo-comportamental a 14,4% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>76) dos doentes. A taxa de cessação tabágica foi de 42,4% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>223). A redução do consumo de tabaco superior a 50% foi de 1,9% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10). A taxa de abandono da consulta, a maioria logo após a primeira consulta, foi de 41,6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>219). A taxa de abandono da consulta relacionou-se com as características dos doentes, a falta de motivação, o preço da terapêutica e o meio ambiente desencorajador.</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusão:</span> Verificou-se nesta população elevada percentagem de indivíduos com patologia psiquiátrica e alto grau de dependência a nicotina, factores que, aliados ao <span class="elsevierStyleItalic">stress</span> como causa <span class="elsevierStyleItalic">major</span> de aumento de consume de tabaco, implicaram uma especial atenção ao suporte cognitivo-comportamental no sentido de garantir melhores resultados. O sucesso terapêutico esteve sem dúvida relacionado com a aderência à consulta, a terapia comportamental e a terapêutica farmacológica.</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (2): 179-197</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Smoking is an important cause of pulmonary pathology and this addiction can be regarded as a chronic, recurrent disease. The benefits of smoking cessation are unquestionable and all physicians should become more active and assertive in recommending it.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim:</span> To characterise the population seeking medical support for smoking cessation and understand why some successfully stop smoking and others do not.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods:</span> Retrospective analysis of medical records of outpatients in follow-up between January 2003 and June 2006. Age, gender, age at smoking initiation, smoking burden (number of pack–years), associated diseases, degree of dependence (Fagerström test for nicotine addiction), prior attempts at and motivation for smoking cessation, need for cognitive/behavioural support and success and abandonment rates were evaluated.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results:</span> Five hundred and twenty six patients were studied, 50% male with an average age of 45.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.4<span class="elsevierStyleHsp" style=""></span>years. Almost half (43.1 %; n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>227) of the patients started smoking before the age of 15. Average smoking burden was 35.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20 pack-years although 21.4% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>113) smoked more than 50 pack-years. Respiratory disease was present in 52.1% (COPD, 39.9% and others, 12.2%) and cardiovascular disease in 14.6% of the patients. In 46% of patients (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>242) a relevant psychiatric disorder was identified; depression (21.4%), anxiety disorder (19.4%), other dependencies (2.1%) bipolar disorder (1.5%) and schizophrenia (0.6%). The evaluation of degree of addiction revealed maximum level in 69.7% of the patients (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>380). Many patients (72.2%; n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>380) reported prior attempts to quit smoking. The strongest reasons for giving up smoking were concern over health (83.5%), financial issues (8.2%) and search for better quality of life (5.7%). Most patients (81.7%; n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>430) had undergone nicotine replacement therapy; skin patches (53.3%), chewing gum (1.1%) or both (45.6%). Psychopharmacological treatment included administration of sedative-hypnotics (86.5%), bupropion hydrochloride (2.3%) and antidepressants (0.6%). Seventy six patients (14%) benefited from cognitive/behavioural support. Two hundred and twenty three patients (42.4%) were successful in giving up smoking while 219 (41.6%) abandoned follow up, the majority after the first appointment. Most patients that abandoned follow up reported lack of motivation and the price of therapy.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions:</span> The population under study had a high rate of psychiatric disorders and a high level of dependence and lack of motivation that might justify the drop-out rate. Successful treatment was associated with close follow up, behavioural support and pharmacological therapy.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (2): 179-197</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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George" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.070627" "Revista" => array:7 [ "tituloSerie" => "CMAJ" "fecha" => "2007" "volumen" => "177" "numero" => "11" "paginaInicial" => "1373" "paginaFinal" => "1380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18025429" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bb0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tabagismo em Portugal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Fraga" 1 => "S. Sousa" 2 => "A.C. Santos" 3 => "M. Mello" 4 => "N. Lunet" 5 => "P. Padrão" 6 => "H. Barros" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arqui Med" "fecha" => "2005" "volumen" => "19" "numero" => "5-6" "paginaInicial" => "207" "paginaFinal" => "229" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bb0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "titulo" => "The European Tobacco Control Report" "fecha" => "2007" "editorial" => "World Health Organization" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bb0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Surgeon General’s report. The Health Consequences of Involuntary Exposure to Tobacco Smoke" "fecha" => "2006" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bb0030" "etiqueta" => "6." 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Article information
ISSN: 08732159Original language: Portuguese
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