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    "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Smoking has devastating health effects and is a recognized risk factor for the development of cardiovascular&#44; cerebrovascular&#44; respiratory&#44; and oncological diseases&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> The Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; recommends the diagnosis of chronic obstructive pulmonary disease &#40;COPD&#41; based on a reduction in the FEV1&#47;FVC ratio&#46;<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> However&#44; this diagnostic criterion is valid only for advanced COPD&#44; leading to the underdiagnosis of early functional changes in chronic smoking&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> There are few studies concerning pulmonary function alterations in smokers and the deleterious effects of smoking on functional parameters vary&#44; depending on the studies&#46;</p><p class="elsevierStylePara">Cigarette smoking has a detrimental effect on the airways&#44; causing inflammation and&#44; consequently&#44; airflow limitations and lung hyperinflation&#46;<a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> In thoracic radiographs&#44; one sign of lung hyperinflation is the reduction in the cardiothoracic index &#40;&#8216;heart in gout&#8217;&#41;&#46; Some authors claim that a reduction in FEV1 is more than just a measure of airflow limitation&#44; that it is&#44; in fact&#44; a marker of premature death&#44; with a wideranging utility in assessing the risks of COPD&#44; lung cancer&#44; coronary artery disease&#44; and stroke&#44; which collectively account for 70&#8211;80&#37; of premature deaths in smokers&#46;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Some studies have encouraged the use of new methods in the detection of precursory anomalies of pulmonary disease during the subclinical phase in patients at risk&#46;</p><p class="elsevierStylePara">The authors present a case control study developed in outpatient clinic with the smoking cessation program at Sousa Martins Hospital &#40;HSM&#41;&#44; Local Health Unit&#44; Guarda &#40;Portugal&#41;&#46; The main objective of our study was to investigate the respiratory function and lung hyperinflation in asymptomatic smokers without a history of lung pathology and with normal chest radiographs&#46; Secondary objectives consisted of identifying tobacco-related diseases and correlating tobacco consumption&#44; duration of exposure to tobacco smoke&#44; and urinary cotinine with the existence of tobacco-related disease&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Materials and methods</span><p class="elsevierStylePara">The authors developed a case-controlled study paired by sex&#44; age and body mass index&#46; The cases were defined as smokers &#40;with a smoking habit for at least one year&#41;&#44; who presented for their first appointment at the smoking cessation program at HSM during the period of 11 December 2012 to 8 December 2013&#44; without respiratory symptoms and with normal chest radiographs&#46; Smoking subgroups were integrated using evidence of the history of tobacco-related pathology&#46; The exclusion criterion was applied to cases previously diagnosed with pulmonary pathology&#46;</p><p class="elsevierStylePara">The controls were participants who exhibited normal examination in plethysmography and chest radiographs in HSM&#46; The following exclusion criteria were applied to the controls&#58; known prior history of pulmonary pathology and current and&#47;or past smoking&#46; In the controls&#44; maximum passive exposure was assumed for the determination of carbon monoxide &#40;CO&#41; in the exhaled air &#40;0&#8211;6&#160;ppm&#41; and urinary cotinine &#40;&#60;150&#160;ng&#47;mL&#41;&#46;</p><p class="elsevierStylePara">The pulmonary function tests were performed using the Plethysmograph Autobox DI SensorMedics 6200 &#40;California&#44; USA&#41; at the Department of Pathophysiology of Respiratory Diseases at HSM&#46; The technical recommendations and standardized reference values of the American Thoracic Society were used to perform the functional tests&#46; A chest X-ray was obtained while the patient was in the standing and forward positions at maximal inspiration&#44; which complies with the criteria for good technical quality&#46; The ratio between the maximum transverse diameter of the heart and the maximum internal diameter of the chest &#40;the calculation of the cardiothoracic index&#41; was determined&#46; A normal thoracic radiograph was considered to be one without pleuroparenchymal alterations and with a cardiothoracic index below 0&#46;5&#46;</p><p class="elsevierStylePara">As a biomarker of current smoking&#44; a determination of the CO in the exhaled air was used&#46; Cotinine in the urine was used as a marker for the cumulative consumption of tobacco intake&#46; The measurement of the CO in the exhaled air was performed during the consultation period of smoking cessation in the Micro Medical smoke check &#40;Kent&#44; England&#41;&#46; Assays were stratified into the following CO levels&#58; 0&#8211;6&#160;ppm&#44; green&#160;&#61;&#160;no smoking&#59; 7&#8211;10&#160;ppm&#44; yellow&#160;&#61;&#160;light smoker&#59; 11&#8211;20&#160;ppm&#44; red&#160;&#61;&#160;strong smoker&#59; and &#62;20&#160;ppm&#44; red with beep&#160;&#61;&#160;very strong smoker&#46; The assay of urinary cotinine was executed using gas&#47;mass spectrophotometry chromatography&#46; The assays of urinary cotinine were stratified as follows&#58; &#60;150&#160;ng&#47;mL&#160;&#61;&#160;passive smoking&#59; 150&#8211;499&#160;ng&#47;mL&#160;&#61;&#160;light smoker&#59; 500&#8211;2500&#160;ng&#47;mL&#160;&#61;&#160;moderate smoker&#59; and &#62;2500&#160;ng&#47;mL&#160;&#61;&#160;strong smoker&#46;</p><p class="elsevierStylePara">The criteria for hyperinflation included the presence of either a reduction in the cardiothoracic index or an increase in RV&#47;TLC measured using plethysmography&#46; The minimum value of the cardiothoracic index that defines hyperinflation is not yet clearly established in the literature&#46;</p><p class="elsevierStylePara">Statistical analyses were performed using IBM SPSS Statistics software 19<span class="elsevierStyleSup">&#174;</span>&#46; Exploratory and descriptive analyses were applied to the variables&#44; and in the continuous variables&#44; such as the <span class="elsevierStyleItalic">T</span>-test &#40;2 groups&#41; and the Pearson correlation coefficient&#46; The level of significance was set at <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46;</p><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">During the study period&#44; 64 subject samples were obtained&#58; 32 cases and 32 controls&#46; The 32 cases included smokers in the smoking cessation program at HSM&#58; 65&#46;6&#37; were male&#44; and 34&#46;4&#37; were female&#46; The mean age of male subjects was 45&#46;57 years&#44; and that of female subjects was 37&#46;27 years&#46; There were statistically significant differences between the groups &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The controls included 32 non-smoking individuals&#44; matched with cases by sex&#44; age&#44; and body mass index&#46; The lung function tests were performed at the Division of Respiratory Pathophysiology&#44; HSM&#46; <a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#44; <a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a> characterize the cases by gender in terms of age at onset of smoking&#44; tobacco consumption&#44; urinary cotinine assay&#44; and CO in exhaled air&#46;</p><p class="elsevierStylePara">Table 1&#46; Characteristics of smokers by gender&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Variables</td><td colspan="4">Smokers &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;</td></tr><tr align="left"><td>&#160;</td><td>Male subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;21&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Female subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;11&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Total<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td><span class="elsevierStyleItalic">T</span> test<br></br>&#40;<span class="elsevierStyleItalic">p</span> value&#41;</td></tr><tr align="left"><td>Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;</td><td>26&#46;45&#160;&#177;&#160;4&#46;17</td><td>25&#46;06&#160;&#177;&#160;5&#46;02</td><td>25&#46;97&#160;&#177;&#160;4&#46;45</td><td>0&#46;41</td></tr><tr align="left"><td>Age &#40;years&#41;</td><td>45&#46;57&#160;&#177;&#160;11&#46;63</td><td>37&#46;27&#160;&#177;&#160;6&#46;74</td><td>42&#46;72&#160;&#177;&#160;10&#46;86</td><td>0&#46;038</td></tr><tr align="left"><td>Age of smoking initiation &#40;years&#41;</td><td>16&#46;67&#160;&#177;&#160;4&#46;73</td><td>16&#46;83&#160;&#177;&#160;3&#46;66</td><td>16&#46;72&#160;&#177;&#160;4&#46;33</td><td>0&#46;927</td></tr><tr align="left"><td>Tobacco consumption &#40;packs per year&#41;</td><td>30&#46;33&#160;&#177;&#160;14&#46;46</td><td>12&#46;73&#160;&#177;&#160;5&#46;26</td><td>24&#46;28&#160;&#177;&#160;14&#46;69</td><td>2&#46;91&#160;&#215;&#160;10<span class="elsevierStyleSup">&#8722;5</span></td></tr><tr align="left"><td>Urinary cotinine &#40;ng&#47;mL&#41;</td><td>1315&#46;33&#160;&#177;&#160;895&#46;45</td><td>699&#46;91&#160;&#177;&#160;465&#46;00</td><td>1103&#46;78&#160;&#177;&#160;821&#46;74</td><td>0&#46;042</td></tr></table><p class="elsevierStylePara">Table 2&#46; Determination of CO in exhaled air in smokers by gender&#46;</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Determination of CO in exhaled air &#40;ppm&#41;</td><td colspan="3">Smokers &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;</td></tr><tr align="left"><td>&#160;</td><td>Male subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;21&#41;<br></br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</td><td>Female subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;11&#41;<br></br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</td><td>Total<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</td></tr><tr align="left"><td>0&#8211;6&#160;&#61;&#160;&#8216;non-smoker&#8217;</td><td>0 &#40;0&#37;&#41;</td><td>0 &#40;0&#37;&#41;</td><td>0 &#40;0&#37;&#41;</td></tr><tr align="left"><td>7&#8211;10&#160;&#61;&#160;&#8216;light smoker&#8217;</td><td>0 &#40;0&#37;&#41;</td><td>1 &#40;9&#46;09&#37;&#41;</td><td>1 &#40;3&#46;13&#37;&#41;</td></tr><tr align="left"><td>11&#8211;20&#160;&#61;&#160;&#8216;strong smoker&#8217;</td><td>10 &#40;47&#46;62&#37;&#41;</td><td>8 &#40;72&#46;73&#37;&#41;</td><td>18 &#40;56&#46;25&#37;</td></tr><tr align="left"><td>&#62;20&#160;&#61;&#160;&#8216;very strong smoker&#8217;</td><td>11 &#40;52&#46;38&#37;&#41;</td><td>2 &#40;18&#46;18&#37;&#41;</td><td>13 &#40;40&#46;63&#37;&#41;</td></tr></table><p class="elsevierStylePara">It was found that the age of onset of smoking was similar in both genders&#46; Female smokers had a mean tobacco consumption &#40;12&#46;73 packs per year&#41; and mean cotinine &#40;699&#46;91&#160;ng&#47;mL&#41;&#44; which was lower than that of the male subjects &#40;30&#46;33 packs per year and 1315&#46;33&#160;ng&#47;mL&#41;&#44; with statistical significance &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; With regard to CO in exhaled air&#44; 84&#46;62&#37; of the male subjects were considered to be strong smokers vs&#46; 15&#46;38&#37; of the female subjects&#46; The mean duration of exposure to smoking in male subjects was 28&#46;9 years and 20&#46;45 years for female subjects&#44; with statistically significant differences &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">There was a weak correlation between urinary cotinine and tobacco consumption &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;124&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;5&#41;&#46;</p><p class="elsevierStylePara">A review of the cases and controls using plethysmography is shown in <a href="&#35;t0015" class="elsevierStyleCrossRefs">Table 3</a>&#46; In the cases identified&#44; 9&#46;38&#37; &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3&#41; of the smokers exhibited spirometric COPD criteria&#58; mean FEV1&#47;FVC 65&#37; and mean FEV1 89&#37;&#46; The mean FEV1&#47;FVC of the cases was 77&#46;78&#37; &#40;standard deviation &#91;SD&#93;&#160;&#61;&#160;6&#46;50&#37;&#41;&#44; with 81&#46;41&#37; in the controls &#40;SD&#160;&#61;&#160;5&#46;84&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46; The means of the FEF 75&#37; and FEF 25&#8211;75&#37; were also lower&#46; The mean FEF 75&#37; was 63&#46;78&#37; &#40;SD&#160;&#61;&#160;26&#46;44&#37;&#41; in the cases and 86&#46;09&#37; in the controls &#40;SD&#160;&#61;&#160;28&#46;99&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46; The mean FEF 25&#8211;75&#37; in the cases was 83&#46;16&#37; &#40;SD&#160;&#61;&#160;26&#46;44&#37;&#41; and 97&#46;19&#37; &#40;SD&#160;&#61;&#160;23&#46;82&#41; in the controls &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The reduction was greater in the FEF 75&#37; and FEF 25&#8211;75&#37; parameters&#46;</p><p class="elsevierStylePara">Table 3&#46; Evaluation by plethysmography of smokers and controls&#46;</p><a name="t0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Respiratory function tests</td><td>Smokers<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Controls<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td><span class="elsevierStyleItalic">T</span> test<br></br>&#40;<span class="elsevierStyleItalic">p</span> value&#41;</td></tr><tr align="left"><td>FVC &#40;&#37;&#41;</td><td>110&#46;34&#160;&#177;&#160;13&#46;49</td><td>108&#46;84&#160;&#177;&#160;14&#46;87</td><td>0&#46;674</td></tr><tr align="left"><td>FEV1 &#40;&#37;&#41;</td><td>102&#46;78&#160;&#177;&#160;12&#46;06</td><td>106&#46;13&#160;&#177;&#160;12&#46;96</td><td>0&#46;289</td></tr><tr align="left"><td>FEV1&#47;FVC &#40;&#37;&#41;</td><td>77&#46;88&#160;&#177;&#160;6&#46;50</td><td>81&#46;41&#160;&#177;&#160;5&#46;84</td><td>0&#46;026</td></tr><tr align="left"><td>FEF 25&#37; &#40;&#37;&#41;</td><td>92&#46;78&#160;&#177;&#160;21&#46;47</td><td>88&#46;91&#160;&#177;&#160;17&#46;44</td><td>0&#46;431</td></tr><tr align="left"><td>FEF 50&#37; &#40;&#37;&#41;</td><td>94&#46;75&#160;&#177;&#160;31&#46;86</td><td>105&#46;34&#160;&#177;&#160;26&#46;61</td><td>0&#46;154</td></tr><tr align="left"><td>FEF 75&#37; &#40;&#37;&#41;</td><td>63&#46;78&#160;&#177;&#160;26&#46;44</td><td>86&#46;09&#160;&#177;&#160;28&#46;99</td><td>0&#46;002</td></tr><tr align="left"><td>FEF 25&#8211;75&#37; &#40;&#37;&#41;</td><td>83&#46;16&#160;&#177;&#160;26&#46;44</td><td>97&#46;19&#160;&#177;&#160;23&#46;82</td><td>0&#46;029</td></tr><tr align="left"><td>PEF &#40;&#37;&#41;</td><td>91&#46;41&#160;&#177;&#160;17&#46;61</td><td>87&#46;59&#160;&#177;&#160;16&#46;79</td><td>0&#46;379</td></tr><tr align="left"><td>TLC &#40;&#37;&#41;</td><td>104&#46;09&#160;&#177;&#160;13&#46;42</td><td>100&#46;16&#160;&#177;&#160;12&#46;79</td><td>0&#46;234</td></tr><tr align="left"><td>RV &#40;&#37;&#41;</td><td>94&#46;5&#160;&#177;&#160;27&#46;11</td><td>88&#46;97&#160;&#177;&#160;19&#46;88</td><td>0&#46;356</td></tr><tr align="left"><td>RV&#47;TLC &#40;&#37;&#41;</td><td>27&#46;53&#160;&#177;&#160;7&#46;63</td><td>27&#46;81&#160;&#177;&#160;6&#46;00</td><td>0&#46;870</td></tr><tr align="left"><td>Airway resistance &#8211; raw &#40;L&#47;s&#47;cmH<span class="elsevierStyleInf">2</span>O&#41;</td><td>0&#46;2440&#160;&#177;&#160;0&#46;091</td><td>0&#46;2615&#160;&#177;&#160;0&#46;120</td><td>0&#46;513</td></tr><tr align="left"><td rowspan="2">Specific airway conductance &#8211; sGaw &#40;cmH<span class="elsevierStyleInf">2</span>O&#47;L&#47;s&#41;</td><td>&#9794;&#160;1&#46;122&#160;&#177;&#160;0&#46;564</td><td>&#9794;&#160;1&#46;1057&#160;&#177;&#160;0&#46;477</td><td>&#9794;&#160;0&#46;920</td></tr><tr align="left"><td>&#9792;&#160;1&#46;300&#160;&#177;&#160;0&#46;4306</td><td>&#9792;&#160;1&#46;543&#160;&#177;&#160;0&#46;640</td><td>&#9792;&#160;0&#46;309</td></tr></table><p class="elsevierStylePara">The reductions in FEV1&#47;FVC&#44; FEF 75&#37; and FEF 25&#8211;75&#37; were correlated inversely with tobacco consumption&#44; but this was not statistically significant &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;305 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;089&#44; <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;203 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;265&#44; <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;15 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;391&#44; respectively&#41;&#46;</p><p class="elsevierStylePara">Regarding the assessment of the cardiothoracic index&#44; the mean was 0&#46;424 &#40;SD&#160;&#61;&#160;0&#46;04&#41; in the cases and 0&#46;458 &#40;SD&#160;&#61;&#160;0&#46;04&#41; in the controls&#44; with a statistically significant difference &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; A moderate correlation between the cardiothoracic index and TLC was found in the cases &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;371&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">Approximately 31&#46;2&#37; &#40;10&#41; of the cases had a history of extra-pulmonary pathology associated with tobacco&#58; 21&#46;88&#37; &#40;seven patients&#41; had hypertension&#44; 6&#46;25&#37; &#40;two cases&#41; had stroke&#44; 3&#46;13&#37; &#40;one case&#41; had acute myocardial infarction and 3&#46;13&#37; &#40;one case&#41; had repeated miscarriages&#46; 9&#46;38&#37; &#40;three smokers&#41; were diagnosed with COPD&#46; In 68&#46;8&#37; &#40;22 smokers&#41;&#44; there was no history of tobacco-related disease&#46; <a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a> shows the comparison of the cases in subgroups&#44; with and without tobacco-related disease&#44; in relation to age&#44; age at smoking onset&#44; tobacco consumption&#44; duration of tobacco exposure&#44; urinary cotinine assay&#44; plethysmography variables&#44; and cardiothoracic index&#46; In relation to the distribution by gender in these two subgroups&#44; it was verified that among the smokers with tobacco-related pathology &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;12&#41;&#44; eight were male and six were female&#59; among smokers without tobacco-related pathology &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;20&#41;&#44; 13 were male and seven were female&#46;</p><p class="elsevierStylePara">Table 4&#46; Analysis of subgroups of smokers with and without tobacco-related pathology&#46;</p><a name="t0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Variables</td><td>Smokers with tobacco-related pathology and COPD<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;12&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Smokers without tobacco-related pathology<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;20&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td><span class="elsevierStyleItalic">T</span> test<br></br>&#40;<span class="elsevierStyleItalic">p</span> value&#41;</td></tr><tr align="left"><td>Age &#40;years&#41;</td><td>48&#46;33&#160;&#177;&#160;10&#46;13</td><td>39&#46;35&#160;&#177;&#160;10&#46;05</td><td>0&#46;021</td></tr><tr align="left"><td>Age of smoking initiation &#40;years&#41;</td><td>17&#46;25&#160;&#177;&#160;4&#46;07</td><td>16&#46;40&#160;&#177;&#160;4&#46;55</td><td>0&#46;599</td></tr><tr align="left"><td>Tobacco consumption &#40;packs per year&#41;</td><td>27&#46;75&#160;&#177;&#160;14&#46;22</td><td>22&#46;20&#160;&#177;&#160;14&#46;93</td><td>0&#46;309</td></tr><tr align="left"><td>Tobacco exposure time &#40;years&#41;</td><td>31&#46;08&#160;&#177;&#160;11&#46;147</td><td>22&#46;95&#160;&#177;&#160;11&#46;422</td><td>0&#46;058</td></tr><tr align="left"><td>Urinary cotinine &#40;ng&#47;mL&#41;</td><td>1075&#160;&#177;&#160;979&#46;72</td><td>1121&#46;05&#160;&#177;&#160;738&#46;37</td><td>0&#46;881</td></tr><tr align="left"><td>FVC &#40;&#37;&#41;</td><td>106&#46;33&#160;&#177;&#160;10&#46;47</td><td>112&#46;75&#160;&#177;&#160;14&#46;73</td><td>0&#46;197</td></tr><tr align="left"><td>FEV1 &#40;&#37;&#41;</td><td>97&#46;17&#160;&#177;&#160;7&#46;41</td><td>106&#46;15&#160;&#177;&#160;13&#46;176</td><td>0&#46;039</td></tr><tr align="left"><td>FEV1&#47;FVC &#40;&#37;&#41;</td><td>76&#46;08&#160;&#177;&#160;8&#46;607</td><td>78&#46;95&#160;&#177;&#160;4&#46;774</td><td>0&#46;306</td></tr><tr align="left"><td>FEF 25&#37; &#40;&#37;&#41;</td><td>94&#46;25&#160;&#177;&#160;23&#46;336</td><td>91&#46;90&#160;&#177;&#160;20&#46;843</td><td>0&#46;770</td></tr><tr align="left"><td>FEF 50&#37; &#40;&#37;&#41;</td><td>88&#46;92&#160;&#177;&#160;35&#46;367</td><td>98&#46;25&#160;&#177;&#160;29&#46;963</td><td>0&#46;431</td></tr><tr align="left"><td>FEF 75&#37; &#40;&#37;&#41;</td><td>57&#46;17&#160;&#177;&#160;29&#46;634</td><td>67&#46;75&#160;&#177;&#160;24&#46;253</td><td>0&#46;280</td></tr><tr align="left"><td>FEF 25&#8211;75&#37; &#40;&#37;&#41;</td><td>77&#46;67&#160;&#177;&#160;30&#46;312</td><td>86&#46;46&#160;&#177;&#160;23&#46;676</td><td>0&#46;368</td></tr><tr align="left"><td>PEF &#40;&#37;&#41;</td><td>93&#160;&#177;&#160;20&#46;657</td><td>90&#46;45&#160;&#177;&#160;16&#46;011</td><td>0&#46;698</td></tr><tr align="left"><td>TLC &#40;&#37;&#41;</td><td>101&#46;47&#160;&#177;&#160;9&#46;09</td><td>105&#46;7&#160;&#177;&#160;15&#46;448</td><td>0&#46;391</td></tr><tr align="left"><td>RV &#40;&#37;&#41;</td><td>100&#46;67&#160;&#177;&#160;23&#46;153</td><td>90&#46;80&#160;&#177;&#160;29&#46;163</td><td>0&#46;327</td></tr><tr align="left"><td>RV&#47;TLC &#40;&#37;&#41;</td><td>31&#46;92&#160;&#177;&#160;7&#46;798</td><td>24&#46;90&#160;&#177;&#160;6&#46;357</td><td>0&#46;009</td></tr><tr align="left"><td>Raw &#40;L&#47;s&#47;cmH<span class="elsevierStyleInf">2</span>O&#41;</td><td>0&#46;205&#160;&#177;&#160;0&#46;05</td><td>0&#46;2674&#160;&#177;&#160;0&#46;1028</td><td>0&#46;061</td></tr><tr align="left"><td>sGaw &#40;cmH<span class="elsevierStyleInf">2</span>O&#47;L&#47;s&#41;</td><td>1&#46;2867&#160;&#177;&#160;0&#46;445</td><td>1&#46;121&#160;&#177;&#160;0&#46;565</td><td>0&#46;393</td></tr><tr align="left"><td>Cardiothoracic index</td><td>0&#46;45&#160;&#177;&#160;0&#46;03</td><td>0&#46;41&#160;&#177;&#160;0&#46;04</td><td>0&#46;056</td></tr></table><p class="elsevierStylePara">It was found that the mean age of the patients with tobacco-related pathologies was 48&#46;33 years &#40;SD&#160;&#61;&#160;10&#46;13 years&#41;&#44; which was higher than that of the group without pathologies &#40;39&#46;35 years&#44; SD&#160;&#61;&#160;10&#46;05 years&#41;&#44; with statistically significant differences between the two groups &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The mean duration of exposure to tobacco was higher in the subgroup with tobacco-related pathologies &#40;31&#46;08 years&#44; SD&#160;&#61;&#160;11&#46;12&#41;&#44; compared with the subgroup without pathologies &#40;22&#46;95 years&#44; SD&#160;&#61;&#160;11&#46;42&#41;&#44; although without statistical significance&#46;</p><p class="elsevierStylePara">With regard to the RV&#47;TLC ratio&#44; the cases with tobacco-related diseases had a higher mean &#40;31&#46;92&#37;&#44; SD&#160;&#61;&#160;7&#46;80&#37;&#41; compared with the subgroup without pathologies &#40;24&#46;90&#37;&#44; SD&#160;&#61;&#160;6&#46;36&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The cases with the tobacco-related pathologies &#40;12 cases&#41; had higher tobacco consumption and lower cotinine compared with the subgroup without pathologies but without statistically significant differences &#40;<span class="elsevierStyleItalic">p</span>&#160;&#62;&#160;0&#46;05&#41;&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">This study reflects a sample of asymptomatic smokers from the respiratory point of view&#44; with high tobacco consumption&#46; The age of onset of smoking was similar in both genders&#46; The female subjects who presented to the HSM smoking cessation program were younger than the male subjects &#40;mean age lower&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; Tobacco consumption&#44; mean duration of exposure to tobacco smoke&#44; and urinary cotinine levels of the female subjects were below in comparison with of the male subjects &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">There were reduced FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37;&#44; and cardiothoracic indices in cases and moderate inverse correlations between the TLC and cardiothoracic index&#44; with statistical significance&#46; The potential value of these variables was validated using the statistical significance found in the reduced sample&#46; At the time of our study&#44; 31&#46;2&#37; of the smokers showed extra-pulmonary pathologies related to tobacco consumption&#46; Three smokers &#40;9&#46;38&#37;&#41; were diagnosed with subclinical COPD&#46; Smokers with tobacco-related diseases had a higher mean age&#44; a lower FEV1&#44; and greater RV&#47;TLC compared with smokers without pathologies &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; These findings show individual susceptibility to the development of pulmonary disease in later life and&#47;or show a decline of pulmonary function by age&#59; this phenomenon was identified by Flecher&#46; There was no statistical significance in terms of smoking history&#44; mean duration of exposure to tobacco smoke&#44; and urinary cotinine&#46; This is determined by the homogeneity of the groups regarding tobacco consumption&#44; because all the included smokers presented with high tobacco consumption&#46;</p><p class="elsevierStylePara">As indicated in the previous studies&#44; the FEV1 and FEV1&#47;FVC ratio are not sensitive markers of early changes in lung pathophysiology or the emergence of COPD in smokers&#46; Structural and functional changes are present in the smoker&#39;s lungs before the onset of clinical signs of airway obstruction&#46; Thus&#44; the underdiagnosis of early functional changes in chronic smoking represents an opportunity for early intervention&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">Our sample reflects a population of smokers &#40;young adults without underlying lung pathologies&#41; with declining respiratory function parameters &#40;reduction of mean values of FEV1&#47;FVC&#44; FEF 75&#37; and FEF 25&#8211;75&#37;&#41; and lung hyperinflation compared with adult non-smokers in the same age group&#46; In smokers with a history of tobacco-related extra-pulmonary disease&#44; these changes may indicate pulmonary dysfunction at an early stage&#46; We need to know which subgroup of individual susceptibility factors confer greater propensity for the harmful effects of tobacco&#59; that is&#44; which subgroup indicates that systemic disease with multiple organ involvement in COPD occurs as a late manifestation of the disease&#63; The changes found in our study may reflect the premonitory signs of the progression to COPD at a later stage of disease in patients with extra-pulmonary pathologies related to tobacco&#46;</p><p class="elsevierStylePara">In conclusion&#44; smoking must be considered a disease which has potentially multisystemic repercussions&#46; The study of the subgroup of patients with previous extrapulmonary pathologies related to tobacco has particular relevance for the demonstration of a greater individual susceptibility to the development of pulmonary alterations in a later spectrum of the illness&#46; These findings show that a reduction of the mean values of FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index may be indicative variables for the precocious detection of these patients&#46;</p><p class="elsevierStylePara">This study has some limitations&#44; in particular&#44; the small sample size&#44; the inclusion of a lower number of female smokers than male smokers&#44; and the absence of evaluation of diffusing capacity for CO &#40;DLCO&#41;&#46;</p><p class="elsevierStylePara">With this preliminary study&#44; we have sought to increase awareness of the variables that should be included in a prospective study&#59; we intend to conduct future comparisons in the respiratory function variables and the cardiothoracic index of smokers before and after smoking cessation&#46; These studies will aim to assess the possible reversibility of the changes found after smoking cessation&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Acknowledgments</p><p class="elsevierStylePara">The authors of this study would like to thank all of their colleagues and the technicians at the Sousa Martins Hospital&#44; Local Health Unit&#44; Guarda who participated in this study&#46;</p><p class="elsevierStylePara">Received 15 March 2014 <br></br>Accepted 14 July 2014 </p><p class="elsevierStylePara">Corresponding author&#46; ritad&#95;gomes&#64;hotmail&#46;com</p>"
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            0 => "Smoking"
            1 => "Spirometry"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><br/><p class="elsevierStylePara">To investigate the respiratory function and lung hyperinflation in asymptomatic smokers without previous pulmonary pathology and with normal chest radiography&#46; To identify tobacco-related diseases and to correlate tobacco consumption&#44; duration of exposure to tobacco smoke and urinary cotinine with the existence of tobacco-related disease&#46;</p><span class="elsevierStyleSectionTitle">Material and methods</span><br/><p class="elsevierStylePara">Case-controlled study with pairing by sex&#44; age&#44; and body mass index&#46; Case definition&#58; smokers who presented to the first appointment of smoking cessation at the Hospital Sousa Martins &#40;HSM&#41; without respiratory symptoms and with normal chest radiography&#46; Definition of control&#58; users without current and&#47;or past tobacco exposition and with plethysmography and chest radiography at HSM within normal parameters&#46;</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">Reductions in FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index were detected in smokers and showed a moderated inverse correlation of TLC &#40;with statistical meaning&#41; compared with the control group&#46; Approximately 31&#46;2&#37; of the smokers showed extrapulmonary disease related to tobacco&#44; and 9&#46;38&#37; of the smokers exhibited subclinical chronic obstructive pulmonary disease &#40;COPD&#41;&#46; Smokers with tobacco-related diseases presented a mean age and RV&#47;TLC ratio superior to smokers without pathology&#46;</p><span class="elsevierStyleSectionTitle">Discussion</span><br/><p class="elsevierStylePara">The reduction of the mean values of FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index seems to indicate precocious pulmonary dysfunction&#46; This work aims to reveal the importance of detecting premonitory anomalies of pulmonary disease during the subclinical phase in patients at risk&#46; Smoking must be considered a factor of multisystemic repercussion&#59; thus&#44; intervention opportunities in this particular group must not be wasted&#46; This preliminary study identifies potentially promising variables with the aim of testing the hypothesis that there can be premonitory alterations in COPD&#44; according to its evolution versus reversibility after smoking cessation&#46; This work will be concluded in a future study&#46;</p>"
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Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers: Preliminary study
R.. Gomesa,
,b
, F.. Luísa,b, A.. Tavaresa,b, N.. Sousaa,b, S.. Correiaa,b, M.. Reisa
a Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal
b Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
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            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
            "correspondencia" => "Corresponding author. ritad_gomes@hotmail.com"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Smoking has devastating health effects and is a recognized risk factor for the development of cardiovascular&#44; cerebrovascular&#44; respiratory&#44; and oncological diseases&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> The Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; recommends the diagnosis of chronic obstructive pulmonary disease &#40;COPD&#41; based on a reduction in the FEV1&#47;FVC ratio&#46;<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> However&#44; this diagnostic criterion is valid only for advanced COPD&#44; leading to the underdiagnosis of early functional changes in chronic smoking&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> There are few studies concerning pulmonary function alterations in smokers and the deleterious effects of smoking on functional parameters vary&#44; depending on the studies&#46;</p><p class="elsevierStylePara">Cigarette smoking has a detrimental effect on the airways&#44; causing inflammation and&#44; consequently&#44; airflow limitations and lung hyperinflation&#46;<a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> In thoracic radiographs&#44; one sign of lung hyperinflation is the reduction in the cardiothoracic index &#40;&#8216;heart in gout&#8217;&#41;&#46; Some authors claim that a reduction in FEV1 is more than just a measure of airflow limitation&#44; that it is&#44; in fact&#44; a marker of premature death&#44; with a wideranging utility in assessing the risks of COPD&#44; lung cancer&#44; coronary artery disease&#44; and stroke&#44; which collectively account for 70&#8211;80&#37; of premature deaths in smokers&#46;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Some studies have encouraged the use of new methods in the detection of precursory anomalies of pulmonary disease during the subclinical phase in patients at risk&#46;</p><p class="elsevierStylePara">The authors present a case control study developed in outpatient clinic with the smoking cessation program at Sousa Martins Hospital &#40;HSM&#41;&#44; Local Health Unit&#44; Guarda &#40;Portugal&#41;&#46; The main objective of our study was to investigate the respiratory function and lung hyperinflation in asymptomatic smokers without a history of lung pathology and with normal chest radiographs&#46; Secondary objectives consisted of identifying tobacco-related diseases and correlating tobacco consumption&#44; duration of exposure to tobacco smoke&#44; and urinary cotinine with the existence of tobacco-related disease&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Materials and methods</span><p class="elsevierStylePara">The authors developed a case-controlled study paired by sex&#44; age and body mass index&#46; The cases were defined as smokers &#40;with a smoking habit for at least one year&#41;&#44; who presented for their first appointment at the smoking cessation program at HSM during the period of 11 December 2012 to 8 December 2013&#44; without respiratory symptoms and with normal chest radiographs&#46; Smoking subgroups were integrated using evidence of the history of tobacco-related pathology&#46; The exclusion criterion was applied to cases previously diagnosed with pulmonary pathology&#46;</p><p class="elsevierStylePara">The controls were participants who exhibited normal examination in plethysmography and chest radiographs in HSM&#46; The following exclusion criteria were applied to the controls&#58; known prior history of pulmonary pathology and current and&#47;or past smoking&#46; In the controls&#44; maximum passive exposure was assumed for the determination of carbon monoxide &#40;CO&#41; in the exhaled air &#40;0&#8211;6&#160;ppm&#41; and urinary cotinine &#40;&#60;150&#160;ng&#47;mL&#41;&#46;</p><p class="elsevierStylePara">The pulmonary function tests were performed using the Plethysmograph Autobox DI SensorMedics 6200 &#40;California&#44; USA&#41; at the Department of Pathophysiology of Respiratory Diseases at HSM&#46; The technical recommendations and standardized reference values of the American Thoracic Society were used to perform the functional tests&#46; A chest X-ray was obtained while the patient was in the standing and forward positions at maximal inspiration&#44; which complies with the criteria for good technical quality&#46; The ratio between the maximum transverse diameter of the heart and the maximum internal diameter of the chest &#40;the calculation of the cardiothoracic index&#41; was determined&#46; A normal thoracic radiograph was considered to be one without pleuroparenchymal alterations and with a cardiothoracic index below 0&#46;5&#46;</p><p class="elsevierStylePara">As a biomarker of current smoking&#44; a determination of the CO in the exhaled air was used&#46; Cotinine in the urine was used as a marker for the cumulative consumption of tobacco intake&#46; The measurement of the CO in the exhaled air was performed during the consultation period of smoking cessation in the Micro Medical smoke check &#40;Kent&#44; England&#41;&#46; Assays were stratified into the following CO levels&#58; 0&#8211;6&#160;ppm&#44; green&#160;&#61;&#160;no smoking&#59; 7&#8211;10&#160;ppm&#44; yellow&#160;&#61;&#160;light smoker&#59; 11&#8211;20&#160;ppm&#44; red&#160;&#61;&#160;strong smoker&#59; and &#62;20&#160;ppm&#44; red with beep&#160;&#61;&#160;very strong smoker&#46; The assay of urinary cotinine was executed using gas&#47;mass spectrophotometry chromatography&#46; The assays of urinary cotinine were stratified as follows&#58; &#60;150&#160;ng&#47;mL&#160;&#61;&#160;passive smoking&#59; 150&#8211;499&#160;ng&#47;mL&#160;&#61;&#160;light smoker&#59; 500&#8211;2500&#160;ng&#47;mL&#160;&#61;&#160;moderate smoker&#59; and &#62;2500&#160;ng&#47;mL&#160;&#61;&#160;strong smoker&#46;</p><p class="elsevierStylePara">The criteria for hyperinflation included the presence of either a reduction in the cardiothoracic index or an increase in RV&#47;TLC measured using plethysmography&#46; The minimum value of the cardiothoracic index that defines hyperinflation is not yet clearly established in the literature&#46;</p><p class="elsevierStylePara">Statistical analyses were performed using IBM SPSS Statistics software 19<span class="elsevierStyleSup">&#174;</span>&#46; Exploratory and descriptive analyses were applied to the variables&#44; and in the continuous variables&#44; such as the <span class="elsevierStyleItalic">T</span>-test &#40;2 groups&#41; and the Pearson correlation coefficient&#46; The level of significance was set at <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46;</p><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">During the study period&#44; 64 subject samples were obtained&#58; 32 cases and 32 controls&#46; The 32 cases included smokers in the smoking cessation program at HSM&#58; 65&#46;6&#37; were male&#44; and 34&#46;4&#37; were female&#46; The mean age of male subjects was 45&#46;57 years&#44; and that of female subjects was 37&#46;27 years&#46; There were statistically significant differences between the groups &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The controls included 32 non-smoking individuals&#44; matched with cases by sex&#44; age&#44; and body mass index&#46; The lung function tests were performed at the Division of Respiratory Pathophysiology&#44; HSM&#46; <a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#44; <a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a> characterize the cases by gender in terms of age at onset of smoking&#44; tobacco consumption&#44; urinary cotinine assay&#44; and CO in exhaled air&#46;</p><p class="elsevierStylePara">Table 1&#46; Characteristics of smokers by gender&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Variables</td><td colspan="4">Smokers &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;</td></tr><tr align="left"><td>&#160;</td><td>Male subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;21&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Female subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;11&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Total<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td><span class="elsevierStyleItalic">T</span> test<br></br>&#40;<span class="elsevierStyleItalic">p</span> value&#41;</td></tr><tr align="left"><td>Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;</td><td>26&#46;45&#160;&#177;&#160;4&#46;17</td><td>25&#46;06&#160;&#177;&#160;5&#46;02</td><td>25&#46;97&#160;&#177;&#160;4&#46;45</td><td>0&#46;41</td></tr><tr align="left"><td>Age &#40;years&#41;</td><td>45&#46;57&#160;&#177;&#160;11&#46;63</td><td>37&#46;27&#160;&#177;&#160;6&#46;74</td><td>42&#46;72&#160;&#177;&#160;10&#46;86</td><td>0&#46;038</td></tr><tr align="left"><td>Age of smoking initiation &#40;years&#41;</td><td>16&#46;67&#160;&#177;&#160;4&#46;73</td><td>16&#46;83&#160;&#177;&#160;3&#46;66</td><td>16&#46;72&#160;&#177;&#160;4&#46;33</td><td>0&#46;927</td></tr><tr align="left"><td>Tobacco consumption &#40;packs per year&#41;</td><td>30&#46;33&#160;&#177;&#160;14&#46;46</td><td>12&#46;73&#160;&#177;&#160;5&#46;26</td><td>24&#46;28&#160;&#177;&#160;14&#46;69</td><td>2&#46;91&#160;&#215;&#160;10<span class="elsevierStyleSup">&#8722;5</span></td></tr><tr align="left"><td>Urinary cotinine &#40;ng&#47;mL&#41;</td><td>1315&#46;33&#160;&#177;&#160;895&#46;45</td><td>699&#46;91&#160;&#177;&#160;465&#46;00</td><td>1103&#46;78&#160;&#177;&#160;821&#46;74</td><td>0&#46;042</td></tr></table><p class="elsevierStylePara">Table 2&#46; Determination of CO in exhaled air in smokers by gender&#46;</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Determination of CO in exhaled air &#40;ppm&#41;</td><td colspan="3">Smokers &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;</td></tr><tr align="left"><td>&#160;</td><td>Male subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;21&#41;<br></br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</td><td>Female subjects<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;11&#41;<br></br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</td><td>Total<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</td></tr><tr align="left"><td>0&#8211;6&#160;&#61;&#160;&#8216;non-smoker&#8217;</td><td>0 &#40;0&#37;&#41;</td><td>0 &#40;0&#37;&#41;</td><td>0 &#40;0&#37;&#41;</td></tr><tr align="left"><td>7&#8211;10&#160;&#61;&#160;&#8216;light smoker&#8217;</td><td>0 &#40;0&#37;&#41;</td><td>1 &#40;9&#46;09&#37;&#41;</td><td>1 &#40;3&#46;13&#37;&#41;</td></tr><tr align="left"><td>11&#8211;20&#160;&#61;&#160;&#8216;strong smoker&#8217;</td><td>10 &#40;47&#46;62&#37;&#41;</td><td>8 &#40;72&#46;73&#37;&#41;</td><td>18 &#40;56&#46;25&#37;</td></tr><tr align="left"><td>&#62;20&#160;&#61;&#160;&#8216;very strong smoker&#8217;</td><td>11 &#40;52&#46;38&#37;&#41;</td><td>2 &#40;18&#46;18&#37;&#41;</td><td>13 &#40;40&#46;63&#37;&#41;</td></tr></table><p class="elsevierStylePara">It was found that the age of onset of smoking was similar in both genders&#46; Female smokers had a mean tobacco consumption &#40;12&#46;73 packs per year&#41; and mean cotinine &#40;699&#46;91&#160;ng&#47;mL&#41;&#44; which was lower than that of the male subjects &#40;30&#46;33 packs per year and 1315&#46;33&#160;ng&#47;mL&#41;&#44; with statistical significance &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; With regard to CO in exhaled air&#44; 84&#46;62&#37; of the male subjects were considered to be strong smokers vs&#46; 15&#46;38&#37; of the female subjects&#46; The mean duration of exposure to smoking in male subjects was 28&#46;9 years and 20&#46;45 years for female subjects&#44; with statistically significant differences &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">There was a weak correlation between urinary cotinine and tobacco consumption &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;124&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;5&#41;&#46;</p><p class="elsevierStylePara">A review of the cases and controls using plethysmography is shown in <a href="&#35;t0015" class="elsevierStyleCrossRefs">Table 3</a>&#46; In the cases identified&#44; 9&#46;38&#37; &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3&#41; of the smokers exhibited spirometric COPD criteria&#58; mean FEV1&#47;FVC 65&#37; and mean FEV1 89&#37;&#46; The mean FEV1&#47;FVC of the cases was 77&#46;78&#37; &#40;standard deviation &#91;SD&#93;&#160;&#61;&#160;6&#46;50&#37;&#41;&#44; with 81&#46;41&#37; in the controls &#40;SD&#160;&#61;&#160;5&#46;84&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46; The means of the FEF 75&#37; and FEF 25&#8211;75&#37; were also lower&#46; The mean FEF 75&#37; was 63&#46;78&#37; &#40;SD&#160;&#61;&#160;26&#46;44&#37;&#41; in the cases and 86&#46;09&#37; in the controls &#40;SD&#160;&#61;&#160;28&#46;99&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46; The mean FEF 25&#8211;75&#37; in the cases was 83&#46;16&#37; &#40;SD&#160;&#61;&#160;26&#46;44&#37;&#41; and 97&#46;19&#37; &#40;SD&#160;&#61;&#160;23&#46;82&#41; in the controls &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The reduction was greater in the FEF 75&#37; and FEF 25&#8211;75&#37; parameters&#46;</p><p class="elsevierStylePara">Table 3&#46; Evaluation by plethysmography of smokers and controls&#46;</p><a name="t0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Respiratory function tests</td><td>Smokers<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Controls<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;32&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td><span class="elsevierStyleItalic">T</span> test<br></br>&#40;<span class="elsevierStyleItalic">p</span> value&#41;</td></tr><tr align="left"><td>FVC &#40;&#37;&#41;</td><td>110&#46;34&#160;&#177;&#160;13&#46;49</td><td>108&#46;84&#160;&#177;&#160;14&#46;87</td><td>0&#46;674</td></tr><tr align="left"><td>FEV1 &#40;&#37;&#41;</td><td>102&#46;78&#160;&#177;&#160;12&#46;06</td><td>106&#46;13&#160;&#177;&#160;12&#46;96</td><td>0&#46;289</td></tr><tr align="left"><td>FEV1&#47;FVC &#40;&#37;&#41;</td><td>77&#46;88&#160;&#177;&#160;6&#46;50</td><td>81&#46;41&#160;&#177;&#160;5&#46;84</td><td>0&#46;026</td></tr><tr align="left"><td>FEF 25&#37; &#40;&#37;&#41;</td><td>92&#46;78&#160;&#177;&#160;21&#46;47</td><td>88&#46;91&#160;&#177;&#160;17&#46;44</td><td>0&#46;431</td></tr><tr align="left"><td>FEF 50&#37; &#40;&#37;&#41;</td><td>94&#46;75&#160;&#177;&#160;31&#46;86</td><td>105&#46;34&#160;&#177;&#160;26&#46;61</td><td>0&#46;154</td></tr><tr align="left"><td>FEF 75&#37; &#40;&#37;&#41;</td><td>63&#46;78&#160;&#177;&#160;26&#46;44</td><td>86&#46;09&#160;&#177;&#160;28&#46;99</td><td>0&#46;002</td></tr><tr align="left"><td>FEF 25&#8211;75&#37; &#40;&#37;&#41;</td><td>83&#46;16&#160;&#177;&#160;26&#46;44</td><td>97&#46;19&#160;&#177;&#160;23&#46;82</td><td>0&#46;029</td></tr><tr align="left"><td>PEF &#40;&#37;&#41;</td><td>91&#46;41&#160;&#177;&#160;17&#46;61</td><td>87&#46;59&#160;&#177;&#160;16&#46;79</td><td>0&#46;379</td></tr><tr align="left"><td>TLC &#40;&#37;&#41;</td><td>104&#46;09&#160;&#177;&#160;13&#46;42</td><td>100&#46;16&#160;&#177;&#160;12&#46;79</td><td>0&#46;234</td></tr><tr align="left"><td>RV &#40;&#37;&#41;</td><td>94&#46;5&#160;&#177;&#160;27&#46;11</td><td>88&#46;97&#160;&#177;&#160;19&#46;88</td><td>0&#46;356</td></tr><tr align="left"><td>RV&#47;TLC &#40;&#37;&#41;</td><td>27&#46;53&#160;&#177;&#160;7&#46;63</td><td>27&#46;81&#160;&#177;&#160;6&#46;00</td><td>0&#46;870</td></tr><tr align="left"><td>Airway resistance &#8211; raw &#40;L&#47;s&#47;cmH<span class="elsevierStyleInf">2</span>O&#41;</td><td>0&#46;2440&#160;&#177;&#160;0&#46;091</td><td>0&#46;2615&#160;&#177;&#160;0&#46;120</td><td>0&#46;513</td></tr><tr align="left"><td rowspan="2">Specific airway conductance &#8211; sGaw &#40;cmH<span class="elsevierStyleInf">2</span>O&#47;L&#47;s&#41;</td><td>&#9794;&#160;1&#46;122&#160;&#177;&#160;0&#46;564</td><td>&#9794;&#160;1&#46;1057&#160;&#177;&#160;0&#46;477</td><td>&#9794;&#160;0&#46;920</td></tr><tr align="left"><td>&#9792;&#160;1&#46;300&#160;&#177;&#160;0&#46;4306</td><td>&#9792;&#160;1&#46;543&#160;&#177;&#160;0&#46;640</td><td>&#9792;&#160;0&#46;309</td></tr></table><p class="elsevierStylePara">The reductions in FEV1&#47;FVC&#44; FEF 75&#37; and FEF 25&#8211;75&#37; were correlated inversely with tobacco consumption&#44; but this was not statistically significant &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;305 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;089&#44; <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;203 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;265&#44; <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;15 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;391&#44; respectively&#41;&#46;</p><p class="elsevierStylePara">Regarding the assessment of the cardiothoracic index&#44; the mean was 0&#46;424 &#40;SD&#160;&#61;&#160;0&#46;04&#41; in the cases and 0&#46;458 &#40;SD&#160;&#61;&#160;0&#46;04&#41; in the controls&#44; with a statistically significant difference &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; A moderate correlation between the cardiothoracic index and TLC was found in the cases &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;371&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">Approximately 31&#46;2&#37; &#40;10&#41; of the cases had a history of extra-pulmonary pathology associated with tobacco&#58; 21&#46;88&#37; &#40;seven patients&#41; had hypertension&#44; 6&#46;25&#37; &#40;two cases&#41; had stroke&#44; 3&#46;13&#37; &#40;one case&#41; had acute myocardial infarction and 3&#46;13&#37; &#40;one case&#41; had repeated miscarriages&#46; 9&#46;38&#37; &#40;three smokers&#41; were diagnosed with COPD&#46; In 68&#46;8&#37; &#40;22 smokers&#41;&#44; there was no history of tobacco-related disease&#46; <a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a> shows the comparison of the cases in subgroups&#44; with and without tobacco-related disease&#44; in relation to age&#44; age at smoking onset&#44; tobacco consumption&#44; duration of tobacco exposure&#44; urinary cotinine assay&#44; plethysmography variables&#44; and cardiothoracic index&#46; In relation to the distribution by gender in these two subgroups&#44; it was verified that among the smokers with tobacco-related pathology &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;12&#41;&#44; eight were male and six were female&#59; among smokers without tobacco-related pathology &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;20&#41;&#44; 13 were male and seven were female&#46;</p><p class="elsevierStylePara">Table 4&#46; Analysis of subgroups of smokers with and without tobacco-related pathology&#46;</p><a name="t0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Variables</td><td>Smokers with tobacco-related pathology and COPD<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;12&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td>Smokers without tobacco-related pathology<br></br>&#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;20&#41;<br></br>Mean&#160;&#177;&#160;standard deviation</td><td><span class="elsevierStyleItalic">T</span> test<br></br>&#40;<span class="elsevierStyleItalic">p</span> value&#41;</td></tr><tr align="left"><td>Age &#40;years&#41;</td><td>48&#46;33&#160;&#177;&#160;10&#46;13</td><td>39&#46;35&#160;&#177;&#160;10&#46;05</td><td>0&#46;021</td></tr><tr align="left"><td>Age of smoking initiation &#40;years&#41;</td><td>17&#46;25&#160;&#177;&#160;4&#46;07</td><td>16&#46;40&#160;&#177;&#160;4&#46;55</td><td>0&#46;599</td></tr><tr align="left"><td>Tobacco consumption &#40;packs per year&#41;</td><td>27&#46;75&#160;&#177;&#160;14&#46;22</td><td>22&#46;20&#160;&#177;&#160;14&#46;93</td><td>0&#46;309</td></tr><tr align="left"><td>Tobacco exposure time &#40;years&#41;</td><td>31&#46;08&#160;&#177;&#160;11&#46;147</td><td>22&#46;95&#160;&#177;&#160;11&#46;422</td><td>0&#46;058</td></tr><tr align="left"><td>Urinary cotinine &#40;ng&#47;mL&#41;</td><td>1075&#160;&#177;&#160;979&#46;72</td><td>1121&#46;05&#160;&#177;&#160;738&#46;37</td><td>0&#46;881</td></tr><tr align="left"><td>FVC &#40;&#37;&#41;</td><td>106&#46;33&#160;&#177;&#160;10&#46;47</td><td>112&#46;75&#160;&#177;&#160;14&#46;73</td><td>0&#46;197</td></tr><tr align="left"><td>FEV1 &#40;&#37;&#41;</td><td>97&#46;17&#160;&#177;&#160;7&#46;41</td><td>106&#46;15&#160;&#177;&#160;13&#46;176</td><td>0&#46;039</td></tr><tr align="left"><td>FEV1&#47;FVC &#40;&#37;&#41;</td><td>76&#46;08&#160;&#177;&#160;8&#46;607</td><td>78&#46;95&#160;&#177;&#160;4&#46;774</td><td>0&#46;306</td></tr><tr align="left"><td>FEF 25&#37; &#40;&#37;&#41;</td><td>94&#46;25&#160;&#177;&#160;23&#46;336</td><td>91&#46;90&#160;&#177;&#160;20&#46;843</td><td>0&#46;770</td></tr><tr align="left"><td>FEF 50&#37; &#40;&#37;&#41;</td><td>88&#46;92&#160;&#177;&#160;35&#46;367</td><td>98&#46;25&#160;&#177;&#160;29&#46;963</td><td>0&#46;431</td></tr><tr align="left"><td>FEF 75&#37; &#40;&#37;&#41;</td><td>57&#46;17&#160;&#177;&#160;29&#46;634</td><td>67&#46;75&#160;&#177;&#160;24&#46;253</td><td>0&#46;280</td></tr><tr align="left"><td>FEF 25&#8211;75&#37; &#40;&#37;&#41;</td><td>77&#46;67&#160;&#177;&#160;30&#46;312</td><td>86&#46;46&#160;&#177;&#160;23&#46;676</td><td>0&#46;368</td></tr><tr align="left"><td>PEF &#40;&#37;&#41;</td><td>93&#160;&#177;&#160;20&#46;657</td><td>90&#46;45&#160;&#177;&#160;16&#46;011</td><td>0&#46;698</td></tr><tr align="left"><td>TLC &#40;&#37;&#41;</td><td>101&#46;47&#160;&#177;&#160;9&#46;09</td><td>105&#46;7&#160;&#177;&#160;15&#46;448</td><td>0&#46;391</td></tr><tr align="left"><td>RV &#40;&#37;&#41;</td><td>100&#46;67&#160;&#177;&#160;23&#46;153</td><td>90&#46;80&#160;&#177;&#160;29&#46;163</td><td>0&#46;327</td></tr><tr align="left"><td>RV&#47;TLC &#40;&#37;&#41;</td><td>31&#46;92&#160;&#177;&#160;7&#46;798</td><td>24&#46;90&#160;&#177;&#160;6&#46;357</td><td>0&#46;009</td></tr><tr align="left"><td>Raw &#40;L&#47;s&#47;cmH<span class="elsevierStyleInf">2</span>O&#41;</td><td>0&#46;205&#160;&#177;&#160;0&#46;05</td><td>0&#46;2674&#160;&#177;&#160;0&#46;1028</td><td>0&#46;061</td></tr><tr align="left"><td>sGaw &#40;cmH<span class="elsevierStyleInf">2</span>O&#47;L&#47;s&#41;</td><td>1&#46;2867&#160;&#177;&#160;0&#46;445</td><td>1&#46;121&#160;&#177;&#160;0&#46;565</td><td>0&#46;393</td></tr><tr align="left"><td>Cardiothoracic index</td><td>0&#46;45&#160;&#177;&#160;0&#46;03</td><td>0&#46;41&#160;&#177;&#160;0&#46;04</td><td>0&#46;056</td></tr></table><p class="elsevierStylePara">It was found that the mean age of the patients with tobacco-related pathologies was 48&#46;33 years &#40;SD&#160;&#61;&#160;10&#46;13 years&#41;&#44; which was higher than that of the group without pathologies &#40;39&#46;35 years&#44; SD&#160;&#61;&#160;10&#46;05 years&#41;&#44; with statistically significant differences between the two groups &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The mean duration of exposure to tobacco was higher in the subgroup with tobacco-related pathologies &#40;31&#46;08 years&#44; SD&#160;&#61;&#160;11&#46;12&#41;&#44; compared with the subgroup without pathologies &#40;22&#46;95 years&#44; SD&#160;&#61;&#160;11&#46;42&#41;&#44; although without statistical significance&#46;</p><p class="elsevierStylePara">With regard to the RV&#47;TLC ratio&#44; the cases with tobacco-related diseases had a higher mean &#40;31&#46;92&#37;&#44; SD&#160;&#61;&#160;7&#46;80&#37;&#41; compared with the subgroup without pathologies &#40;24&#46;90&#37;&#44; SD&#160;&#61;&#160;6&#46;36&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; The cases with the tobacco-related pathologies &#40;12 cases&#41; had higher tobacco consumption and lower cotinine compared with the subgroup without pathologies but without statistically significant differences &#40;<span class="elsevierStyleItalic">p</span>&#160;&#62;&#160;0&#46;05&#41;&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">This study reflects a sample of asymptomatic smokers from the respiratory point of view&#44; with high tobacco consumption&#46; The age of onset of smoking was similar in both genders&#46; The female subjects who presented to the HSM smoking cessation program were younger than the male subjects &#40;mean age lower&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; Tobacco consumption&#44; mean duration of exposure to tobacco smoke&#44; and urinary cotinine levels of the female subjects were below in comparison with of the male subjects &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">There were reduced FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37;&#44; and cardiothoracic indices in cases and moderate inverse correlations between the TLC and cardiothoracic index&#44; with statistical significance&#46; The potential value of these variables was validated using the statistical significance found in the reduced sample&#46; At the time of our study&#44; 31&#46;2&#37; of the smokers showed extra-pulmonary pathologies related to tobacco consumption&#46; Three smokers &#40;9&#46;38&#37;&#41; were diagnosed with subclinical COPD&#46; Smokers with tobacco-related diseases had a higher mean age&#44; a lower FEV1&#44; and greater RV&#47;TLC compared with smokers without pathologies &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; These findings show individual susceptibility to the development of pulmonary disease in later life and&#47;or show a decline of pulmonary function by age&#59; this phenomenon was identified by Flecher&#46; There was no statistical significance in terms of smoking history&#44; mean duration of exposure to tobacco smoke&#44; and urinary cotinine&#46; This is determined by the homogeneity of the groups regarding tobacco consumption&#44; because all the included smokers presented with high tobacco consumption&#46;</p><p class="elsevierStylePara">As indicated in the previous studies&#44; the FEV1 and FEV1&#47;FVC ratio are not sensitive markers of early changes in lung pathophysiology or the emergence of COPD in smokers&#46; Structural and functional changes are present in the smoker&#39;s lungs before the onset of clinical signs of airway obstruction&#46; Thus&#44; the underdiagnosis of early functional changes in chronic smoking represents an opportunity for early intervention&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">Our sample reflects a population of smokers &#40;young adults without underlying lung pathologies&#41; with declining respiratory function parameters &#40;reduction of mean values of FEV1&#47;FVC&#44; FEF 75&#37; and FEF 25&#8211;75&#37;&#41; and lung hyperinflation compared with adult non-smokers in the same age group&#46; In smokers with a history of tobacco-related extra-pulmonary disease&#44; these changes may indicate pulmonary dysfunction at an early stage&#46; We need to know which subgroup of individual susceptibility factors confer greater propensity for the harmful effects of tobacco&#59; that is&#44; which subgroup indicates that systemic disease with multiple organ involvement in COPD occurs as a late manifestation of the disease&#63; The changes found in our study may reflect the premonitory signs of the progression to COPD at a later stage of disease in patients with extra-pulmonary pathologies related to tobacco&#46;</p><p class="elsevierStylePara">In conclusion&#44; smoking must be considered a disease which has potentially multisystemic repercussions&#46; The study of the subgroup of patients with previous extrapulmonary pathologies related to tobacco has particular relevance for the demonstration of a greater individual susceptibility to the development of pulmonary alterations in a later spectrum of the illness&#46; These findings show that a reduction of the mean values of FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index may be indicative variables for the precocious detection of these patients&#46;</p><p class="elsevierStylePara">This study has some limitations&#44; in particular&#44; the small sample size&#44; the inclusion of a lower number of female smokers than male smokers&#44; and the absence of evaluation of diffusing capacity for CO &#40;DLCO&#41;&#46;</p><p class="elsevierStylePara">With this preliminary study&#44; we have sought to increase awareness of the variables that should be included in a prospective study&#59; we intend to conduct future comparisons in the respiratory function variables and the cardiothoracic index of smokers before and after smoking cessation&#46; These studies will aim to assess the possible reversibility of the changes found after smoking cessation&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Acknowledgments</p><p class="elsevierStylePara">The authors of this study would like to thank all of their colleagues and the technicians at the Sousa Martins Hospital&#44; Local Health Unit&#44; Guarda who participated in this study&#46;</p><p class="elsevierStylePara">Received 15 March 2014 <br></br>Accepted 14 July 2014 </p><p class="elsevierStylePara">Corresponding author&#46; ritad&#95;gomes&#64;hotmail&#46;com</p>"
    "pdfFichero" => "320v21n03a90418839pdf001.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec640984"
          "palabras" => array:6 [
            0 => "Smoking"
            1 => "Spirometry"
            2 => "Plethysmography"
            3 => "Cotinine"
            4 => "Radiography"
            5 => "Thoracic"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><br/><p class="elsevierStylePara">To investigate the respiratory function and lung hyperinflation in asymptomatic smokers without previous pulmonary pathology and with normal chest radiography&#46; To identify tobacco-related diseases and to correlate tobacco consumption&#44; duration of exposure to tobacco smoke and urinary cotinine with the existence of tobacco-related disease&#46;</p><span class="elsevierStyleSectionTitle">Material and methods</span><br/><p class="elsevierStylePara">Case-controlled study with pairing by sex&#44; age&#44; and body mass index&#46; Case definition&#58; smokers who presented to the first appointment of smoking cessation at the Hospital Sousa Martins &#40;HSM&#41; without respiratory symptoms and with normal chest radiography&#46; Definition of control&#58; users without current and&#47;or past tobacco exposition and with plethysmography and chest radiography at HSM within normal parameters&#46;</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">Reductions in FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index were detected in smokers and showed a moderated inverse correlation of TLC &#40;with statistical meaning&#41; compared with the control group&#46; Approximately 31&#46;2&#37; of the smokers showed extrapulmonary disease related to tobacco&#44; and 9&#46;38&#37; of the smokers exhibited subclinical chronic obstructive pulmonary disease &#40;COPD&#41;&#46; Smokers with tobacco-related diseases presented a mean age and RV&#47;TLC ratio superior to smokers without pathology&#46;</p><span class="elsevierStyleSectionTitle">Discussion</span><br/><p class="elsevierStylePara">The reduction of the mean values of FEV1&#47;FVC&#44; FEF 75&#37;&#44; FEF 25&#8211;75&#37; and the cardiothoracic index seems to indicate precocious pulmonary dysfunction&#46; This work aims to reveal the importance of detecting premonitory anomalies of pulmonary disease during the subclinical phase in patients at risk&#46; Smoking must be considered a factor of multisystemic repercussion&#59; thus&#44; intervention opportunities in this particular group must not be wasted&#46; This preliminary study identifies potentially promising variables with the aim of testing the hypothesis that there can be premonitory alterations in COPD&#44; according to its evolution versus reversibility after smoking cessation&#46; This work will be concluded in a future study&#46;</p>"
      ]
    ]
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Article information
ISSN: 08732159
Original language: English
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