Cessação Tabágica e Ganho Ponderal: Linhas de Orientação

Fumar é a primeira causa evitável de doença, incapacidade e morte prematura nos países desenvolvidos, estando associada a seis das oito primeiras causas de morte a nível mundial. Em 2010, o consumo de tabaco foi responsável, em Portugal, pela morte de cerca de 11 000 pessoas fumadoras ou ex-fumadoras, causadas por doenças respiratórias, cancro ou doenças do aparelho cardiovascular. Os indivíduos que cessam os hábitos tabágicos antes dos 50 anos têm metade do risco de morrer nos 15 anos seguintes. Deixar de fumar diminui o risco de desenvolver doenças cardiovasculares e doenças respiratórias, bem como inúmeros tipos de cancro. Ao longo do processo da cessação tabágica, cujo sucesso passa pelo acompanhamento de uma equipa multidisciplinar, a vontade de comer e de ingerir alimentos particularmente ricos em energia é frequente, bem como o aumento de peso. Este último é citado frequentemente como o principal motivo para a relutância em parar de fumar e recaída depois da cessação, especialmente nos fumadores que apresentam preocupações com o seu peso. Contudo, é hoje consensual que os benefícios da cessação do consumo de tabaco superam eventuais riscos que esta possa apresentar. De forma a promover um consumo alimentar adequado durante a cessação tabágica, fazem-se diversas recomendações, baseadas na evidência científica mais recente, facilitando a adesão terapêutica e a continuação do processo e reduzindo o risco do aumento de peso corporal.

COPD control: Can a consensus be found?

There are currently no reliable instruments for assessing the onset and progression of chronic obstructive pulmonary disease (COPD) or predicting its prognosis. Currently, a comprehensive assessment of COPD including several objective and subjective parameters is recommended. However, the lack of biomarkers precludes a correct assessment of COPD severity, which consequently hampers adequate therapeutic approaches and COPD control. In the absence of a definition of "well-controlled disease", a consensus regarding COPD control will be difficult to reach. However, COPD patient assessment should be multidimensional, and anchored in five points: control of symptoms, decline of pulmonary function, levels of physical activity, exacerbations, and Quality of Life. Several non-pharmacological and pharmacological measures are currently available to achieve disease control. Smoking cessation, vaccination, exercise training programs and pulmonary rehabilitation are recognized as important non-pharmacological measures but bronchodilators are the pivotal therapy in the control of COPD. This paper discusses several objective and subjective parameters that may bridge the gap between disease assessment and disease control. The authors conclude that, at present, it is not possible to reach a consensus regarding COPD control, essentially due to the lack of objective instruments to measure it. Some recommendations are set forth, but true COPD control awaits further objective assessments.

Equity-focused health impact assessment of Portuguese tobacco control legislation

The World Health Organization recommend the Equity-Focused Health Impact Assessment (HIA) as a means to assess the impact of social and economic policies on the health of populations, and acknowledges their contribution to health inequality. We describe the application of the Equity-focusedImpact Assessment methodology on the Portuguese law on Smoking Prevention and Tobacco Control (Law No. 37/2007). A rapid assessment was carried out to issue recommendations which could be incorporated into the law during a revision in 2014. Quantitative (consumption and health status indicators; equity analysis) and qualitative (Focus Group) approaches were taken to evaluate the impact of the law and formulate recommendations. Young people, men and women of low socioeconomic status, and pregnant women were identified as requiring specific and appropriate interventions to prevent smoking and support smoking cessation.