The Finnish National Programme for Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) 1998-2007 was set up to reduce the prevalence of COPD, improve COPD diagnosis and care, reduce the number of moderate to severe cases of the disease, and reduce hospitalisations and treatment costs due to COPD. Over 900 events for 25,000 participating healthcare workers were arranged. The major strengths of this programme included multidisciplinary strategies and web-based guidelines in nearly all primary health care centres around the country.
Data from national registries, epidemiological studies and questionnaires were used to measure whether the goals had been reached.
The prevalence of COPD remained unchanged. Smoking decreased in males from 30% to 26% (p
Comment In: Prim Care Respir J. 2011 Jun;20(2):109-1021603847
KL-6 is a high-molecular-weight glycoprotein classified as a human MUC1 mucin. It was hypothesized that KL-6 could be detectable in the circulating blood and especially in airway secretions in lung diseases associated with mucus production such as chronic obstructive pulmonary disease (COPD). Additional aims of this study were to investigate whether the levels of KL-6 in plasma and sputum are related to ageing and smoking history.
The concentrations of KL-6 in plasma and induced sputum supernatants from young and/or middle aged/elderly non-smokers, smokers and patients with COPD were assayed by ELISA (n = 201). The subjects were classified into five groups according to age, smoking status and presence of COPD. In addition, KL-6 expression in control and diseased lung i.e. samples from patients with COPD (n = 28), were analyzed by immunohistochemistry and digital image analysis.
The plasma levels of KL-6 increased with age both in non-smokers and smokers. Among middle aged/elderly subjects, plasma KL-6 levels in all smokers regardless of COPD were significantly higher than in non-smokers, whereas sputum levels of KL-6 were significantly higher in COPD compared not only to non-smokers but also to smokers. KL-6 was more prominently expressed in the bronchiolar/alveolar epithelium in COPD than in the control lungs. Plasma and sputum KL-6 levels correlated inversely with obstruction and positively with smoking history and ageing. The linear multiple regression analysis confirmed that age and cigarette smoking had independent effects on plasma KL-6.
KL-6 increases with ageing and chronic smoking history, but prospective studies will be needed to elucidate the significance of KL-6 in chronic airway diseases.
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Our aim was to study the role of oxidant and nitric oxide (NO)-derived damage in human breast carcinomas by studying the expression of nitrotyrosine in tumor tissue. To elucidate whether nitrotyrosine levels associate with NO synthesis and have an effect on antioxidative enzyme response or angiogenesis, we also studied the expression of all three nitric oxide synthases (NOS), manganese superoxide dismutase (MnSOD), catalase and vascular endothelial growth factor (VEGF) in the tumors. A large set of breast cancer samples in microarray blocks were stained with antibodies to nitrotyrosine, iNOS, eNOS, nNOS, MnSOD, catalase and VEGF. Nitrotyrosine expression was seen in 56% of the cases. There was a close relationship between the expression of nitrotyrosine and all three NOS isoforms (for all p
AIMS: Relatively little is known about the attitudes of young people to restrictions on smoking in public places and to environmental second-hand smoke in housing estates. The objective was to explore the attitudes of young male adults after the new smoke-free legislation was implemented in Finland. METHODS: A survey of 1167 Finnish male military conscripts was performed. The main outcome variables were their attitudes to the new restrictions on smoking in public places and concerns about second-hand smoke in the home originating from their neighbours. RESULTS: Almost half of the youths (43.5%) reported that they supported the more restrictive smoking regulations, with 44.8% having a neutral view. Only 16.0% of the respondents were irritated about the second-hand smoke entering to their house from outside and 48.6% were not concerned about smoking in their neighbourhood. A total of 555 (47.6%) conscripts were current smokers. Current smokers were more often totally opposed to the legislation and had less negative views about the exposure to second-hand smoke than non-smokers. Strong nicotine dependence increased the feelings of anxiety and stigmatisation when the new restrictions were introduced. CONCLUSIONS: Finnish young men do accept new smoking restrictions. However, smoking with high nicotine dependence was surprisingly common among these young men and the negative attitude to the legislation can be traced to this group of smokers. The repulsion felt towards second-hand smoke by non-smokers represents an opportunity for public health initiatives to guarantee a smoke-free environment in public and private places.
Given that the assessment of health-related quality of life (HRQoL) is an essential outcome measure to optimize chronic obstructive pulmonary disease (COPD) patient management, there is a need for a short and fast, reliable and valid instrument for routine use in clinical practice. The objective of this study was to analyse the relationship between the disease-specific Airways questionnaire (AQ20) and the generic 15D health-related quality of life (HRQoL) instrument simultaneously in a large cohort of patients with COPD. We also compare the HRQoL of COPD patients with that of the general population.
The AQ20 and 15D were administered to 739 COPD patients representing an unselected hospital-based COPD population. The completion rates and validity of, and correlations among the questions and dimension scores were examined. A factor analysis with varimax rotation was performed in order to find subsets of highly correlating items of the questionnaires.
The summary scores of AQ20 and 15D were highly correlated (r = - 0.71, p
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Oxidant-antioxidant balance is known to regulate growth factors and invasion of tumor cells. Manganese superoxide dismutase (MnSOD), copper zinc SOD (CuZnSOD), and extracellular SOD (ECSOD), the first-line antioxidant defenses, were studied in lung carcinomas by immunohistochemical analysis (n = 139, 56, and 37, respectively) and in 8 lung tumor specimens by Western blot analysis and SOD activity measurement. Altogether, 49% of squamous cell carcinomas and 43% of the adenocarcinomas were positive for MnSOD by immunohistochemical analysis; corresponding values for CuZnSOD were 79% and 93%, respectively. MnSOD and CuZnSOD by Western blot analysis were 27% and 22% higher, and CuZnSOD activity was 93% higher (P = .06) in carcinomas than in nonmalignant lung tissue samples. ECSOD, a mainly extracellular enzyme, showed weak positivity only in 4 of 37 carcinomas, and by Western blot analysis showed 70% lower immunoreactivity (P
Glutathione (GSH) plays a major role in protecting the airways against oxidative stress. The rate-limiting enzyme in de novo GSH synthesis is gamma-glutamylcysteine synthetase (gamma-GCS), which is induced by acute exposure to GSH-depleting cytokines and oxidants, but downregulated by transforming growth factor beta and prolonged oxidant exposure, at least in vitro. Cell-specific expression or regulation of gamma-GCS may play an important role both in the defense against oxidants and in the pathogenesis of oxidant-associated airway diseases. In this study, the localizations of gamma-GCS heavy (gamma-GCS-HS) and light (gamma-GCS-LS) subunits were investigated by immunohistochemistry in 22 patients with chronic obstructive pulmonary disease (COPD), 20 smokers without COPD, and 13 lifelong nonsmokers. The ultrastructural distributions of both gamma-GCS subunits were assessed by immuno-electron microscopy. Both subunits were expressed most prominently in the large airways, and their ultrastructural localization was both cytoplasmic and along the plasma membrane. The expression of gamma-GCS-HS was stronger in the central bronchial epithelium than in the peripheral bronchioli (p = 0.020), or in alveolar macrophages (p = 0.008). The expression of gamma-GCS-HS in the central bronchial epithelium showed a tendency to be higher in nonsmokers compared with all smokers (p = 0.052). Alveolar macrophages of nonsmokers had higher levels of gamma-GCS-HS (p = 0.001) and gamma-GCS-LS (p = 0.001) than did smokers. The expression of gamma-GCS-HS in the central bronchial epithelium was more marked in nonsmokers than in patients with COPD (p = 0.015), the difference between smokers and patients with COPD was not significant. In conclusion, the heavy and light subunits of gamma-GCS are mainly expressed in the large airways. Their tendency to decrease in cigarette smokers may further predispose lung cells to ongoing oxidant stress, which contributes to the progression of lung injury.
Comment In: Am J Respir Crit Care Med. 2002 Sep 1;166(5):635-612204855
We studied cell-specific protein expression of all the major antioxidant enzymes (AOEs) and related proteins, such as copper-zinc superoxide dismutase (CuZnSOD), manganese SOD (MnSOD), extracellular SOD (ECSOD), catalase, the heavy and light chains of gamma-glutamylcysteine synthetase (gamma-GCS-l and gamma-GCS-h, also called glutamate cysteine ligase), the rate-limiting enzyme in glutathione synthesis, hemeoxygenase-1 (HO-1), and thioredoxin (Trx), in developing human lung, respiratory distress syndrome, and bronchopulmonary dysplasia by immunohistochemistry. Generally, after 17 weeks of gestational age, MnSOD was predominantly expressed in bronchial epithelium, alveolar epithelium, and macrophages, CuZnSOD was expressed in bronchial epithelium, ECSOD was expressed in bronchial epithelium, vascular endothelium, and the extracellular matrix, catalase was expressed in bronchial epithelium and alveolar macrophages, gamma-GCS-h was expressed in bronchial epithelium and endothelium, and gamma-GCS-l was expressed in bronchial epithelium. Trx was restricted to bronchial epithelium and to a lesser extent to alveolar macrophages, and HO-1 found in alveolar macrophages. Basically, the expression of these enzymes was similar in normal and diseased lung. It can be concluded that various AOEs and related proteins differ in their distribution and expression in lung before term, but generally it seems that infants are better adapted to high oxygen tension than might be expected.
The sale of smokeless tobacco has been totally banned in Finland since the country joined the European Union in 1995. Adolescents have continued to use smokeless tobacco even after the sales ban. The objective was to describe dual use of Swedish snuff (snus) and cigarettes in young adults living in Northern Finland.
This study on male military recruits (n = 1151, mean age 19.4 years; response rate 80%) investigated association of snus use with self-reported tobacco use, nicotine dependence and attempts to quit smoking.
Overall, 15.6% (n = 179) reported daily snus use, and almost half of them were dual users who used both products, i.e. cigarettes and snus, daily. Daily smokers were often occasional snus users (66.3%), and those with dual use smoked equal number of cigarettes per day as daily smokers who were not snus users. In addition, dual snus use seemed to increase the dependence to cigarettes, although this trend did not reach statistical significance. Dual users tried to quit less likely than exclusive smokers. Very few snus users were 'switchers' (ex-smokers) [3.2% (n = 22) of all snus users].
Dual use of snus and cigarettes is common among young in Finland, despite the sales ban on snus. The role of snus in reducing cigarette smoking is unclear, but it is likely that snus use complicates the attempts to quit smoking.
OBJECTIVE: Though the prevalence of COPD is related to the definition, even with this proviso COPD remains under-diagnosed. Screening can detect many new COPD cases, but its effects on smoking cessation remain unknown. DESIGN: To evaluate symptoms in "healthy" cigarette smokers, to screen new COPD cases using international and national guidelines, and to assess the success of a smoking cessation. SUBJECTS: Healthy asymptomatic smokers with a >20 pack-years smoking history were recruited. The first visit included a standardized personal interview, Fagerstom nicotine dependence test (FNDT) and individualized smoking counselling by Motivational Interviewing. At the follow-up visit two years later, the same analyses were repeated and smoking status assessed. To avoid bias in the counselling attributable to spirometry, the test was evaluated at the two-year follow-up assessment. RESULTS: Almost all, 93.2%, of 584 participants attended the second visit. Spirometry revealed COPD by GOLD criteria in 11.0% and by national guidelines in 15.3%, mid-expiratory flow (MEF50) had significantly declined in 19.5%, chronic cough or sputum production was detected in 62% of the subjects. After two years, 23.3% had succeeded in giving up smoking. There were four predictors of successful quitting, i.e. positive attitude to the intervention, pharmacotherapy, older age, and higher BMI, whereas other factors such as cough, obstruction, gender, pack-years, or nicotine dependence showed no association with ability to achieve successful cessation. CONCLUSION: Significant numbers of "healthy" smokers experience symptoms, according to detailed questionnaires, and have COPD. Motivation is the most significant factor in determining the chance of stopping smoking.