PURPOSE: To collect available data on nicotine dependence, as defined by the Fagerström Test of Nicotine Dependence (FTND), and to compare levels of dependence among workers, assigning the prevalence of smoking and COPD prevalence.
METHODS: Prevalence study conducted from 01.01.2000-28.11.2003 consisted in a two-part process of symptom-based questionnaire inspired by European Community Respiratory Health Survey and FTND. Sampling and randomized selection of workers included every the 14-th case from original data base. All 202 randomized workers, having respiratory symptoms, performed lung function tests with a Flow Screen Jaeger device. Those with fixed airway obstruction as measured by post-bronchodilator FEV1/FVC < 0.70 were selected and interogated with more detailed about occupational history, smoking, pack-years follow-up FTND questioning.
RESULTS: More than 80% of randomized workers had a suggestive symptom-based questionnaire(n=111/132;84%). 60.79% of all workers recognized smoking addiction (n=143/202) but only 93 of them recognized tobacco dependence with 4 different degree of nicotine dependence. According to severity of FTND score dependence, 18 workers had low dependence (< 3 points), 25 an above average dependence (4-5 points), 38 a strong dependence (6-7 points) and 12 were extremely dependent(8-10 points). The prevalence of COPD (including chronic bronchitis) was 33.6% (68/202). The prevalence of COPD among workers by smoking status is significant higher among active smokers (AS=48/93; 51.6%) and ex-smokers (ES=12/50; 24%) versus non smokers (NS=8/59; 13.5%)(p< 0.002). The comparison of COPD prevalence among AS by the level of nicotine dependence revealed a progressive increase from low degree of nicotine addiction (n= 7/18;38.9%) to above average (n= 17/25;68%), strong dependence (n= 28/38;47.4%) and, finally, 91.6% in the group with extreme dependence (n= 11/12).
CONCLUSION: Tobacco smoking is responsible for the majority of COPD cases.A simple FTND can be used to identify patients with a high likelihood of having COPD, for whom strong dependence is particularly important.
CLINICAL IMPLICATIONS: Most respiratory guidelines agree that spirometry is the basis for COPD diagnosis. Symptom-based questionnaires in conjunction with spirometry and Fagerström Test of Nicotine Dependence might enhance the diagnostic accuracy of COPD.
DISCLOSURE: Oana Arghir, No Financial Disclosure Information; No Product/Research Disclosure Information