呼吸道和支气管炎症状在已患有慢性阻塞性肺疾病或有患病风险的当前吸烟者中预测戒烟意愿
2016/11/09
摘要
理论依据：戒烟是慢性阻塞性肺疾病（COPD）患者最重要的干预措施。什么会导致患有COPD疾病的吸烟者戒烟仍未知。
目的：我们试图探讨呼吸道症状和COPD严重程度的其他标志物与可能患有COPD的吸烟者戒烟意愿之间的关系。
方法:我们进行了横断面研究，受试者在临床通过肺功能检测被诊断为慢性阻塞性肺病或不可逆性气流阻塞。受试者在慢性阻塞性肺病的预后为基础临床疗效和研究翻译的多中心登记的网络中被确认。主要结果是在未来的30天内（是或否）是否有戒烟意愿，这是通过建立多变量回归模型，研究位点进行聚类分析确定。
测试和主要结果:我们通过注册表确定了338个患有COPD的当前吸烟者。在这些受试者中，57.4%例（N = 194）根据肺功能检测证实了气流阻塞。近三分之一（29.2%；N = 99）打算在未来的30天内戒烟。在调整后的分析中，与肺功能测试显示的没有气流阻塞的受试者相比，根据慢性阻塞性肺疾病全球倡议，I/II期COPD的患者更有可能具有戒烟意愿（比值比[OR]，1.85；95%可信区间[CI]，1.37-2.49），戒烟意愿与III / IV期COPD受试者没有关系。整个队列中，频繁的咳痰（OR，2.10；95% CI，1.22-3.64）、咳嗽（OR，1.74；95% CI，1.01-2.99）、喘息（OR，1.73；95% CI，1.09-3.18）、以及较高的修改版医学研究委员会呼吸困难评分（OR，每点1.26；95% CI，1.13-1.41）与戒烟意愿的几率增加有关。较低的自我报告健康与较低的戒烟意愿相关（OR，0.75；95% CI，0.62-0.92）。
结论：频繁的咳嗽、咳痰、喘息、气短与打算在未来30天内戒烟有关，与疾病严重程度（根据肺功能测试分级）和自测健康的关系不明确。这些研究结果可以用来告知戒烟干预的内容，为呼吸道疾病，如慢性阻塞性肺病患者提供一个更合适的方法。
（苏欣 审校）
Ann Am Thorac Soc. 2016 Sep;13(9):1490-6. doi: 10.1513/AnnalsATS.201601-075OC.
Respiratory and Bronchitic Symptoms Predict Intention to Quit Smoking among Current Smokers with, and at Risk for, Chronic Obstructive Pulmonary Disease.
Melzer AC1,2, Feemster LC1,2, Crothers K1, Carson SS3, Gillespie SE4, Henderson AG3, Krishnan JA5, Lindenauer PK6, McBurnie MA4, Mularski RA4,Naureckas ET7, Pickard AS8, Au DH1,2; COPD Outcomes-based Network for Clinical Effectiveness and Research Translation Consortium.
Author information
Abstract
RATIONALE:Smoking cessation is the most important intervention for patients with chronic obstructive pulmonary disease (COPD). What leads smokers with COPD to quit smoking remains unknown.
OBJECTIVES:We sought to examine the association between respiratory symptoms and other markers of COPD severity with intention to quitsmoking among a cohort of patients with probable COPD.
METHODS:We conducted a cross-sectional study of subjects with COPD or fixed airflow obstruction clinically diagnosed on the basis of pulmonary function testing. The subjects were identified in the COPD Outcomes-based Network for Clinical Effectiveness and Research Translation multicenter registry. The primary outcome was the intention to quit smoking within the next 30 days (yes or no), which was examined using model building with multivariable logistic regression, clustered by study site.
MEASUREMENTS AND MAIN RESULTS:We identified 338 current smokers with COPD via the registry. Of these subjects, 57.4% (n = 194) had confirmed airflow obstruction based on pulmonary function testing. Nearly one-third (29.2%; n = 99) intended to quit smoking in the next 30 days. In adjusted analyses, compared with subjects without airflow obstruction based on pulmonary function testing, subjects with Global Initiative for Chronic Obstructive Lung Disease stage I/II COPD were more likely to be motivated to quit (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.37-2.49), with no association found for subjects with Global Initiative for Chronic Obstructive Lung Disease stage III/IV disease. Among the entire cohort, frequent phlegm (OR, 2.10; 95% CI, 1.22-3.64), cough (OR, 1.74; 95% CI, 1.01-2.99), wheeze (OR, 1.73; 95% CI, 1.09-3.18), and higher modified Medical Research Council dyspnea score (OR, 1.26 per point; 95% CI, 1.13-1.41) were associated with increased odds of intending toquit smoking. Low self-reported health was associated with decreased odds of intending to quit (OR, 0.75; 95% CI, 0.62-0.92).
CONCLUSIONS:Frequent cough, phlegm, wheeze, and shortness of breath were associated with intention to quit smoking in the next 30 days, with a less clear relationship for severity of illness graded by pulmonary function testing and self-rated health. These findings can be used to inform the content of tobacco cessation interventions to provide a more tailored approach for patients with respiratory diseases such as COPD.
KEYWORDS:cessation; chronic obstructive pulmonary disease; tobacco
Ann Am Thorac Soc. 2016 Sep;13(9):1490-6. doi: 10.1513/AnnalsATS.201601-075OC.
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