哮喘联盟

   摘要
   背景：戒烟对所有吸烟患者来说至关重要。然而，戒烟怎样影响COPD患者肺功能和HRCT表现，对此知之甚少。
   方法：在本单中心研究中，我们对40～80岁间的重度吸烟者(n=358)进行肺活量筛查。然后我们在选定的2组受试者中进行戒烟效果研究：伴COPD的吸烟者 (n=38)和正常肺活量的吸烟者(n=55)。同时，我们为正在戒烟的受试者设定一个不吸烟的对照组。
   结果：戒烟的COPD患者在6周时FEV1有显著而短暂的提高(+184ml, n=17, p<0.01)，12周时仍有提高(+81ml, n=17, p<0.05)，只有部分患者提高持续到一年。相反，伴COPD的戒烟者(+0•47mmol/min/kPa, n=17, p<0•01)和肺活量正常的戒烟者(+0•40mmol/min/kPa, n=35, p<0•01)在6周时一氧化碳转移因子(TLCO)都有提高。在基线时74%的COPD吸烟者（28/38）肺上部HRCT结果证明基线时，74%（28/38）的COPD吸烟者存在肺气肿，29%（16/55）的健康吸烟者存在肺气肿。戒烟对肺气肿发生率无明显影响，但可以减少HRCT上的微结节。
   解读：即使在正常肺功能的受试者中，吸烟也可导致广泛的肺功能和HRCT结果异常。戒烟对肺功能（FEV1和气体交换）和HRCT结果（肺气肿和微结节）的影响不同。COPD吸烟者戒烟后会出现短暂的FEV1改善和小结节减少，为戒烟期间的伴随治疗提供了机会以增加这些效果。尽早戒烟对最小化肺永久性损伤至关重要。
 

（刘国梁 审校）
Chest. 2014 Feb 13. doi: 10.1378/chest.13-2220. [Epub ahead of print]

 

Smoking cessation in COPD causes a transient improvement in spirometry and decreases micronodules on HRCT.
 

Dhariwal J, Tennant RC, Hansell DM, Westwick J, Walker C, Ward SP, Pride N, Barnes PJ, Kon OM, Hansel TT.
 

Abstract
BACKGROUND: Smoking cessation is of major importance for all smokers: however, in patients with COPD there is little information on how this influences lung function and HRCT appearances.
METHODS: In this single centre study we performed screening spirometry in a group of heavy smokers aged 40 to 80 years (n=358). We then studied the effects of smoking cessation in 2 groups of selected subjects: smokers with COPD (n=38) and smokers with normal spirometry (n=55). In parallel, to subjects undergoing smoking cessation we studied a control group of non-smokers (n=19).
FINDINGS: Patients with COPD who quit smoking had a marked but transient improvement in FEV1 at six weeks (+184ml, n=17, p&lt;0•01), still present at 12 weeks (+81ml, n=17, p&lt;0•05), and only partially maintained at one year. In contrast, there was an improvement in the transfer factor for carbon monoxide (TLCO) at six weeks in both quitters with COPD (+0•47mmol/min/kPa, n=17, p&lt;0•01) and quitters with normal spirometry (+0•40mmol/min/kPa, n=35, p&lt;0•01). An upper zone single HRCT slice reliably identified emphysema at baseline in 74% of smokers with COPD (28 of 38) and 29% of healthy smokers (16 of 55). Smoking cessation had no significant effect on the appearances of emphysema but decreased the presence of micronodules on HRCT.
INTERPRETATION: Cigarette smoking causes extensive lung function and HRCT abnormalities, even in subjects with normal spirometry. Smoking cessation has differential effects on lung function (FEV1 and gas transfer) and features on HRCT (emphysema and micronodules). Cessation of smoking in COPD patients causes a transient improvement in FEV1, and decreases the presence of micronodules, offering an opportunity for concomitant therapy during smoking cessation to augment these effects. Smoking cessation at the earliest possible opportunity is vital to minimise permanent damage to the lungs.
 

Chest. 2014 Feb 13. doi: 10.1378/chest.13-2220. [Epub ahead of print]