Bohadana Abraham B, Nilsson Fredrik, Westin Ake, Martinet Nadine, Martinet Yves
INSERM ERI 11, Faculté de Médecine, B.P. 184-9, Av de la Forêt de Haye, 54505 Vandoeuvre-lès-Nancy Cedex, France.
Respir Med. 2006 Aug;100(8):1423-30. doi: 10.1016/j.rmed.2005.11.005. Epub 2005 Dec 13.
Individuals exposed both to cigarette smoke and respiratory pollutants at work incur a greater risk of development of airway hyperresponsiveness (AHR) and accelerated decline in forced expiratory volume in 1 s (FEV1) than that incurred by subjects undergoing each exposure separately. We examined whether smoking cessation or smoking reduction improves AHR and thereby slows down the decline in FEV1 in occupationally exposed workers.
We examined 165 workers (137 males and 28 females) participating in a smoking cessation programme. Nicotine tablets were used for smoking cessation or smoking reduction. Respiratory symptoms were assessed by questionnaire, FEV1 by spirometry and AHR by methacholine challenge test. At 1 year, subjects were classified into quitters, reducers, or continuing smokers.
Sixty-seven subjects completed the study (32 quitters; 17 reducers; 18 continuing smokers). Respiratory symptoms improved markedly in quitters (P<0.001 for all comparisons) and less so in reducers (P values between 0.163 and 0.027). At 1 year, FEV1 had slightly but significantly improved in quitters (P=0.006 vs. smokers; P=0.038 vs. reducers) and markedly deteriorated in reducers and continuing smokers. Concurrent, 1-year change in AHR did not differ significantly among the groups.
In occupationally exposed workers, stopping smoking markedly improved respiratory symptoms and, in males, slowed the annual decline in FEV1. Smoking reduction resulted in smaller improvements in symptoms but deterioration in FEV1. These findings were independent of AHR. While smoking cessation should remain the ultimate goal in workplace cessation programmes more studies are necessary to better ascertain the benefits of smoking reduction.
在工作中同时接触香烟烟雾和呼吸道污染物的个体，相较于单独接触其中一种污染物的受试者，发生气道高反应性（AHR）以及1秒用力呼气容积（FEV1）加速下降的风险更高。我们研究了戒烟或减少吸烟量是否能改善职业暴露工人的AHR，从而减缓FEV1的下降。
我们对165名参与戒烟计划的工人（137名男性和28名女性）进行了研究。使用尼古丁片来戒烟或减少吸烟量。通过问卷调查评估呼吸道症状，通过肺量计测量FEV1，通过乙酰甲胆碱激发试验评估AHR。在1年时，将受试者分为戒烟者、减少吸烟者或持续吸烟者。
67名受试者完成了研究（32名戒烟者；17名减少吸烟者；18名持续吸烟者）。戒烟者的呼吸道症状明显改善（所有比较的P<0.001），减少吸烟者的改善程度较小（P值在0.163至0.027之间）。在1年时，戒烟者的FEV1略有但显著改善（与吸烟者相比P=0.006；与减少吸烟者相比P=0.038），而减少吸烟者和持续吸烟者的FEV1则明显恶化。同时，1年时AHR的变化在各组之间没有显著差异。
在职业暴露工人中，戒烟显著改善了呼吸道症状，在男性中减缓了FEV1的年度下降。减少吸烟量使症状改善较小，但FEV1恶化。这些发现与AHR无关。虽然戒烟应仍然是工作场所戒烟计划的最终目标，但需要更多研究来更好地确定减少吸烟量的益处。
