Institute of Social and Preventive Medicine, University of Geneva, CMU, 1 rue Michel-Servet, CH-1211 Geneva 4, Switzerland.
Eur Respir J. 2010 Jun;35(6):1249-55. doi: 10.1183/09031936.00090509. Epub 2009 Nov 19.
Smoking is the first risk factor for chronic obstructive pulmonary disease (COPD). Some recent reports suggest that, unexpectedly, some respiratory symptoms may increase transiently after smoking cessation, but there is a dearth of short-term data to test this hypothesis. The aim of the present study was to assess the validity of an online screening tool and to describe short-term associations between smoking behaviour and self-reported respiratory symptoms, in cross-sectional and longitudinal data. An internet survey was conducted in 2003-2009, on a smoking cessation website, with a follow-up survey after 30 days. There were 15,916 participants at baseline and 1,831 at follow-up. In the 252 baseline smokers who had quit smoking at 30-day follow-up, there was a substantial decrease in the proportion of participants who declared that they often coughed even without a cold (from 51.6% at baseline to 15.5% at follow-up), expectorated when they coughed in the morning (from 47.6% to 19.4%), were out of breath after climbing stairs or after a quick walk (from 75.0% to 48.4%), and who had a wheezing respiration (from 33.7% to 10.3%) (p<0.001 for all before/after comparisons). In participants who did not change their smoking behaviour between assessments, the test-retest reliability was r = 0.87 for a score summing these four symptoms. Smoking cessation was followed by a rapid and substantial improvement in self-reported respiratory symptoms. COPD is largely underdiagnosed and undertreated. Internet screening is reliable and may allow for the early detection of COPD symptoms at a large scale, in patients who may otherwise have no access to COPD case-finding efforts.
吸烟是慢性阻塞性肺疾病（COPD）的首要危险因素。一些最新的报告表明，出乎意料的是，一些呼吸道症状在戒烟后可能会短暂增加，但缺乏短期数据来验证这一假设。本研究旨在评估在线筛查工具的有效性，并描述在横断面和纵向数据中吸烟行为与自我报告的呼吸道症状之间的短期关联。2003-2009 年，在一个戒烟网站上进行了一项互联网调查，并在 30 天后进行了随访调查。基线时有 15916 名参与者，随访时有 1831 名参与者。在 252 名基线吸烟者中，有 252 名在 30 天随访时戒烟，他们中有相当一部分人报告说，即使没有感冒，他们也经常咳嗽（从基线时的 51.6%降至随访时的 15.5%），早上咳嗽时会咳痰（从 47.6%降至 19.4%），爬楼梯或快走后会喘不过气来（从 75.0%降至 48.4%），并且有喘息呼吸（从 33.7%降至 10.3%）（所有前后比较均 p<0.001）。在评估期间没有改变吸烟行为的参与者中，这些四个症状得分总和的测试重测信度为 r=0.87。戒烟后，自我报告的呼吸道症状迅速而显著改善。COPD 很大程度上被漏诊和治疗不足。互联网筛查是可靠的，可能允许在大规模患者中早期发现 COPD 症状，这些患者可能无法获得 COPD 筛查工作。
