Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London.
Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit, National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London.
Chest. 2014 May;145(5):1006-1015. doi: 10.1378/chest.13-2220.
Smoking cessation is of major importance for all smokers; however, in patients with COPD, little information exists on how smoking cessation influences lung function and high-resolution CT (HRCT) scan appearances.
In this single-center 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 two 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 nonsmokers (n = 19).
Subjects with COPD who quit smoking had a marked, but transient improvement in FEV1 at 6 weeks (184 mL, n = 17, P < .01) that was still present at 12 weeks (81 mL, n = 17, P < .05) and only partially maintained at 1 year. In contrast, we saw improvement in the transfer factor of lung for carbon monoxide at 6 weeks in both subjects with COPD who quit smoking (0.47 mmol/min/kPa, n = 17, P < .01) and subjects who quit smoking with normal spirometry (0.40 mmol/min/kPa, n = 35, P < .01). An upper-zone single HRCT image 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 imaging.
Cigarette smoking causes extensive lung function and HRCT image abnormalities, even in patients with normal spirometry. Smoking cessation has differential effects on lung function (FEV1 and gas transfer) and features on HRCT images (emphysema and micronodules). Cessation of smoking in patients with COPD 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 minimize permanent damage to the lungs.
戒烟对所有吸烟者都非常重要；然而，对于 COPD 患者，关于戒烟如何影响肺功能和高分辨率 CT（HRCT）扫描结果的信息很少。
在这项单中心研究中，我们对一组年龄在 40 至 80 岁的重度吸烟者进行了筛查肺功能检查（N=358）。然后，我们研究了两组选定受试者的戒烟效果：COPD 吸烟者（n=38）和肺功能正常的吸烟者（n=55）。在对戒烟者进行研究的同时，我们还研究了一组非吸烟者（n=19）作为对照组。
戒烟的 COPD 患者在 6 周时出现了明显但短暂的 FEV1 改善（184mL，n=17，P <.01），在 12 周时仍存在（81mL，n=17，P <.05），但仅部分维持到 1 年。相比之下，我们看到戒烟的 COPD 患者的一氧化碳肺转移因子在 6 周时得到改善（0.47mmol/min/kPa，n=17，P <.01）和肺功能正常的戒烟者（0.40mmol/min/kPa，n=35，P <.01）。在基线时，HRCT 上的一个上区单层图像切片能够可靠地识别 74%的 COPD 吸烟者（38 例中的 28 例）和 29%的健康吸烟者（55 例中的 16 例）存在肺气肿。戒烟对肺气肿的表现没有显著影响，但减少了 HRCT 图像上的微结节存在。
吸烟会导致广泛的肺功能和 HRCT 图像异常，即使在肺功能正常的患者中也是如此。戒烟对肺功能（FEV1 和气体转移）和 HRCT 图像特征（肺气肿和微结节）有不同的影响。COPD 患者戒烟会导致 FEV1 短暂改善，并减少微结节的存在，为戒烟期间进行伴随治疗以增强这些效果提供了机会。尽早戒烟对于最大限度地减少肺部的永久性损伤至关重要。
