1 Center for Chronic Disease Outcomes Research.
2 Section of Pulmonary and Critical Care Medicine, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota.
Ann Am Thorac Soc. 2018 Mar;15(3):341-347. doi: 10.1513/AnnalsATS.201707-582OC.
Adults with chronic lower respiratory disease differ in their barriers to smoking cessation but also suffer from tobacco-related health concerns, which may motivate quit attempts. Few studies have examined differences in tobacco treatment response between smokers with and without chronic lower respiratory disease.
We examined the effectiveness of a proactive outreach program for cessation among smokers with and without chronic lower respiratory disease.
Subgroup analysis of the Veterans Victory over Tobacco Study, a pragmatic randomized controlled trial that demonstrated the effectiveness of proactive outreach and the choice of tobacco treatments compared with usual care. Smokers identified via the electronic medical record were proactively offered phone-based counseling and care coordination to receive medication from their Veterans Affairs providers or in-person care. We compared the response among those with and without an International Classification of Diseases, 9th Revision diagnosis of a chronic lower respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, asthma). We used stratification by propensity scores to adjust for imbalanced covariates between groups with and without chronic lower respiratory disease within each treatment arm, using complete case analysis accounting for the stratified sampling by site.
The study participants were predominantly older, white, male smokers. Overall, 19.6% had chronic lower respiratory disease. A total of 3,307 had outcome data with the following assignments to the intervention: proactive care: n = 1,272 without chronic lower respiratory disease, n = 301 with chronic lower respiratory disease; usual care: n = 1,387 without chronic lower respiratory disease, n = 347 with chronic lower respiratory disease. A total of 1,888 had both complete baseline and outcome data and were included in the primary analysis. In unadjusted analyses (n = 3,307), among individuals with chronic lower respiratory disease, 13.1% in the proactive group reported 6-month prolonged abstinence compared with 8.7% of those in the usual care group (odds ratio, 1.57; 95% confidence interval, 0.93-2.65). Among individuals without chronic lower respiratory disease, 13.1% quit in the proactive group compared with 11.0% in the usual care group (odds ratio, 1.22; 95% confidence interval, 0.95-1.55). In adjusted analyses (n = 1,888), the association between treatment arm and quit rate varied by the presence of chronic lower respiratory disease, with a stronger association between allocation to the proactive group and quit rate among those with chronic lower respiratory disease (odds ratio, 3.45; 95% confidence interval, 1.59-7.47) than those without chronic lower respiratory disease (odds ratio, 1.34; 95% confidence interval, 0.95-1.88; P for interaction with chronic lower respiratory disease = 0.03).
Smokers with chronic lower respiratory disease may be more likely to respond to a proactive outreach intervention for tobacco cessation treatment than those without chronic lower respiratory disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00608426).
患有慢性下呼吸道疾病的成年人在戒烟障碍方面存在差异，但也同样受到与烟草相关的健康问题的困扰，这些问题可能会促使他们尝试戒烟。很少有研究调查过有和没有慢性下呼吸道疾病的吸烟者在烟草治疗反应方面的差异。
我们研究了针对有和没有慢性下呼吸道疾病的吸烟者的戒烟主动外展计划的有效性。
退伍军人战胜烟草研究的亚组分析，这是一项实用随机对照试验，证明了主动外展和选择烟草治疗的有效性，与常规护理相比。通过电子病历确定的吸烟者会被主动提供基于电话的咨询和护理协调，以从他们的退伍军人事务提供者那里获得药物或进行面对面的护理。我们比较了那些有和没有国际疾病分类，第 9 版慢性下呼吸道疾病（慢性阻塞性肺疾病、慢性支气管炎、肺气肿、哮喘）诊断的人之间的反应。我们使用倾向评分分层来调整每个治疗臂中患有和不患有慢性下呼吸道疾病的组之间不平衡的协变量，使用完整案例分析考虑到站点的分层抽样。
研究参与者主要是年龄较大、白人、男性吸烟者。总体而言，19.6%的人患有慢性下呼吸道疾病。共有 3307 人有结果数据，并被分配到干预措施中：主动护理：无慢性下呼吸道疾病的 n=1272，有慢性下呼吸道疾病的 n=301；常规护理：无慢性下呼吸道疾病的 n=1387，有慢性下呼吸道疾病的 n=347。共有 1888 人同时具有完整的基线和结果数据，并被纳入主要分析。在未调整的分析（n=3307）中，在患有慢性下呼吸道疾病的人群中，主动组中有 13.1%的人报告在 6 个月时持续戒断，而常规护理组中只有 8.7%（比值比，1.57；95%置信区间，0.93-2.65）。在没有慢性下呼吸道疾病的人群中，主动组中有 13.1%的人戒烟，而常规护理组中有 11.0%（比值比，1.22；95%置信区间，0.95-1.55）。在调整后的分析（n=1888）中，治疗臂与戒烟率之间的关联因慢性下呼吸道疾病的存在而有所不同，在患有慢性下呼吸道疾病的人群中，主动组与戒烟率之间的关联更强（比值比，3.45；95%置信区间，1.59-7.47），而在没有慢性下呼吸道疾病的人群中（比值比，1.34；95%置信区间，0.95-1.88；与慢性下呼吸道疾病的交互作用 P 值=0.03）。
患有慢性下呼吸道疾病的吸烟者可能比没有慢性下呼吸道疾病的吸烟者更有可能对主动外展戒烟治疗做出反应。临床试验在 www.clinicaltrials.gov 注册（NCT 00608426）。
