COPD 患者戒烟后的变化及其临床后果：来自 CHAIN 队列的前瞻性分析。

Changes and Clinical Consequences of Smoking Cessation in Patients With COPD: A Prospective Analysis From the CHAIN Cohort.

机构信息

Department of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain.

Department of Respiratory Medicine, Hospital Universitario Nuestra Señora de Candelaria/Universidad de La Laguna, Tenerife, Spain.

出版信息

Chest. 2018 Aug;154(2):274-285. doi: 10.1016/j.chest.2018.02.007. Epub 2018 Feb 22.

DOI:10.1016/j.chest.2018.02.007

PMID:29476876

Abstract

BACKGROUND

Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real life are still low among patients with COPD. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of patients with COPD.

METHODS

CHAIN (COPD History Assessment in Spain) is a Spanish multicenter study carried out at pulmonary clinics including active and former smokers with COPD. Smoking status was certified by clinical history and co-oximetry. Clinical presentation and disease impact were recorded via validated questionnaires, including the London Chest Activity of Daily Living (LCADL) and the Hospital Anxiety and Depression Scale (HADS). No specific smoking cessation intervention was carried out. Factors associated with and clinical consequences of smoking cessation were analyzed by multivariate regression and decision tree analyses.

RESULTS

One thousand and eighty-one patients with COPD were included (male, 80.8%; age, 65.2 [SD 8.9] years; FEV, 60.2 [20.5]%). During the 2-year follow-up time (visit 2, 906 patients; visit 3, 791 patients), the majority of patients maintained the same smoking habit. Decision tree analysis detected chronic expectoration as the most relevant variable to identify persistent quitters in the future, followed by an LCADL questionnaire (cutoff 9 points). Total anxiety HADS score was the most relevant clinical impact associated with giving up tobacco, followed by the LCADL questionnaire with a cutoff value of 10 points.

CONCLUSIONS

In this real-life prospective COPD cohort with no specific antismoking intervention, the majority of patients did not change their smoking status. Our study also identifies baseline expectoration, anxiety, and dyspnea with daily activities as the major determinants of smoking status in COPD.

TRIAL REGISTRY

ClinicalTrials.gov; No. NCT01122758; URL: www.clinicaltrials.gov.

摘要

背景

尽管存在基于证据的戒烟干预措施，但 COPD 患者在现实生活中实现这一目标的机会仍然很低。我们试图评估在 COPD 患者的大型队列中改变吸烟习惯的临床后果。

方法

CHAIN（西班牙 COPD 病史评估）是一项在包括 COPD 患者的肺科诊所进行的西班牙多中心研究，包括活跃和曾经的吸烟者。吸烟状况通过临床病史和 co-oximetry 进行认证。通过经过验证的问卷记录临床表现和疾病影响，包括伦敦胸部日常活动量表（LCADL）和医院焦虑和抑郁量表（HADS）。没有进行特定的戒烟干预。通过多变量回归和决策树分析分析与戒烟相关的因素和临床后果。

结果

共纳入 1081 例 COPD 患者（男性，80.8%；年龄，65.2[8.9]岁；FEV，60.2[20.5]%）。在 2 年随访期间（访视 2 时，906 例；访视 3 时，791 例），大多数患者保持相同的吸烟习惯。决策树分析发现，慢性咳痰是未来识别持续戒烟者的最相关变量，其次是 LCADL 问卷（9 分）。总焦虑 HADS 评分是与戒烟最相关的临床影响，其次是 LCADL 问卷，其截断值为 10 分。