Cardiovascular-pulmonary Department, Sant' Andrea Hospital-Sapienza University, Via di Grottarossa, 1035/39 , I-00189; Rome, Italy.
J Breath Res. 2018 Aug 6;12(4):046007. doi: 10.1088/1752-7163/aad0a8.
Tobacco smoke is the leading cause of chronic obstructive pulmonary disease (COPD). Smoking cessation can change the natural history of COPD, as we know from the GOLD guidelines. Little is known about the short-term clinical and functional effects of smoking cessation treatment combined with anti-muscarinic bronchodilators.
To determine whether quitting smoking, obtained by smoking cessation treatment combined with the use of a new long-acting muscarinic antagonist bronchodilator (LAMA), can improve lung function tests and respiratory symptoms more than the use of LAMA alone.
We evaluated, in a retrospective analysis, the functional and clinical data, collected in one year, of 120 patients who were current smokers affected by mild COPD and who quit smoking using smoking cessation treatment combined with glycopirronium. We compared them with a group of 80 patients with mild COPD undergoing the same treatment but who did not quit smoking. All patients underwent functional and clinical tests at baseline and at a third-month check.
The two groups were homogeneous in terms of demographic data without significant differences. All patients used varenicline for smoking cessation. They all performed the following tests: a spirometry with detection of resistances, the 6 min walking test, haemogasanalysis, the exhaled CO test, the COPD assessment test (CAT) and finally the modified Medical Research Council test (mMRC). A significant improvement in the functional tests at the third-month check was found in both groups-quitters and non-quitters. However, a notable increase in the examined parameters was registered in the group of patients who quit smoking, in particular, we observed a significant increase at the third-month check of the parameter forced expiratory volume in 1 s (FEV1) of more than 200 ml with p < 0.001. A comparison between quitters and non-quitters revealed a major benefit derived from smoking cessation in terms of functional changes and symptom relief. In particular, not only FEV1 but also forced expiratory flow at 25%-75% of vital capacity (FEF 25-75) (p < 0.01) and CAT (p < 0.001) were found to be significantly improved in patients who quit than in patients who did not at the check time point.
Smoking cessation treatment obtained by varenicline was confirmed as a crucial therapeutic option, especially when combined with bronchodilator in mild COPD. Patients who quit smoking could already benefit from both treatments in the short term, improving lung function and respiratory symptoms and therefore improving their quality of life.
烟草烟雾是慢性阻塞性肺疾病（COPD）的主要病因。我们从 GOLD 指南中了解到，戒烟可以改变 COPD 的自然病程。但是，对于戒烟治疗联合使用新型长效抗胆碱能支气管扩张剂（LAMA）的短期临床和功能效果知之甚少。
确定通过戒烟治疗联合使用新型长效抗胆碱能支气管扩张剂（LAMA）获得的戒烟是否比单独使用 LAMA 更能改善肺功能测试和呼吸症状。
我们在回顾性分析中评估了 120 名患有轻度 COPD 的当前吸烟者的功能和临床数据，这些吸烟者通过使用戒烟治疗联合使用格隆溴铵来戒烟。我们将他们与 80 名患有轻度 COPD 且未戒烟的患者进行了比较。所有患者在基线和第三个月检查时均进行了功能和临床测试。
两组在无显著差异的情况下在人口统计学数据方面具有同质性。所有患者均使用伐尼克兰进行戒烟。他们都进行了以下测试：肺活量测定，阻力检测，6 分钟步行测试，血液气体分析，呼气 CO 测试，COPD 评估测试（CAT）和改良的医学研究委员会测试（mMRC）。在第三个月检查时，两组-戒烟者和非戒烟者的功能测试均有明显改善。但是，在戒烟的患者中，观察到所检查参数的明显增加，尤其是在第三个月检查时，用力呼气量（FEV1）增加了 200ml 以上，p<0.001。戒烟者和非戒烟者之间的比较显示，戒烟在功能变化和症状缓解方面带来了重大益处。特别是，不仅 FEV1，而且用力呼气量在 25%-75%肺活量时的流速（FEF 25-75）（p<0.01）和 CAT（p<0.001）在检查时均明显改善，与未戒烟的患者相比。
通过伐尼克兰获得的戒烟治疗被确认为一种重要的治疗选择，尤其是在轻度 COPD 中联合使用支气管扩张剂时。戒烟的患者可以在短期内同时从两种治疗中受益，改善肺功能和呼吸症状，从而提高生活质量。
