基于认知干预的戒烟策略对 COPD 患者的长期影响。

The long-term outcomes of tobacco control strategies based on the cognitive intervention for smoking cessation in COPD patients.

机构信息

Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.

出版信息

Respir Med. 2020 Oct;172:106155. doi: 10.1016/j.rmed.2020.106155. Epub 2020 Sep 12.

DOI:10.1016/j.rmed.2020.106155

PMID:32949957

Abstract

OBJECTIVE

To evaluate the long-term efficacy of tobacco control strategies based on cognitive intervention for smoking cessation in chronic obstructive pulmonary disease (COPD) patients, and to provide basis for clinical practice.

MATERIALS AND METHODS

102 COPD patients with a long-term history of smoking from the outpatient clinic were recruited in the study. These smokers were randomly divided into intervention group and control group. The intervention group received a cognitive intervention containing individual consultation, telephone follow-ups and self-help materials, etc. The prevalence of quitting smoking, acute exacerbation (AE), lung function and survival were compared in the groups in 10 years.

RESULTS

There were significant differences between the intervention group and the control group in the rate of persistent quitting smoking in half a year (17.6% vs 3.9%) (P < 0.05), the rate of quitting smoking at the 6th month (58.8% vs 33.3%) (P < 0.05). After 3 months (P < 0.01) and 6 months (P < 0.01), the difference in body weight between the intervention group and the control group was statistically significant. Intervention-group patients had fewer AE per year (P < 0.01) and higher FEV1/FVC ratio (P < 0.01) after 5-year and 10-year follow-up. Besides, the FEV1% predicted in the intervention patients was higher than that in control group after 10-year follow-up. The ages of patients in the death group were greater than those in the survival group. Death-group patients had longer smoking times, higher smoking index, and later onset of COPD symptoms. Death-group patients had lower FEV1% predicted (P < 0.05) and FEV1/FVC ratio (P < 0.01). During 10-year follow-up, 30 patient deaths were recorded (the control group: n = 48; 19 deaths, and intervention group: n = 46; 11 deaths), and patients in the control group had lower survival than those in the intervention group. (P < 0.05).

CONCLUSION

The method of quitting smoking based on cognitive intervention is an effective way for COPD patients to quit smoking successfully. Quitting smoking can slower deterioration in lung function and improve the survival of COPD patients.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2000031239 (Chinese clinical trial registry).

摘要

目的

评估基于认知干预的戒烟策略对慢性阻塞性肺疾病（COPD）患者戒烟的长期疗效，为临床实践提供依据。

材料与方法

从门诊招募了 102 名有长期吸烟史的 COPD 患者，将这些吸烟者随机分为干预组和对照组。干预组接受认知干预，包括个体咨询、电话随访和自助材料等。比较两组患者在 10 年内的戒烟成功率、急性加重（AE）、肺功能和生存率。

结果

干预组和对照组在半年持续戒烟率（17.6%比 3.9%）（P<0.05）和第 6 个月戒烟率（58.8%比 33.3%）（P<0.05）方面存在显著差异。干预组和对照组在 3 个月（P<0.01）和 6 个月（P<0.01）时体重差异有统计学意义。干预组患者每年 AE 次数较少（P<0.01），5 年和 10 年随访时 FEV1/FVC 比值较高（P<0.01）。此外，10 年随访时干预组患者的 FEV1%预测值高于对照组。死亡组患者年龄大于生存组。死亡组患者吸烟时间更长、吸烟指数更高、COPD 症状出现时间更晚。死亡组患者 FEV1%预测值（P<0.05）和 FEV1/FVC 比值（P<0.01）较低。在 10 年随访期间，记录了 30 例患者死亡（对照组：n=48；19 例死亡，干预组：n=46；11 例死亡），对照组患者的生存率低于干预组（P<0.05）。