| Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Respiratory disease (mainly COPD) is ranked No. 4 (13.89%) among the main causes of death in urban of china, which is ranked No. 1 in rural areas (22.04%). The survey of 20245 adult of 7 areas investigated by Medical Association of China showed that the prevalence of COPD accounted for 8.2% in the population over 40 years old. The incidence and mortality of COPD are still on the rise.Smoking is the leading risk factor of COPD. About 15% ~ 20% of smokers will become the patients of COPD. The number of smokers suffered from COPD is 3 ~ 5 times higher than that of non-smokers. COPD incidence and smoking intensity have dose-response relationship. Evidence-based medicine (evidence-based medicine, EBM) confirmed that smoking cessation and long-term oxygen therapy were the important steps to delay the progression of COPD. The long-term oxygen therapy for the rural and poor areas is very difficult, so smoking cessation is very important to them.Therefore, the aim of our study is to confirm that smoking cessation can improve the clinical symptoms and the lung function of the COPD patients in different periods (3, 6, 9 months after stop smoking), and then provide help for clinical prevention of COPD. ObjectiveTo study the effects of smoking cessation on clinical symptoms and lung function with chronic obstructive pulmonary disease.MethodThe subjects of study are the patients of COPD who visited at the Affiliated Hospital of Chengde Medical College Hospital from September 2008 to December 2009, the total number of them was 131(current smokers 77 cases, ex-smokers 34 cases who had quit smoking more than 2 years, non-smokers 20 cases). The current smokers were randomly designed into two groups: one group received smoking interventions except for conventional treatment; the other group only received conventional therapy.Ex-smoker group and non-smokers group also received conventional therapy.We record basic information of all patients by questionnaire, carry out the scores of comprehensive clinical symptom, and measure concentration of the expired air carbon monoxide (CO) for them. In addition, test pulmonary function for four group patients, including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in one second/forced vital capacity (FEV1/FVC), account"LungAge"of all patients and lung presenility years, and monitoring the Peak expiratory flow (PEF). These above indexes were tested in the 3month, 6 month, 9 month pay a return visit after the date of observation. At the end of 9 months, we carry out the scores again and to record the frequency of acute exacerbation. Observe the changes of the above indexes, analysis the effects of smoking cessation on clinical symptoms and lung function with COPD.Results1. Expired air carbon monoxide:The carbon monoxide level in expired air of smoking cessation group and smoking group were significantly higher than the ex-smokers group and non-smokers group, the differences were statistically significant (P<0.05). Concentration of CO exhaled of the smoking cessation group was decreased after they quit smoking 3 months, the difference was statistically significant(P<0.05), and compared with the smoking group, the difference was statistically significant (P<0.05); and it sequentially maintained low level which closed to the ex-smokers group and the non-smokers group (P>0.05). The concentrations of CO exhaled of smoking group kept high level after 3 months, 6 month, 9 month compared with original, the differences were not statistically significant(P>0.05), and compared with the other three groups, the differences were statistically significant (P<0.05).2. Score of clinical symptoms:The comprehensive score of clinical symptoms of smoking cessation group decreased after they quit smoking 9 months, the difference was statistically significant(P<0.05), compare with the smoking group, the difference was statistically significant (P<0.05), and compare with the ex-smoking group and the non-smoker group, the differences were not statistically significant (P>0.05).3. The number of acute exacerbation:The numbers of acute exacerbation of the smoking cessation group in 9 months after they quit smoking decreased than original, the difference was statistically significant (P<0.05), and compared with the other groups, the differences were not statistically significant (P>0.05).4. The changes of Lung function and the peak expiratory flow:4.1 The most indexes of lung function of the smoking cessation group improved after they quit smoking. Among of them, the changes of FEV1 , PEF were increased in the third and sixth month after stop smoking, the differences were statistically significant(P<0.05); in the ninth month, the changes of VC, FVC, FEV1, PEF were increased than original, the differences were statistically significant(P<0.05).The most indexes of lung function of smoking group declined in different follow-up time. In the third month, the changes of PEF was decreased than original, the difference was statistically significant(P<0.05); In the sixth and the ninth montthe, the changes of VC, FVC, FEV1, PEF were increased than original, the differences were statistically significant(P<0.05). The indexes of lung function of the ex-smokers group and the non-smokers group were declined than original, the degree of decreased less than the smoking group, the differences were not statistically significant (P>0.05).4.2 The changes value of VC, FVC of smoking cessation group higher than the smoking group in 6 months, the differences were statistically significant(P < 0.05); in 9 months, compare with smoking group and ex-smokers group, the differences were statistically significant (P<0.05).The changes value of FEV1 of the smoking cessation group higher than smoking group in 3 months, the differences were statistically significant (P<0.05); in 6 months, compare with smoking group and ex-smokers group, the differences were statistically significant (P<0.05); in 9 months, compare with other three group, the differences were statistically significant (P<0.05). The changes value of PEF of the smoking cessation group higher than other three group in follow-up 3 months,6 months, 9 months, the differences were statistically significant (P<0.05).5."LungAge":The"LungAge"of the smoking cessation group was declined than original after they quit smoking, in 3, 6, 9 months, the differences were statistically significant(P<0.05).The"LungAge"of the other three group were increased than original. The"LungAge"of smoking group was increased than original in 6, 9 months, the differences were statistically significant(P<0.05). The"LungAge"of ex-smoking group and non-smoking group were increased than original, the differences were not statistically significant(P > 0.05).The changes value of"LungAge"of the smoking cessation group lower than smoking group. In 6, 9months, compare with other three group, the differences were statistically significant (P<0.05). The changes of"lung presenility years"was the same changes of the"LungAge".ConclusionConcentration of CO exhaled of the smoking cessation group was decreased after they quit smoking, compared with the smoking group the difference was statistically significant,and it sequentially maintained low level which closed to the ex-smokers group and the non-smokers group.The clinical symptoms of the patients of COPD, including cough, sputum, wheezing and so on, relieved obviously after they quit smoking.The score of clinical symptom and the numbers of acute exacerbation during the period of the patients who quited smonking decreased than before.Most of indexes of lung function of the patients of COPD recovered after they quit smoking for 3month, 6 month,9 month compared with smokers, which indicate smoking cessation can delay the decline of lung function.Therefore, smoking cessation is an important part of the preventive of COPD. In order to keep more patients away from the harmful effects of smoking and improve their quality of life, we should do more to make the patients quit smoking. |
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