戒烟对烟草依赖支气管哮喘患者肺功能和生活质量的影响及伐尼克兰的辅助戒烟作用

Effect of Smoking Cessation with the Aid of Varenicline on the Values of Pulmonary Function Parameters and Asthma-related Life Quality in Bronchial Asthma Patients with Nicotine Dependence

目的探讨戒烟对烟草依赖支气管哮喘(简称哮喘)患者肺功能和生活质量的影响及伐尼克兰的辅助戒烟作用。方法收集2014年8月—2016年4月中山大学附属第三医院收治的符合纳入标准的44例吸烟的哮喘患者的临床资料。根据患者干预3个月后的戒烟状况,将其分为完全戒烟组(n=17)、部分戒烟组(n=14)和继续吸烟组(n=13)。比较3组患者哮喘控制情况[包括医生角度(干预后)和患者角度(干预前后),患者角度以哮喘控制测试表(ACT)评价],干预前后肺功能情况[第1秒用力呼气末容积占预计值百分比(FEV_1%pred)、用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气末容积占用力肺活量百分比(FEV_1/FVC)、晨间呼气峰流速(PEFam)、夜间呼气峰流速(PEFpm)]、生活质量[采用哮喘生活质量问卷简略版本(mini AQLQ)评价],伐尼克兰使用情况。结果 3组患者干预后哮喘控制情况(医生角度)比较,差异有统计学意义(P<0.05)。3组患者干预前哮喘控制情况(患者角度)比较,差异无统计学意义(P>0.05);完全戒烟组患者干预后哮喘控制情况(患者角度)优于继续吸烟组和部分戒烟组(P<0.05)。3组患者干预前FEV_1%pred、FVC%pred、FEV_1/FVC、PEFam、PEFpm比较,差异无统计学意义(P>0.05);3组患者干预后FEV_1/FVC比较,差异无统计学意义(P>0.05);完全戒烟组患者干预后FEV_1%pred、PEFpm高于继续吸烟组(P<0.05);继续吸烟组患者干预后FVC%pred、PEFam低于部分戒烟组、完全戒烟组(P<0.05);干预后部分戒烟组、完全戒烟组患者FEV_1%pred、FVC%pred、PEFam、PEFpm高于干预前(P<0.05)。3组患者干预前mini AQLQ评分比较,差异无统计学意义(P>0.05);完全戒烟组患者干预后mini AQLQ评分高于继续吸烟组(P<0.05)。3组患者伐尼克兰使用率比较,差异有统计学意义(P<0.05)。结论伐尼克兰辅助戒烟可增加哮喘患者戒烟率,戒烟可改善吸烟哮喘患者病情、肺功能及生活质量。

Objective To determine whether the values of pulmonary function parameters and asthma-related life quality can be improved after smoking cessation with the aid of varenicline in bronchial asthma patients with nicotine dependence. Methods A total of 44 previously smoked patients with bronchial asthma who were treated in the Third Affiliated Hospital,Sun Yat-sen University from August 2014 to April 2016 and met the inclusion criteria were recruited. According to the smoking status after 3-month intervention,the patients were divided into complete smoking cessation group（ n = 17）,partial smoking cessation group（ n = 14） and continued smoking group（ n = 13）. The status of control of asthma was assessed by the doctor after intervention,and by patients themselves by completing the Asthma Control Test（ ACT） before and after intervention,values of pulmonary function parameters [FEV_1% pred, FVC% pred, FEV_1/FVC, domiciliary morning/evening peak expiratory flow（ PEFam/pm） ]before and after intervention,asthma-related life quality assessed by mini AQLQ before and after intervention,and rate of varenicline use were compared among the three groups. Results Statistically significant difference was observed among the three groups after intervention in the control of asthma assessed by doctors（ P 0. 05）. Although no significant differences were noted in patient self-rated ACT scores among the three groups before intervention（ P 0. 05）,quitters showed a significant improvement than partial quitters and continued smokers after treatment（ P 0. 05）. No significant differences were observed in the baseline lung function estimations（ FEV_1% pred, FVC% pred, FEV_1/FVC, PEFam and PEFpm） among the three groups（ P 0. 05）,however,after treatment,only the value of FEV_1/FVC remained stable in all groups throughout the study period（ P 0. 05）,the quitters and partial quitters showed significant improvement in the values of other four parameters（ P 0. 05）; quitters showed higher values of FEV_1% pred and PEFpm than continued smokers（ P 0. 05）,and continued smokers demonstrated lower values of FVC% pred and PEFam than partial quitters and complete quitters（ P 0. 05）. Although mini AQLQ scores did not differ significantly among the three groups before treatment（ P 0. 05）,quitters demonstrated a remarkable improvement than continued smokers after treatment（ P 0. 05）. A significant difference in the rate of varenicline use was observed after intervention among the three groups（ P 0. 05）. Conclusion Varenicline could be utilized with a high probability of success for tobacco cessation in smokers with asthma. Asthmatic patients who quit or decreased smoking showed greater improvement in airway obstruction,symptom score,and asthma-related quality of life than those who continued smoking,suggesting that abstaining from smoking is therapeutically beneficial in the management of asthma.