Ertürk ERDİNÇ, Aytemur Zeynep SOLAK, Kaçmaz Özen BAŞOĞLU

Kronik obstrüktif akciğer hastalığı olgularında sigarayı bırakma başarısı

Sigara içenlerin %15-20’sinde kronik obstrüktif akciğer hastalığı (KOAH) gelişmektedir. Sigara içimi ile yıllık FEV1 düşüşü hızlanırken, bu düşüşü yavaşlatan en önemli faktörün sigaranın bırakılması olduğu saptanmıştır. Bu prospektif çalışmada, KOAH’lı olguların sigarayı bırakma başarısı ve bunu etkileyen faktörler, yanı sıra sigarayı bırakmanın yıllık FEV1 düşüşüne etkisini araştırmak amaçlanmıştır. Sigarayı bırakma polikliniğimize başvuran 65 ardışık KOAH’lı olgu çalışmaya alınmış; benzer yaş ve cinsiyet özellikleri olan 50 sağlıklı sigara içen olgu kontrol grubu olarak seçilmiştir. Her iki gruba da yalnız yoğun destek tedavisi, yoğun destek + nikotin replasman tedavisi veya yoğun destek + bupropion HCL tedavisi uygulanmış ve bir yıllık sigarayı bırakma başarıları değerlendirilmiştir. Olguların demografik özelliklerinin ve KOAH anamnezlerinin sigarayı bırakma başarısına etkisi olmadığı gözlenmiştir. Bir yıl sonunda KOAH grubunda sigarayı bırakma oranı %29 iken, kontrol grubunda %49 olarak bulunmuştur (p< 0.05). Uygulanan farklı tedavi yöntemlerinin sigarayı bırakma başarısı üzerine üstünlüğü olmadığı gösterilmiştir. Bir yıl sonunda sigarayı bırakmış KOAH olgularında yıllık FEV1 düzeyleri 29 mL artarken, içmeyi sürdürenlerde 25 mL azalmıştır (p> 0.05). Çalışmamızda sigarayı bırakma polikliniğine başvuran KOAH’lı olguların sigarayı bırakma başarısının sağlıklı sigara içicilerine göre daha düşük olduğu ve bırakanlarda yıllık FEV1 düşüşünün azaldığı sonucuna varılmıştır.

Success of smoking cessation in patients with chronic obstructive pulmonary disease

Smoking causes chronic obstructive pulmonary disease (COPD) in 15 to 20% of smokers. Smoking accelerates the annual rate of FEV1 decline, whereas it was demonstrated that smoking cessation is the major factor that reduces this decline. The aims of this prospective study were to assess the success rate and factors affecting smoking cessation, besides, to evaluate the effect of cessation on annual FEV1 decline. Sixty-five consecutive patients with COPD and as a control group 50 ageand sex-matched healthy smokers who were admitted to our smoking cessation clinic were enrolled in the study. Intensive behavioral therapy alone or with nicotine replacement therapy or bupropion HCL was given to both groups and success rate of smoking cessation after one year was assessed. It was shown that demographic features of the subjects and the history of COPD had no effect on success of smoking cessation. At the end of one year the rate of smoking cessation was 29% in patients with COPD and 49% in the control group (p< 0.05). All different therapy interventions had similar effects on smoking cessation. The annual FEV1 values increased 29 mL in quitters and decreased 25 mL in patients continuing smoking (p> 0.05). In this study, we concluded that the success of smoking cessation in COPD patients admitted to the smoking cessation clinic was significantly lower than healthy smokers and annual FEV1 decline was decreased in quitters.

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1.Wouters EF. Management of severe COPD. Lancet 2004; 364: 883-95.
2.Tashkin DP, Kanner R, Bailey W, et al. Smoking cessati on in patients with chronic obstructive pulmonary disease: A double-blind, placebo-controlled, randomised trial. Lancet 2001; 357: 1571-5.
3.Sullivan SD, Ramsey SD, Lee TA. The economic burden of COPD. Chest 2000; 117 (Suppl 2): 5-9.
4.US Department of Health and Human Services. The health benefits of smoking cessation. Rockville, MD: Office on Smoking and Health. Department of Health and Human Services 1990; Publication No. (CDC) 8.416
5.Lange P, Groth S, Nyobe J. Effect of smoking and changes in smoking habits on the decline of FEV1 Eur Respir J 1989; 2: 811-6.
6.Wagena EJ, van der Meer RM, Ostelo RJ, et al. The efficacy of smoking cessation strategies in people with chronic obstructive pulmonary disease: Results from a systematic review. Respir Med 2004; 98: 805-15.
7.Willemse BW, Postma DS, Timens W, ten Hacken NH. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J 2004; 23: 464-76.
8.Pauwels RA. National and international guidelines for COPD: The need for evidence. Chest 2000; 117: 20-2.
9.Sherman SE, Lanto AB, Nield M, Yano E. Smoking cessation care received by veterans with chronic obstructive pulmonary disease. J Rehabil Res Dev 2003; 40 (5 Suppl 2): 1-12.
10.Jimenez-Ruiz CA, Masa F, Miravitlles M, et al. IBERPOC Study Investigators. Smoking characteristics. Differences in attitudes and dependence between healty smokers ans smokers with COPD. Chest 2001; 119: 1365-70.
11.Sachs D. Treatment of cigarette dependency: What American pulmonary physicians do? Am Rev Respir Dis 1984; 129: 1010-3.
12.Pauwels RA, Buist AS, Calverly PM, et al. The GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med 2001; 163: 1256-76.
13.Fabbri LM, Hurd SS. GOLD Scientific Committee. Global Strategy for the Diagnosis, Management and Prevention of COPD: 2003 update. Eur Respir J 2003; 22: 1-2.
14.Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-70.
15.Fagerström KO, Heatherton TF, Kozlowski LT. Nicotine addiction and its assessment. Ear Nosa Throat J 1992; 69: 763-7.
16.A clinical practice guideline for treating tobacco use and dependence. A US Public Health Service Report. JAMA 2000; 283: 3244-54.
17.Jorenby DE, Smith SS, Fiore MC, et al. Varying nicotine patch dose and type of smoking cessation counselling. JAMA 1995; 274:1347-52.
18.Özge C, Tümkaya M, Özgür ES, Eker S. Solunumsal yakınması olan hastaların sigara alışkanlık durumlarının değerlendirilmesi. Solunum Hastalıkları 2005; 16: 12-7.
19.Sampablo I, Lores L, Coll-Klein F, et al. Predictive factors in smoking cessation with bupropion and nicotine patches. Monaldi Arch Chest Disease 2003; 59: 171-6.
20.Monninkhof E, van der Valk P, van der Palen J, et al. The effect of a minimal contact smoking cessation programme in out-patients with chronic obstructive pulmonary disease: A pre-post-test study. Patient Educ Couns 2004; 55: 121-8.
21.Uzaslan EK, Özyardımcı N, Karadağ M, et al. The physician's intervention in smoking cessation: Results of the five years of smoking cessation clinic. Ann Med Sci 2000; 9: 63-9.
22.Solak ZA, Telli CG, Erdinç E. Sigarayı bırakma tedavisinin sonuçları. Toraks Dergisi 2003; 4: 73-7.
23.Çan G, Öztuna F, Özlü T. The evaluation of outpatient smoking cessation clinic results. Tuberk Toraks 2004; 52: 63-74.
24.Schwartz J, Wiss ST. Dietary factors and their relation to respiratory symptoms. Am J Epidemiol 1990; 132:67-76.
25.Menezes AMB, Victora CG, Rigatto M. Prevalence and risk factors for chronic bronchitis in Pelotas, RS, Brazil: A population-based study. Thorax 1994; 49: 1217-21.
26.Pierce JP, Fiore MC, Novotny TE, et al. Trends in cigarette smoking in the United States: Projections to the year 2000. JAMA 1989; 261: 61-5.
27.Peat JK, Woolcock AJ, Cullen K. Decline of lung function and development of chronic airflow limitation: A longitudinal study of non-smokers and smokers in Busselton, Western Australia. Thorax 1990; 45: 32-7.
28.Scanlon PD, Connett JE, Waller A, et al. Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med 2001; 161:381-90.