論文No1061
Determinants of Smoking Cessation in Patients With COPD Treated in the Outpatient Setting
Sandra S. Tøttenborg, MSc; Reimar W. Thomsen, DMSc; Søren P. Johnsen, DMSc; Henrik Nielsen, MSc; Peter Lange, DMSc
Chest. 2016;150(3):554-562. doi:10.1016/j.chest.2016.05.020
＜背景＞
COPDの進行における禁煙の効用はよく知られている。
しかし、多くのCOPD患者は喫煙をつづけている。
＜方法＞
この国家的前向きフォローアップ研究で、我々は3233名のCOPD患者で2008年から2012まで喫煙していた患者の禁煙率、禁煙の臨床および社会的特性について調べた。
多変量Cox回帰分析を使用して、禁煙のハザード比(HRs)を計算した。
＜結果＞
最初に外来に来て1年、５年において禁煙率は19%, 45%であった。
補正解析において、若年だと禁煙率がわるく、70歳以上と比較して50-69歳ではHRは0.84 (95% CI, 0.71-0.99),30-49歳では0.53 (95% CI, 0.37-0.76)であった。
低収入だと (HR, 0.79; 95% CI, 0.67-0.94)、
一人暮らしだと(HR, 0.75; 95% CI, 0.64-0.88)、
無職だと(HR, 0.70; 95% CI, 0.54-0.90)であった。
COPDの程度がGOLD Dと比較して
GOLD AだとHR of 0.67 (95% CI, 0.53-0.84)、GOLD Bだと 0.61 (95% CI, 0.47-0.80) であった。
MRC息切れスコアが<4だと (HR 0.80, 95% CI 0.68-0.95)、
外来で増悪経験ないと(HR, 0.80; 95% CI, 0.68-0.93)であった。
＜感想＞
若年、低収入、一人暮らし、無職、COPDの程度が軽いと、禁煙率が低かったようです。
Background The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke.
Methods In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical and sociodemographic determinants of smoking cessation in 3,233 patients with COPD who smoked on outpatient contact during 2008 to 2012. Using multivariate Cox regression, we calculated hazard ratios (HRs) of quitting.
Results Within 1 and 5 years from first outpatient contact, the probability of quitting was 19% and 45%, respectively. In adjusted analyses, patients were less likely to quit if they were younger, with an HR of 0.84 (95% CI, 0.71-0.99) for patients aged 50 to 69 years and 0.53 (95% CI, 0.37-0.76) for patients aged 30 to 49, compared with those aged 70 years or older, who had lower income (HR, 0.79; 95% CI, 0.67-0.94), lived alone (HR, 0.75; 95% CI, 0.64-0.88), were unemployed (HR, 0.70; 95% CI, 0.54-0.90), had milder COPD with an HR of 0.67 (95% CI, 0.53-0.84) for Global Initiative for Chronic Obstructive Lung Disease (GOLD) A and 0.61 (95% CI, 0.47-0.80) for GOLD B compared with GOLD D, had Medical Research Council (MRC) dyspnea scale score < 4 (HR 0.80, 95% CI 0.68-0.95), or no history of exacerbations treated on an outpatient basis. (HR, 0.80; 95% CI, 0.68-0.93).
Conclusions These findings reinforce that young and socioeconomically disadvantaged patients have more difficulties achieving timely smoking cessation. A novel finding is that patients with milder COPD are less likely to quit. The findings suggest a need for interventional studies focusing on these subgroups to ensure abstinence to halt disease progression.