A randomized controlled trial of supervised smoking cessation on CAT, mMRC, SGRQ score and readmission risk in COPD patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Lifen ¹ , YANG Tianwen ¹ , REN Chaofeng ¹ , YAN Chaofang ² , YANG Yanxia ¹ , LIU Shu ³ , HUANG Qingyuan ¹ , HUANG Qian ¹ , LIU Yang ⁴ ,  LI Meihua ¹

1. Department of Respiratory and Critical Care Medicine, Ganmei Hospital Affiliated to Kunming Medical University, The First People’s Hospital of Kunming, Kunming, Yunnan 650011, P. R. China;
2. School of Public Health, Kunming Medical University, Kunming, Yunnan 650500, P. R. China;
3. Department.of Bone Oncology, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650118, P. R. China;
4. School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan 650500, P. R. China;

Corresponding?author：

LI Meihua, Email: limeihuakm2009@163.com

Keywords：

Smoking cessation; Chronic obstructive pulmonary disease

DOI：

10.7507/1671-6205.202107007

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Objective To investigate the effect of supervised smoking cessation program on COPD Assessment Test (CAT), modified British Medical Research Council (mMRC) and St George’s Respiratory Questionnaire (SGRQ) score and readmission risk in smoking patients with chronic obstructive pulmonary disease (COPD). Methods A total of 200 patients with COPD were enrolled in the study from the Department of Respiratory and Critical Care Medicine of Ganmei Hospital Affiliated to Kunming Medical University (The First People’s Hospital of Kunming) from April 2018 to December 2019. They were randomized divided into a control group (100 cases) and a supervision group (100 cases). The control group stopped smoking by their own will, and the supervision group was interfered on the basis of self-quit. Repeated measure analysis of variance was used to compare the CAT, mMRC, SGRQ scores and hospitalization times of the enrolled subjects before intervention, at the end of 6 months and 12 months of intervention, to evaluate the impact of supervised smoking cessation on the quality of life in smoking patients with COPD. Results CAT scores and mMRC scores were lower in the supervision group than in the control group after 6 months of follow-up compared with the baseline enrollment. There was a significant decrease in the supervision group, from 2.39 to 0.58 respectively; the decrease of control group was not obvious, from 0.15 to 0.01 respectively. After 12 months of follow-up, compared with enrollment and after 6 months of follow-up, the supervision group had a significant decrease, and the CAT score decreased from 4.45 to 2.06, respectively. The mMRC scores decreased by 1.03 and 0.45 points, respectively. The CAT scores of the control group were increased by 0.02 and 0.17 points, respectively, which showed an opposite trend to that of the supervision group. The mMRC score was decreased to a certain extent by 0.16 and 0.15 points, respectively, which was significantly less than that of the supervision group. The differences were statistically significant (P<0.05). After 1 year, compared with enrollment, the average SGRQ score decreased in both the supervision group and the control group. SGRQ symptom score decreased by 4.95 points and 3.51 points respectively; SGRQ activities decreased by 4.01 points and 10.00 points respectively; SGRQ effect score decreased by 5.33 points and 8.65 points respectively; SGRQ total scores were decreased by 6.26 points and 8.95 points respectively. And the number of cigarettes was reduced by 19.01 and 17.15 respectively. The differences were statistically significant (P<0.05). The decreasing range of CAT score, mMRC score, SGRQ symptom score and smoking counts in the supervision group was significantly higher than that in the control group. Considering the supervision to quit smoking can well reflect the improvement of clinical symptoms in COPD patients. In terms of the times of hospitalization, the risk of readmission was lower in the supervision group. Conclusions The mMRC, CAT and SGRQ scores showed that supervised smoking cessation could better improve the quality of life and reduce the risk of readmission in smoking patients. Lung function and quality of life were significantly better after intervention than before.

Citation： YANG Lifen, YANG Tianwen, REN Chaofeng, YAN Chaofang, YANG Yanxia, LIU Shu, HUANG Qingyuan, HUANG Qian, LIU Yang, LI Meihua. A randomized controlled trial of supervised smoking cessation on CAT, mMRC, SGRQ score and readmission risk in COPD patients. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(11): 761-767. doi: 10.7507/1671-6205.202107007 Copy

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2.	He Y, Jiang B, Li LS, et al. Secondhand smoke exposure predicted COPD and other tobacco-related mortality in a 17 -year cohort study in China. Chest, 2012, 142(4): 909-918.
3.	T?nnesen P. Smoking cessation and COPD. Eur Respir Rev, 2013, 22(127): 37-43.
4.	Riesco JA, Alcázar B, Trigueros JA, et al. Active smoking and COPD phenotype: distribution and impact on prognostic factors. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1989-1999.
5.	徐海峰, 孫異鋒, 林歡. 吸煙對慢性阻塞性肺疾病患者相關免疫炎性反應及肺功能的影響. 臨床肺科雜志, 2020, 25(1): 58-61.
6.	Bai JW, Chen XX, Liu S, et al. Smoking cessation affects the natural history of COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 3323-3328.
7.	羅勤利. 戒煙干預對不同風險程度慢性阻塞性肺疾病患者預后的影響對比. 臨床肺科雜志, 2015, 20(6): 1076-1079.
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9.	Miravitlles M, Soler-cataluna JJ, Calle M, et al. Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Phase. Arch Bronconeumol, 2017, 53(6): 324-335.
10.	Eva AM, Onno CP, Geertjan W, et al. Predictors of long-term smoking cessation in patients with COPD: results from a randomised controlled trial. Eur Respir J, 2017, 49(6): 1700561.
11.	Hartmann-Boyce J, Chepkin SC, Ye W, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev, 2018, 5(5): CD000146.
12.	T?ttenborg SS, Thomsen RW, Johnsen SP, et al. Determinants of smoking cessation in patients with COPD treated in the outpatient setting. Chest, 2016, 150(3): 554-562.
13.	Stead LF, Buitrago D, Preciado N, et al. Physician advice for smoking cessation. Cochrane Database Syst Rev, 2013, 2013(5): CD000165.
14.	楊添文, 楊麗芬, 任朝鳳, 等. 督導戒煙及肺康復對慢阻肺患者肺功能及戒煙效果的影響. 昆明醫科大學學報, 2020, 41(2): 104-109.
15.	Cahill K, Lindson-hawley N, Thomas KH, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev, 2016, 2016(5): CD006103.
16.	Howes S, Hartmann-Boyce J, Livingstone-Banks J, et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev, 2020, 4(4): CD000031.
17.	T?ttenborg SS, Clark AJ, Thomsen RW, et al. Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study. Int J Chron Obstruct Pulmon Dis, 2018, 13: 1775-1781.
18.	Chen ZM, Peto R, Zhou MG, et al; China Kadoorie Biobank (CKB) collaborative group. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet, 2015, 386(10002): 1447-1456.
19.	?berg J, Hasselgren M, Montgomery S, et al. Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2019, 14: 961-969.
20.	Raghavan D, Varkey A, Bartter T. Chronic obstructive pulmonary disease. Curr Opin Pulm Med, 2017, 23(2): 117-123.
21.	Martínez-González C, Casanova C, De-torres JP, et al. Changes and clinical consequences of smoking cessation in patients with COPD: a prospective analysis from the chain cohort. Chest, 2018, 154(2): 274-285.
22.	Dong XY, Wang L, Tao YX, et al. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China. Int J Chron Obstruct Pulmon Dis, 2016, 12: 49-58.
23.	Carrión Valero F, Paulos Dos Santos S, Celli BR. Smoking in COPD patients: a new clinical phenotype. Arch Bronconeumol, 2018, 54(5): 249-250.
24.	Au DH, Bryson CL, Chien JW, et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med, 2009, 24(4): 457-463.
25.	Godtfredsen NS, Vestbo J, Osler M, et al. Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax, 2002, 57(11): 967-972.
26.	Josephs L, Culliford D, Johnson M, et al. Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study. Eur Respir J, 2017, 49(5): 1602114.
27.	Carreras G, Pistelli F, Falcone F, et al. Reduction of risk of dying from tobacco-related diseases after quitting smoking in italy. Tumori, 2015, 101(6): 657-663.
28.	Liang WM, Chen JJ, Chang CH, et al. An empirical comparison of the WHOQOL-BREF and the SGRQ among patients with COPD. Quality of Life Research, 2008, 17(5): 793-800.
29.	Zhou ZJ, Zhou AY, Zhao YY, et al. Evaluating the clinical COPD questionnaire: a systematic review. Respirology, 2017, 22(2): 251-262.
30.	杜曉秋, 周軍, 張秋娣. 不同評價指標在慢性阻塞性肺疾病患者綜合評估中的應用. 中國全科醫學, 2016, 19(5): 511-516.
31.	Morishita-Katsu M, Nishimura K, Taniguchi H, et al. The COPD assessment test and St George's Respiratory Questionnaire: are they equivalent in subjects with COPD?. Int J Chron Obstruct Pulmon Dis, 2016, 11: 1543-1551.
32.	Varol Y, Ozacar R, Balci G, et al. Assessing the effectiveness of the COPD Assessment Test (CAT) to evaluate copd severity and exacerbation rates. COPD, 2014, 11(2): 221-225.
33.	蔡柏薔. 放至全球而皆準的策略——我看《GOLD頒布的COPD全球策略(2011年修訂版)》. 中國實用內科雜志, 2012, 32(5): 351-355.
34.	劉賢兵, 李芳, 徐寧, 等. 戒煙干預對早期穩定期慢性阻塞性肺疾病患者氣道局部免疫及生活質量的影響研究. 中國全科醫學, 2021, 24(23): 2927-2939.

1. Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J, 2019, 53(5): 1900164.
2. He Y, Jiang B, Li LS, et al. Secondhand smoke exposure predicted COPD and other tobacco-related mortality in a 17 -year cohort study in China. Chest, 2012, 142(4): 909-918.
3. T?nnesen P. Smoking cessation and COPD. Eur Respir Rev, 2013, 22(127): 37-43.
4. Riesco JA, Alcázar B, Trigueros JA, et al. Active smoking and COPD phenotype: distribution and impact on prognostic factors. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1989-1999.
5. 徐海峰, 孫異鋒, 林歡. 吸煙對慢性阻塞性肺疾病患者相關免疫炎性反應及肺功能的影響. 臨床肺科雜志, 2020, 25(1): 58-61.
6. Bai JW, Chen XX, Liu S, et al. Smoking cessation affects the natural history of COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 3323-3328.
7. 羅勤利. 戒煙干預對不同風險程度慢性阻塞性肺疾病患者預后的影響對比. 臨床肺科雜志, 2015, 20(6): 1076-1079.
8. Vogelmeier CF, Criner GJ, martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of Chronic Obstructive Lung Disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
9. Miravitlles M, Soler-cataluna JJ, Calle M, et al. Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Phase. Arch Bronconeumol, 2017, 53(6): 324-335.
10. Eva AM, Onno CP, Geertjan W, et al. Predictors of long-term smoking cessation in patients with COPD: results from a randomised controlled trial. Eur Respir J, 2017, 49(6): 1700561.
11. Hartmann-Boyce J, Chepkin SC, Ye W, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev, 2018, 5(5): CD000146.
12. T?ttenborg SS, Thomsen RW, Johnsen SP, et al. Determinants of smoking cessation in patients with COPD treated in the outpatient setting. Chest, 2016, 150(3): 554-562.
13. Stead LF, Buitrago D, Preciado N, et al. Physician advice for smoking cessation. Cochrane Database Syst Rev, 2013, 2013(5): CD000165.
14. 楊添文, 楊麗芬, 任朝鳳, 等. 督導戒煙及肺康復對慢阻肺患者肺功能及戒煙效果的影響. 昆明醫科大學學報, 2020, 41(2): 104-109.
15. Cahill K, Lindson-hawley N, Thomas KH, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev, 2016, 2016(5): CD006103.
16. Howes S, Hartmann-Boyce J, Livingstone-Banks J, et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev, 2020, 4(4): CD000031.
17. T?ttenborg SS, Clark AJ, Thomsen RW, et al. Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study. Int J Chron Obstruct Pulmon Dis, 2018, 13: 1775-1781.
18. Chen ZM, Peto R, Zhou MG, et al; China Kadoorie Biobank (CKB) collaborative group. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet, 2015, 386(10002): 1447-1456.
19. ?berg J, Hasselgren M, Montgomery S, et al. Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2019, 14: 961-969.
20. Raghavan D, Varkey A, Bartter T. Chronic obstructive pulmonary disease. Curr Opin Pulm Med, 2017, 23(2): 117-123.
21. Martínez-González C, Casanova C, De-torres JP, et al. Changes and clinical consequences of smoking cessation in patients with COPD: a prospective analysis from the chain cohort. Chest, 2018, 154(2): 274-285.
22. Dong XY, Wang L, Tao YX, et al. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China. Int J Chron Obstruct Pulmon Dis, 2016, 12: 49-58.
23. Carrión Valero F, Paulos Dos Santos S, Celli BR. Smoking in COPD patients: a new clinical phenotype. Arch Bronconeumol, 2018, 54(5): 249-250.
24. Au DH, Bryson CL, Chien JW, et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med, 2009, 24(4): 457-463.
25. Godtfredsen NS, Vestbo J, Osler M, et al. Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax, 2002, 57(11): 967-972.
26. Josephs L, Culliford D, Johnson M, et al. Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study. Eur Respir J, 2017, 49(5): 1602114.
27. Carreras G, Pistelli F, Falcone F, et al. Reduction of risk of dying from tobacco-related diseases after quitting smoking in italy. Tumori, 2015, 101(6): 657-663.
28. Liang WM, Chen JJ, Chang CH, et al. An empirical comparison of the WHOQOL-BREF and the SGRQ among patients with COPD. Quality of Life Research, 2008, 17(5): 793-800.
29. Zhou ZJ, Zhou AY, Zhao YY, et al. Evaluating the clinical COPD questionnaire: a systematic review. Respirology, 2017, 22(2): 251-262.
30. 杜曉秋, 周軍, 張秋娣. 不同評價指標在慢性阻塞性肺疾病患者綜合評估中的應用. 中國全科醫學, 2016, 19(5): 511-516.
31. Morishita-Katsu M, Nishimura K, Taniguchi H, et al. The COPD assessment test and St George's Respiratory Questionnaire: are they equivalent in subjects with COPD?. Int J Chron Obstruct Pulmon Dis, 2016, 11: 1543-1551.
32. Varol Y, Ozacar R, Balci G, et al. Assessing the effectiveness of the COPD Assessment Test (CAT) to evaluate copd severity and exacerbation rates. COPD, 2014, 11(2): 221-225.
33. 蔡柏薔. 放至全球而皆準的策略——我看《GOLD頒布的COPD全球策略(2011年修訂版)》. 中國實用內科雜志, 2012, 32(5): 351-355.
34. 劉賢兵, 李芳, 徐寧, 等. 戒煙干預對早期穩定期慢性阻塞性肺疾病患者氣道局部免疫及生活質量的影響研究. 中國全科醫學, 2021, 24(23): 2927-2939.

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A randomized controlled trial of supervised smoking cessation on CAT, mMRC, SGRQ score and readmission risk in COPD patients

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