Objective To investigate the effects of smoking intensity, duration and cessation on mRNA and protein expressions of matrix metalloproteinase-9 ( MMP-9) in tracheal epitheliumof rats, and the relationship between smoking or smoking cessation and airway remodeling in chronic obstructive pulmonary disease ( COPD) . Methods Forty Wistar rats were randomly divided into 5 groups, ie. a normal control group, a long termheavy smoking group, a short termheavy smoking group, a long termlight smoking group,and a smoking cessation group which was exposed to room air for 10 weeks after long term heavy smoking.The expressions of MMP-9 mRNA and protein in tracheal epithelium of rats were detected by in situ hybridization and munohistochemistry respectively. Results ( 1) The pathological changes of emphysema were observed in the lung tissue of every smoking rat, and were most sever in the long term heavy smoking group. ( 2) Compared with the normal control group [ ( 0. 88 ±0. 88) PU, ( 2. 80 ±1. 66) PU] , the expressions of MMP-9 mRNA and proteins in tracheal epithelium were remarkable elevated in the long term heavy smoking group [ ( 22. 01 ±2. 86) PU, ( 20. 81 ±2. 46) PU] , the short term heavy smoking group [ ( 14. 94 ±3. 46) PU, ( 13. 68 ±2. 00) PU] , the long term light smoking group [ ( 6. 92 ±2. 71) PU,( 8. 84 ±1. 80) PU] and the smoking cessation group [ ( 19. 00 ±3. 36) PU, ( 14. 82 ±1. 74) PU] ( P lt;0. 01) . Compared with the long term heavy smoking group, the expressions of MMP-9 in tracheal epithelium were decreased in other three smoking groups ( P lt; 0. 05) . Conclusions Smoking could increase the expression of MMP-9 in tracheal epithelium and cause trachea damage and remodeling with intensity and duration in rats. Smoking cessation could decrease the MMP-9 expression and alleviate trachea remodeling,suggesting its role in the prevention of COPD.
ObjectiveTo evaluate the effect of long-term systemic education management program on intervention of chronic obstructive pulmonary disease (COPD). MethodsTwo hundred forty-six stable patients were interviewed face-to-face from March to August in 2013.They were divided into a systemic education group, a follow-up group and a control group according to different management program.The investigation contained general conditions, commonly used medicines, the effects of smoking cessation, the frequency of acute exacerbation in the year before investigation, COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC). ResultsThe success rate for smoking cessation in the systemic education group was 97.6%, which was higher than 81.0% in the follow-up group and 73.8% in the control group(P < 0.01).97.6% of patients in the systemic education group and 93.7% of patients in the follow-up group used bronchodilator.Whereas only 65.5% of patients in the control group inhaled bronchodilator, significantly lower than other two groups (P < 0.01).Mucolytic agents were taken by 14.5% and 19.0% of patients in the systemic education group and the follow-up group, and by 36.9% of patients in the control group (P < 0.01).The frequency of acute exacerbation was 0.9±0.9 both in the systemic education group and the follow-up group, which was lower than 1.2±1.0 in the control group (P < 0.05).CAT and mMRC in the systemic education group (10.2±5.7 and 1.5±1.0) and the follow-up group (11.1±5.8 and 1.5±0.9) were significantly lower than those in the control group (15.0±6.6 and 1.9±1.1, P < 0.01). ConclusionsLong-term systemic education management program can improve success rate for smoking cessation and bronchodilator use, reduce the frequency of acute exacerbation, and improve quality of life effectively in COPD patients.
ObjectiveTo systematically review the effectiveness and safety of bupropion for smoking cessation in smokers with cardiovascular disease. MethodsDatabases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, WanFang Data and VIP databases were electronically searched from inception to February 23rd, 2013. Randomized controlled trials (RCTs) on bupropion versus placebo for smoking cessation in smokers with cardiovascular disease were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.1 software. ResultsIn total, 4 studies involving 1 415 patients were finally included. The results of metaanalyses indicated that, compared with placebo, bupropion significantly increased the point prevalence abstinence rate at 3 months (RR=1.79, 95%CI 1.14 to 2.83, P=0.01). However, the point prevalence abstinence rates at 6 months (RR=1.81, 95%CI 0.77 to 4.24, P=0.18) and 12 months (RR=1.46, 95%CI 0.94 to 2.27, P=0.10), and the continuous abstinence rates at 3 months (RR=1.48, 95%CI 0.89 to 2.47, P=0.13), 6 months (RR=1.41, 95%CI 0.79 to 2.51, P=0.25), and 12 months (RR=1.43, 95%CI 0.93 to 2.17, P=0.10) were similar in the two groups. The use of bupropion did not increase all-cause mortality (RR=1.13, 95%CI 0.49 to 2.56, P=0.78) and the incidence of cardiovascular events (RR=1.25, 95%CI 0.95 to 1.64, P=0.11). ConclusionBupropion is safe to use in smokers with cardiovascular disease. Although bupropion could increase the point prevalence abstinence rate at 3 months, it is not effective for long-term smoking cessation. Due to the limited quantity and quality of the included studies, more large-scale high-quality RCTs are required to verify the aforementioned conclusion.
ObjectiveTo investigate the effect of preoperative smoking intervention on the incidence of postoperative complication in patients undergoing total hip replacement. MethodsPatients undergoing elective total hip replacement were randomly (block randomization) assigned to either smoking intervention group or control group 4 weeks before scheduled hip replacement. Smoking intervention group received counseling and nicotine replacement therapy and achieved smoking cessation or at least 50% smoking reduction while the control group received standard care with little or no information about the risk of smoking or smoking cessation counselling. Anesthesia was done in accordance with the practice of our hospital with either general anesthesia or combined spinal-epidural anesthesia (CSEA). An assessor who was masked to the intervention recorded the incidence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance and treatment in intensive care unit (ICU) of two groups of patients. ResultsA total of 120 patients were finally included (60 cases were in each group, all male, ASAⅠ-Ⅲ, aged 65-82 years, weighting 42-75 kg). A total of 56 patients in the smoking intervention group and 57 in the control group were analyzed finally. The results showed that, the smoking intervention group was lower than the control group in the incidences of post-operative complications (12/56 vs. 39/57, P=0.000), postoperative wound-related complications (3/56 vs. 21/57, P=0.000), incision infection (1/56 vs. 13/57, P=0.001), and the requirement of secondary surgery (1/56 vs. 9/57, P=0.022) and wound debridement (1/56 vs. 8/57, P=0.040). The median length of stay in the smoking intervention group was significantly less than that of the control group (14 days vs. 26 days, P=0.000). ConclusionAn effective smoking intervention 4 weeks before surgery reduces incidence of postoperative complications.
ObjectiveThrough the analysis on outcome measurements in domestic and overseas randomized controlled trials (RCTs) of smoking cessation, this study aimed to provide references for clinical trial design in the future. MethodsWe searched CNKI, WanFang Data, VIP, PubMed, EMbase, ScienceDirect and SpringLink databases to collect RCTs regarding smoking cessation from January 1998 to December 2013. Two reviewers screened literature according to the inclusive and exclusive criteria, extracted the data, and analyzed the outcome measurements of included RCTs. ResultsA total of 68 RCTs regarding smoking cessation were included. As for the baseline measurements, the frequency from high to low were age, sex, daily cigarette, smoking duration, Fagerstrom Test For Nicotine Dependence (FTND), race and education, etc.; there were significant differences of race, education level, smoking duration, smoking, starting age of smoking, attempts of trying to stop smoking, the presence of other basic disease, FTND and quit date between English and Chinese RCTs (all P<0.05). As for efficacy measurements, the continuous abstinence rate (77.8%) was mainly adopted in Chinese RCTs, while point abstinence rate (95.1%) and continuous abstinence rate (82.9%) was selected in English RCTs. As for the follow-up measurements, 22.1% of the included RCTs did not report it, 70.6% of the RCTs reported abstinence rate, and the follow-up time in Chinese RCTs was shorter than that in the English RCTs (P<0.05). ConclusionThe selection of outcome measurements is significantly different among RCTs regarding smoking cessation, the Chinese RCTs are inferior to English RCTs, and these are needed to be improved in the future clinical trials.
Objective To systematically review the effectiveness of short message intervention on smoking cessation. Methods Databases including PubMed, The Cochrane Library, EMbase, CBM were searched from inception to August 2016, to collect randomized controlled trials (RCTs) about short message service (SMS) for smoking cessation. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 12.0 software. Results A total of 14 RCTs involving 15 543 participants were included. The results of meta-analysis showed that, compared with the control group, no significant difference was found in self-reported three months continuous abstinence (RR=0.830, 95%CI 0.679 to 1.014, P=0.069), 30 day point quit rate (RR=0.878, 95%CI 0.687 to 1.122, P=0.076). However, there were significant differences in the self-reported 7-day point abstinence (RR=1.149, 95%CI 1.014 to 1.303, P=0.03), the CO biochemical verification abstinence (RR=0.571, 95%CI 0.357 to 0.914, P=0.020), and the average number of cigarettes smoked per day (SMD=–0.25, 95%CI –0.37 to –0.12, P<0.001). Conclusion The available evidence indicates that short message intervention has a better effect on short-term smoking cessation. Therefore, more long-term studies are needed to determine the association between SMS and quit smoking behavior.
ObjectiveTo 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.
ObjectiveTo systematically review the efficacy of exercise intervention on smoking cessation. MethodsCNKI, WanFang Data, VIP, Web of Science, PubMed and EMbase databases were electronically searched to collect randomized controlled trials (RCTs) and randomized cross controlled trials (RCDs) on exercise intervention for smoking cessation from inception to September 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then, meta-analysis was performed using Stata 12.0 software. ResultsA total of 47 studies (35 RCTs and 12 RCDs) involving 5 130 subjects were included. The results of meta-analysis showed that acute exercise could significantly reduce the quitters’ desire to smoke (P<0.05), alleviate most of the withdrawal symptoms, and the effect of acute exercise was maintained for at least 30 minutes. Periodic exercise significantly reduced 7-day point abstinence and sustained abstinence rates in ex-smokers (P<0.05), and the effect of periodic exercise was maintained for at least 12 weeks, however, depression and stress were not found to be effectively relieved, and mood was not found to be significantly improved (P>0.05). ConclusionExercise intervention to quit smoking has a positive effect, however, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy of different non-pharmacological interventions for smoking cessation. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of different non-pharmacological interventions for smoking cessation from inception to November, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, network meta-analysis was performed by using Stata 15.1 software. ResultsA total of 27 RCTs involving 14 interventions were included. The results of the network meta-analysis showed that compared with conventional advice, video counseling (OR=2.34, 95%CI 1.32 to 4.15), mobile phone text message (OR=1.82, 95%CI 1.03 to 3.20), motivational interview (OR=2.00, 95%CI 1.11 to 3.59) and health education (OR=3.40, 95%CI 1.52 to 7.57) were higher in quitting rate (P<0.05). The sort results showed that health education was the most likely to be the best intervention (86.20%), followed by video consultation (74.10%). ConclusionCurrent evidence shows that the smoking cessation effects of health education, video counseling, telephone counseling, mobile phone text message and motivational interview. Among them, health education may be the best. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo explore ways so as to improve smoking cessation rates by studying relevant cases in Hong Kong.MethodsPatients attending the clinical pilot project in Hong Kong from 2010 to 2022 were retrospectively surveyed and analyzed. Information such as patients' general information, reasons for smoking for the first time, situations that enable smoking, barriers to smoking cessation, and withdrawal symptoms were obtained using a pre-designed case report form and analyzed.ResultsA total of 10436 patients, 6936 males and 3500 females, were included. Influenced by friends (67.70%), relieving mental stress (33.12%) and curiosity (30.52%) were the main reasons for smoking for the first time; depression (57.14%), after meals (49.08%) and nervousness (41.26%) were the situations that enable smoking; the main barriers to smoking cessation were physiologic dependence (87.06%) friends or colleagues smoking (37.03%) and compulsiveness to use tobacco (32.45%), top withdrawal symptoms smoking stoppage were craving for cigarettes (50.33%), restlessness (38.33%), and difficulty concentrating (26.63%).ConclusionsThe proportion of patients actively choosing to quit smoking is high in Hong Kong, and smoking cessation methods should be publicized to prompt smokers to take effective measures to quit. A majority of people are influenced by friends to smoke for the first time; thus, adolescent smoking behavior should be supervised to reduce first-time smokers. Moreover, as the most difficult thing to overcome in the process of quitting smoking is psychological addiction, behavioral interventions must be promoted to improve the rate of successful quitting, Steps should be taken to enable the management of withdrawal symptoms to prevent relapse.