만성폐쇄성폐질환 환자에서 금연 중재의 효과: 체계적 문헌고찰

Abstract

Objectives:The prevalence of chronic obstructive pulmonary disease (COPD) is expected to risein not only developed countries, but also developing countries. Smoking is the largest risk factor forCOPD and smoking cessation is the most effective way to prevent or slow the progression of the disease. In this study, we reviewed literatures to investigate the benefits of smoking cessation interventions in COPD patients. Methods:A systematic literature search was performed based on patient, intervention, comparison, outcomes framework. The main searching terms were COPD, emphysema,bronchitis, pulmonary disease, and smoking cessation in PubMed, EMBASE, Cochrane library, KoreaMed, and RISS. The participants were current adult smokers with COPD. We included smokingcessation counselling/education, drugs (varenicline, bupropion), and nicotine replacement treatmentas interventions but excluded cases where the intervention was only a part of disease managementprogram. The comparisons were no treatment, usual care, or placebo. The outcomes were abstainingrate, forced expiratory volume in one second (FEV1) decline rate, and mortality. The follow-up timeof study was at least 6 months. We included randomized/non-randomized controlled trials (RCT/nRCT), and cohort studies written in English or Korean. Authors independently extracted the dataand resolved any disagreements by consensus. Results:The sixteen published articles (12 studies)were selected; 11 RCTs and 1 nRCT. We found consistent evidences that such interventions were verysupportive to help COPD patients quit smoking. Also abstinent COPD patients in the interventiongroup showed better health outcomes than those in the control group in terms of FEV1decline rateand all-cause mortality. Conclusion:Smoking cessation interventions are effective to reduce lungfunction decline rate and mortality by encouraging COPD patients to stop smoking.