老年人非药物途径戒烟 戒断率可达35%

芝加哥——据2013年美国胸科医师协会(ACCP)年会上公布的一项多中心研究，对长期护理机构中的老年人在戒烟方面采取加强教育及其他非药物策略可显著提高戒烟率。


AleksanderShalshin医生

纽约赛奥西特市北岸长岛犹太医疗系统的肺部与危重监护医生Aleksander Shalshin报告指出，在74名当前吸烟者中有34名（46%）在1年时成功戒烟，26名（35%）仍在吸烟。既往研究表面，戒烟医嘱所产生的1年戒烟率一般在5%~10%，46%的戒烟率成功表明药物治疗并非戒烟的惟一途径。

60岁以上的吸烟者大致占当前吸烟者的23%，其死于吸烟相关疾病的风险增加。近期的一项前瞻性研究发现，维持吸烟至70多岁的男性死于癌症、心血管疾病以及呼吸系统疾病的风险较从不吸烟者高出50%。另外，美国和英格兰近期的研究也显示，在60岁或65岁时戒烟的吸烟者能延长2.7~3.7年的寿命。

在当前的研究中，研究者们前瞻性的招募了74名年龄介于65~78岁之间、当前以平均半包香烟/天的量吸烟、吸烟史在5年以上的长期护理机构居民。这些受试者对戒烟都很感兴趣。干预措施包括每天由初级保健医生、护士或护士教育者上门进行戒烟咨询辅导，并定期与肺部顾问见面。咨询还辅以教育自助、视频和印刷材料，各机构还在入口处50英尺范围内设置无烟区，同时鼓励参与者的家人提供支持和接受有关采用多层面的吸烟成瘾治疗方法的益处的教育。

Shalshin医生表示，对于长期护理机构中的患者，大家能很快并且往往也很容易的接触到他们，不必等到下次就诊，这种戒烟措施可以每天进行1次，花点时间和精力就可以做到。这部分人将来会再住院，尤其是如果他们有潜在的慢性阻塞性肺病（COPD）、哮喘或心脏病。之所以不采取药物戒烟，主要是考虑到这些患者中大多数已经在服用20种不同的药物。但在下一期研究中，将会对其余采用多学科非药物疗法无法戒烟的患者采取药物治疗。会议的共同主持人、纽约欧申赛德南纳苏社区医院首席医学官Linda Efferen医生也表示，这对这一活动范围受限的受众实施戒烟措施很有意义，事半功倍。

Shalshin医生及其合著者们无经济内容披露。

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By: PATRICE WENDLING, Internal Medicine News Digital Network

CHICAGO – Intensive counseling and other nonpharmacologic strategies to quit smoking dramatically increased abstinence rates among elderly long-term-care residents in a multicenter study.

Among 74 current smokers, 34 residents (46%) successfully quit smoking and 26 (35%) remained tobacco free at 1 year.
 
Prior research shows that medical advice to quit smoking typically produces 1-year abstinence rates of 5% to 10%.

"With a 46% quit rate, we were successful in showing that pharmacologic therapy isn’t the only way," Dr. AleksanderShalshin said at the annual meeting of the American College of Chest Physicians.

Smokers over the age of 60 years represent about 23% of current smokers and are at increased risk of dying from disorders related to smoking. A recent prospective study found that the risk of dying from cancer, cardiovascular disease, and respiratory disease was 50% higher among men who continued to smoke into their 70s than for never-smokers.

Further, recent studies in the United States and England have shown that smokers who quit at either age 60 or age 65 years gained 2.7-3.7 years of life, said Dr. Shalshin, a pulmonary and critical care physician with North Shore Long Island Jewish Health System, in Syosset, N.Y.

"I always tell my patients it’s never too late to be a quitter," he said.

For the current study, the investigators prospectively recruited 74 long-term-care residents, aged 65-78 years, who were currently smoking an average of half a pack of cigarettes a day and had a tobacco history of more than 5 years. All were interested in quitting.

The intervention included daily smoking-cessation counseling visits from their primary care physician, nurse, or nurse educator, and regular access to a pulmonary consultant.

Counseling was supplemented with educational self-help, video and printed materials and the facilities set up smoke-free zones within 50 feet of their entrances. Participant’s families were also encouraged to provide support and received education on the benefits of a multifaceted approach to tobacco-addiction treatment.

"For patients in long-term-care facilities, where access is immediate and often easy, you don’t have to wait for the next appointment. It can be done on a daily basis with a little bit of time and effort." Dr. Shalshin said.

Session co-moderator Dr. Linda Efferen, chief medical officer, South Nassau Communities Hospital, Oceanside, N.Y., said targeting this captive audience makes sense and provides a bigger bang for the buck.

"These are our future readmissions, especially if they have underlying COPD [chronic obstructive pulmonary disease], asthma, or heart disease," she said in an interview. "To do this without pharmaceuticals and get these results is just phenomenal. We’re in the antipolypharmacy mode also because most of our patients are already on 20 different medications."

Pharmaceutical options will be used in the next phase of the study, however, to target the remaining patients who were unable to quit with the multidisciplinary nonpharmaceutical approach, Dr. Shalshin said in an interview.

Dr. Shalshin and his coauthors reported having no financial disclosures.