抽菸等同降低生活质量


  【24drs.com】新研究认为,即使是短期间有抽菸,也与生活质量(QoL)显著降低有关。
  
  回顾54篇评估生活质量和抽菸关联的研究显示,即使只是短暂期间抽菸,仍与生理、心理、社交功能降低以及增加忧郁有关。
  
  第一作者、亚利桑那州凤凰城Banner Good Samaritan医学中心的Matthew Goldenberg表示,这个讯息对医师和抽菸者都很重要,有助于人们戒菸。
  
  他指出,我们希望改变精神疾病患者或成瘾者对于抽菸的认知,他们认为抽菸有助于情绪且帮助镇定,事实上,抽菸对生活质量有负面影响,即便是只有抽菸几周或几个月。
  
  Goldenberg医师在美国成瘾医学会(ASAM)第45届医学科学研讨会发表研究结果。
  
  他表示,生活质量成为各医学专科在研究与临床领域的重要结果测量指标,但是没有针对抽菸者生活质量的研究进行过严谨回顾。
  
  为了厘清这项议题,研究团队回顾了54篇取自PubMed、Medline、PsychINFO以及Cochrane Database of Systematic Reviews迄2013年的研究。
  
  这些研究都对抽菸者进行生活质量测量,并使用以下量表定义生活质量:
  * 简短版36项健康调查(Short Form 36 Health Survey,SF-36)
  * 世界卫生组织生活质量量表(World Health Organization Quality of Life Scale,WHO-QoL)
  * 戒菸生活质量问卷(Smoking Cessation Quality of Life questionnaire,SCQoL)
  * 临床COPD问卷(Clinical COPD Questionnaire,CCQ)
  
  这篇回顾显示,低生活质量和忧郁与抽菸有高度关联,且成功戒菸率低。
  
  其它研究发现如下:
  * 相较于没有抽菸的青少年,抽菸青少年生理与心里不健康的日子比较多,有活力的日子也比较少(各项P < .01)。
  * 不论男性女性,低生活质量和抽菸率较高有关(P < .001)。
  * 相较于未抽菸者,开始抽菸者的生活质量分数较低,反映在心理健康、健康观念、一般健康状况、活力、社会功能等各项量表(P < .05),除了生理功能之外,女性在这些方面的差异更明显。
  
  Goldenberg医师表示,这篇回顾也显示出,抽菸量越多时,生活质量越低。对于抽菸者身边的照护者或其它长时间相处的亲友,因为二手菸的因素,他们的生活质量也会受到同样地影响。
  
  回顾的研究中有多篇显示,抽菸者的生理活动分数较低且抽菸对社交功能产生负面影响。
  
  有一篇研究发现,重度抽菸者的心理健康项目比美国成年人低了36个百分位;另一篇前瞻世代研究发现,抽菸和生活质量之间为负相关,和恶化临床结果有关,包括增加发病率和死亡率。
  
  当这些人戒菸时,回顾结果一致显示他们的一般健康状况显著改善(P = .01),整体生活质量也是。
  
  戒菸者特别有改善的面向,包括生理功能、角色功能、一般健康观念、活力、社会功能、自我控制和心理健康(各项P < .02)。
  
  Goldenberg医师表示,这次针对戒菸研究进行的回顾最重要的发现是,戒菸显著改善生活质量,研究者认为必须向所有病患和有抽菸的一般大众强调这点,戒菸对生活质量的影响是相当大的。
  
  约翰霍普金斯大学的Margaret Chisolm医师受邀发表评论时表示,认同抽菸和生活质量之间有所关联。
  
  未参与研究的Chisolm医师表示,很难定论是抽菸引起生活质量差、或者是抽菸相关的精神问题引起生活质量差。
  
  Chisolm医师同意,许多精神科病患相信抽菸令他们镇定,她认为这在某种程度上可能是真的。
  
  她表示,抽菸可相当程度的抗焦虑,事实上,单胺氧化酶(MAO [monoamine oxidase])抑制剂这种抗忧郁药和抽菸有一些相同的活性,所以抽菸会让你感到舒服与放松,而她认为导致生活质量差确实是有关联,但并非影响。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7073&x_classno=0&x_chkdelpoint=Y

More Smoking Equals Lower Quality of Life

By Fran Lowry
Medscape Medical News

ORLANDO, Florida ─ Smoking cigarettes, even for a short time, is associated with a significantly lower quality of life (QoL), new research suggests.

A review of 54 studies that assessed QoL in relation to smoking showed that taking up smoking even for a brief duration was associated with lower physical, mental, and social functioning and increased depression.

"The message is important to get across to clinicians and to smokers and may help people quit," lead author Matthew Goldenberg, DO, from Banner Good Samaritan Medical Center, Phoenix, Arizona, told Medscape Medical News.

"We are trying to change the perception that our patients with mental illness or co-occurring addictions have about smoking. They feel that smoking actually helps their nerves and calms them down, when in fact it actually has a negative impact on their quality of life, even if they've been smoking for a few weeks or months," he added.

Dr. Goldenberg presented the study here at the American Society of Addiction Medicine (ASAM) 45th Annual Medical-Scientific Conference.

First QoL Review

QoL has become an important measure of outcomes across all medical specialties, both in research and clinical settings, but there has been no critical review of the research pertaining to quality of life in smokers, he said.

To address this research gap, the investigators reviewed 54 studies obtained from PubMed, Medline, PsychINFO, and the Cochrane Database of Systematic Reviews through 2013.

All studies incorporated QoL measures in smokers and used the following scales to define QoL:

  • Short Form 36 Health Survey (SF-36)

  • World Health Organization Quality of Life Scale (WHO-QoL)

  • Smoking Cessation Quality of Life questionnaire (SCQoL)

  • Clinical COPD Questionnaire (CCQ)

The review showed that low QoL and depression were associated with higher odds of smoking initiation and lower odds of successful smoking cessation.

Other findings included the following:

  • Teens who smoked had more physically and mentally unhealthy days and days in which their activity was limited compared with teens who did not smoke (P < .01 for all).

  • Low QoL was linked to higher odds of smoking in both females and males (P < .001).

  • QoL scores were lower among those who started smoking, as reflected on subscales of mental health, health outlook, general health perceptions, vitality, and social function, compared with nonsmokers (P < .05). These differences were more pronounced for females, except for physical functioning.

The review also showed that the more people smoked, the worse their QoL. This also held true for caregivers and others who were around the smokers for long periods, likely because of secondhand smoke, Dr. Goldenberg said.

Dr. Matthew Goldenberg

Many of the studies in the review showed that smokers had lower physical activity scores and that social functioning was negatively affected by smoking.

One study revealed that heavy smokers scored lower than the 36th percentile of adults in the United States on mental health dimensions. Another prospective cohort study found the negative relationship between smoking and QoL to be associated with worse clinical outcomes, including increased morbidity and mortality.

When people quit smoking, the review results consistently showed that their general health improved significantly (P = .01), as did overall QoL.

Domains that specifically improved in quitters included physical function, role function, pain, general health perception, vitality, social function, self control, and mental health (P < .02 for all).

"I think the most important thing from our review of smoking cessation studies is that quitting smoking significantly improves quality of life. We feel that this needs to be highlighted to all patients, and people in general, who smoke," Dr. Goldenberg said. "The positive effects of quitting on quality of life are impressive."

Association or Effect?

Commenting on this study for Medscape Medical News, Margaret Chisolm, MD, from the Johns Hopkins University School of Medicine, Baltimore, Maryland, agreed that there is a relationship between smoking and QoL.

Dr. Margaret Chisolm

"But whether it's the smoking that causes the poor quality of life or whether it's the comorbid psychiatric problems that are causing the poor quality of life, it's hard to say," Dr. Chisolm, who was not part of the study, said.

Dr. Chisolm agreed that many patients with psychiatric illness believe that smoking calms them, and she added that there is some truth to that perception.

"Smoking is a great anxiolytic. In fact, MAO [monoamine oxidase] inhibitors, a type of antidepressant, have some activity in cigarette smoke. So smoking makes you feel good and is relaxing. But I think the resulting poor quality of life is an association, I don't think it's an effect," she said.

Dr. Goldenberg and Dr. Chisolm report no relevant financial relationships.

American Society of Addiction Medicine (ASAM) 45th Annual Medical-Scientific Conference. Poster 1. Presented April 11, 2014.

    
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