抽菸等同降低生活品質


  【24drs.com】新研究認為,即使是短期間有抽菸,也與生活品質(QoL)顯著降低有關。
  
  回顧54篇評估生活品質和抽菸關聯的研究顯示,即使只是短暫期間抽菸,仍與生理、心理、社交功能降低以及增加憂鬱有關。
  
  第一作者、亞利桑那州鳳凰城Banner Good Samaritan醫學中心的Matthew Goldenberg表示,這個訊息對醫師和抽菸者都很重要,有助於人們戒菸。
  
  他指出,我們希望改變精神疾病患者或成癮者對於抽菸的認知,他們認為抽菸有助於情緒且幫助鎮定,事實上,抽菸對生活品質有負面影響,即便是只有抽菸幾週或幾個月。
  
  Goldenberg醫師在美國成癮醫學會(ASAM)第45屆醫學科學研討會發表研究結果。
  
  他表示,生活品質成為各醫學專科在研究與臨床領域的重要結果測量指標,但是沒有針對抽菸者生活品質的研究進行過嚴謹回顧。
  
  為了釐清這項議題,研究團隊回顧了54篇取自PubMed、Medline、PsychINFO以及Cochrane Database of Systematic Reviews迄2013年的研究。
  
  這些研究都對抽菸者進行生活品質測量,並使用以下量表定義生活品質:
  * 簡短版36項健康調查(Short Form 36 Health Survey,SF-36)
  * 世界衛生組織生活品質量表(World Health Organization Quality of Life Scale,WHO-QoL)
  * 戒菸生活品質問卷(Smoking Cessation Quality of Life questionnaire,SCQoL)
  * 臨床COPD問卷(Clinical COPD Questionnaire,CCQ)
  
  這篇回顧顯示,低生活品質和憂鬱與抽菸有高度關聯,且成功戒菸率低。
  
  其他研究發現如下:
  * 相較於沒有抽菸的青少年,抽菸青少年生理與心裡不健康的日子比較多,有活力的日子也比較少(各項P < .01)。
  * 不論男性女性,低生活品質和抽菸率較高有關(P < .001)。
  * 相較於未抽菸者,開始抽菸者的生活品質分數較低,反映在心理健康、健康觀念、一般健康狀況、活力、社會功能等各項量表(P < .05),除了生理功能之外,女性在這些方面的差異更明顯。
  
  Goldenberg醫師表示,這篇回顧也顯示出,抽菸量越多時,生活品質越低。對於抽菸者身邊的照護者或其他長時間相處的親友,因為二手菸的因素,他們的生活品質也會受到同樣地影響。
  
  回顧的研究中有多篇顯示,抽菸者的生理活動分數較低且抽菸對社交功能產生負面影響。
  
  有一篇研究發現,重度抽菸者的心理健康項目比美國成年人低了36個百分位;另一篇前瞻世代研究發現,抽菸和生活品質之間為負相關,和惡化臨床結果有關,包括增加發病率和死亡率。
  
  當這些人戒菸時,回顧結果一致顯示他們的一般健康狀況顯著改善(P = .01),整體生活品質也是。
  
  戒菸者特別有改善的面向,包括生理功能、角色功能、一般健康觀念、活力、社會功能、自我控制和心理健康(各項P < .02)。
  
  Goldenberg醫師表示,這次針對戒菸研究進行的回顧最重要的發現是,戒菸顯著改善生活品質,研究者認為必須向所有病患和有抽菸的一般大眾強調這點,戒菸對生活品質的影響是相當大的。
  
  約翰霍普金斯大學的Margaret Chisolm醫師受邀發表評論時表示,認同抽菸和生活品質之間有所關聯。
  
  未參與研究的Chisolm醫師表示,很難定論是抽菸引起生活品質差、或者是抽菸相關的精神問題引起生活品質差。
  
  Chisolm醫師同意,許多精神科病患相信抽菸令他們鎮定,她認為這在某種程度上可能是真的。
  
  她表示,抽菸可相當程度的抗焦慮,事實上,單胺氧化酶(MAO [monoamine oxidase])抑制劑這種抗憂鬱藥和抽菸有一些相同的活性,所以抽菸會讓你感到舒服與放鬆,而她認為導致生活品質差確實是有關聯,但並非影響。
  
  資料來源: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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