Early Mobilization in PneumoniaEarly Mobilization in Pneumonia

نویسندگان

  • Mark Metersky
  • Linda M. Mundy
  • Mark Schnitzler
چکیده

difference of 5% between groups of smokers with AL and NLF with p 0.05 and 0.2, the number of smokers in each group should be 603. We suggested in the “Discussion” section that the fact that more smokers with moderate/severe disease as compared to those with mild disease quit smoking might result from more symptoms observed in more advanced disease. We have now looked into our database for more details: 66% of smokers with AL vs 68% of smokers with NLF produced sputum (not significant), and 71% vs 60%, respectively, complained of cough (p 0.05). There was also an increasing trend in the phlegm production in more severe disease, but we have not found significant differences in symptoms after stratifying the patients with AL according to disease severity. Our results (10.1% of patients with COPD and 8.4% of those with NLF who remained nonsmoking after 12 months) compare favorably with the results of the Italian study3 (6.5% of smokers offered spirometric testing and counseling quit as compared to 4.5% of control subjects offered minimal intervention), and the Norwegian study4 in male subjects with low lung function resulting in a 5.6% quit rate at 12 months after sending a personalized letter explaining the results of spirometric testing with advice to stop smoking, as compared to 3.5% in control subjects (p 0.01) who were not informed about their lung function. We have also found, after additional random telephone screening of smokers who did not attend the follow-up visit, that only smokers with airflow limitation quit smoking (an additional four patients who stopped smoking). Also, smokers with the diagnosis of AL were more successful in reducing the number of cigarettes smoked (five fewer cigarettes per day, p 0.05), as compared to smokers without AL (two fewer cigarettes per day, not significant). We believe therefore that the diagnosis of AL motivated smokers to try to quit. Every effort should be made to make people stop smoking. This is especially true for smokers at risk and with early diagnosis of COPD. This issue is now being discussed, in trying to assess the role of spirometric testing in motivating smokers to quit.5–8 We agree with Dr. Kaminsky and Dr. Marcy that larger studies are needed, including a control group of smokers given stopsmoking advice without spirometry, to assess the cost-effectiveness of spirometry as part of a smoking cessation program. But as Krahn and Chapman7 have quoted, “even modest quit rates attributable to screening spirometry may result in highly favorable cost effectiveness ratios.”

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تاریخ انتشار 2004