A personalized approach to smoking cessation within the framework of secondary prevention of chronic obstructive pulmonary disease

Objective. To evaluate the impact of different approaches to smoking status correction within the framework of secondary prevention of chronic obstructive pulmonary disease (COPD) on the severity of systemic inflammation, endothelial dysfunction, and peripheral circulation, as well as on the reduction of dyspnea severity, improvement of quality of life, and increase in blood oxygen saturation levels.

Materials and Methods. A comparative analysis was conducted to assess the impact of different approaches to smoking status correction – complete smoking cessation, switching to alternative nicotine delivery systems, and continued use of conventional cigarettes – within the framework of secondary prevention of chronic obstructive pulmonary disease (COPD), on the concentration of tumor necrosis factor alpha (TNF-α), platelet-derived growth factor AA (PDGF-AA), and the severity of impairments in linear and volumetric microcirculatory blood flow. The study involved 140 COPD patients who were followed dynamically over a 12-month period. Group 1 included 56 patients (mean age 51.65 ± 5.88 years; 63.4% male, 36.6% female) who continued smoking traditional cigarettes throughout the observation period. Group 2 comprised 44 patients (mean age 67.28 ± 7.99 years; 65.4% male, 34.6% female) who completely quit smoking. Group 3 included 40 patients (mean age 63.28 ± 7.19 years; 61.4% male, 38.6% female) who transitioned to the use of electronic heated tobacco systems as an intermediate step in smoking cessation, as part of a harm reduction strategy within secondary prevention. The concentrations of TNF-α and PDGF-AA were measured using enzyme-linked immunosorbent assay (ELISA), while peripheral blood flow was assessed by computerized Doppler ultrasound with a standard transcutaneous sensor.

Results. The present study yielded results indicating that, alongside a reduction in dyspnea severity, improved quality of life, and increased blood oxygen saturation, smoking cessation of conventional cigarettes and switching to electronic heated tobacco systems are associated with a statistically significant change in the concentration of platelet-derived growth factor AA (PDGF-AA) in Group 2, from 325.85 ± 119.7 ng/mL at baseline to 180.41 ± 49.4 ng/mL at the end of the observation period, and in Group 3, from 407.18 ± 123.09 ng/mL to 282.36 ± 33.19 ng/mL, respectively. A similar pattern was observed in the analysis of tumor necrosis factor alpha (TNF-α) concentrations: in Group 2, the baseline value was 14.75 ± 4.52 pg/mL, decreasing to 6.35 ± 2.97 pg/mL after one year; in Group 3, it was 18.59 ± 6.98 pg/mL at baseline and 12.41 ± 4.57 pg/mL after 12 months. In both cases, the differences were statistically significant. Furthermore, a statistically significant positive dynamic was identified in the linear and volumetric velocity parameters of peripheral blood flow in Groups 2 and 3, indicating correction of NO-dependent vasodilation impairments of the microcirculatory bed and endothelial dysfunction against the background of smoking cessation and switching to alternative nicotine delivery sources within the framework of secondary prevention of COPD.

Conclusion. The application of a personalized approach to smoking status correction in patients with COPD, utilizing the harm reduction concept, contributes to the reduction of systemic inflammation severity, endothelial dysfunction, and peripheral circulation impairments, thereby supporting effective secondary prevention of the disease.

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