Impact of Smoking on the Clinical Course of Community - Acquired Pneumonia
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Vispāreji iegūta pneimonija ir pasaules mēroga problēma, kas būtiski palielina
mirstību mazattīstītās valstīs īpaši bērnu un vecāka gada gājuma cilvēku vidū. Smēķēšana ir
vēl viena pasaules mēroga problēma mirstības ziņā, tomēr šis ir modificējams riska factors
saistībā ar vispārēji iegūtas pneimonijas attīstības.
Mērķis. Pētnieciskā darba mērķis ir izvērtēt smēķēšanas ietekmi uz vispārēji iegūtas
pneimonijas attīstības risku, kā arī klīniskas manifestācijas smagumu, komplikacijām,
mirstību, kā arī atšķirībām aktīvo un pasīvo smēķēšanu gadījumos.
Metode. Nepieciešamas zinātniskas publikācijas meklēšana tika veikta caur
ScienceDirect, PubMed, BMJ (British Medical Journals), Dovepress and Wiley Online
Library. Tika atrastas 25 atbilstošas publikācijas, kuras tika iekļautas pētnieciskā darbā,
savukārt kopējo apskatīto publikāciju daudzums bija 120. Iekļautas publikācijas nav vecākas
par 2009. gadu.
Rezultāti. Vispērēji iegūtas pneimonijas risks smēķētāju vidū ir divreiz augstāks un ir
devas atkarīgs pēc liekas daļas pētījumu rezultātiem. Pasīva smēķēšana, savukārt, veicina
vispārēji iegūtas pneimonijas attīstību bērnu un cilvēku pēc 60 gadu vecuma vidū. Slimību
attīstības mehanisms ir komplicēts un ietvēr vairākus aspektus, proti, mukociliāra klīrensa
bojājumus, alveolāro makrofāgu funkciju izmaiņas un traucējumus adhezijas receptoros. Pie
predisponējošiem faktoriem vispārēji iegūtas pneimonijas attīstības smēķētāju vidū pieder arī
traucējumi amūnatbildes reakcijās, kā arī blakusslimības esamība.
Ir atzīts, ka smēkētājiem pneimonija norit smagāk un medz būt ar sepsi un septisko
šoku. Viņiem ir arī augstāks risks ārstēšanai intensīvajā terapijas nodaļā. Pneimokoks ir
biežāk sastopams patogēns smēķētājiem sepses gadījumā. Savukārt, par citiem patogēniem,
ka arī komplikācijām, izņemot sepsi, netika daudz pētīts. Tādējādi nav pietiekoši daudz
pierādījumu, lai viektu pilnvērtīgus secinājumus.
Pētījumu dati attiecībā par mirstību nav vienlīdzīgi.
Secinājumi. Ir pierādīts, ka smēķēšana ietekmē vispārēji iegūtas pneimonijas attīstību.
Pie tam, aktīva smēķēšana viecina pneimonijas attīstību visas vecuma grupās. Tomēr pasīvā
smēķēšana vairāk iesaista bērnus un pieaugušus pēc 60 gadu vecuma. Smēķētajiem novēro
smagāko vispārēji iegūtas pneimonijas klīnisko gaitu ar augstu risku sepsei un septiskām
šokam, it īpaši pneimokoku izraisītas pneimonijas gadījumā. Tomēr, mirstības datu rezultāti
smeķētāju vidū nav vienlīdzīgi pēc pētījumu datiem. Tādējādi, būtu vēlams veikt pētījumus uz
klīnisko gadījumu pamata, lai izdarītu pilnvērtīgus secinājumus par komplikācijām un
mirstību.
Background. Community-acquired pneumonia (CAP) is a global issue with substantial mortality especially in children, elderly and the population of developing countries. Tobacco smoke, another global killer, is one of the most harmful but modifiable risk factors in the development of CAP. Aim. To find out what impact smoking has on the clinical course of communityacquired pneumonia including risk of acquiring pneumonia, severity of the clinical course, complications, mortality and possible differences between active and passive smoking. Methods. Organized searches of ScienceDirect, PubMed, BMJ (British Medical Journals), Dovepress and Wiley Online Library were carried out to find the 25 most suitable publications to include in the literature review. 120 articles were initially identified but later on outsourced based on topicality. The publications included in this literature review are based on relevant and recent data since 2009. Results. Among smokers the risk of CAP is two-folded and follows a dose-dependent pattern according to the majority of the studies included. Passive smoking contributes to the development of CAP, especially in children and adults above 60 years of age. The mechanism is complex and includes local changes including destruction of the cilia, altered function alveolar macrophages and up-regulation of adhesion receptors. Also a defective systemic immune response and comorbidities contributes to the development of CAP in smokers. On admission smokers generally presents with a severe condition including sepsis and septic shock. They are also at higher risk for treatment in the ICU. S.pneumoniae is the most frequent isolated pathogen in smokers with pneumococcal sepsis. Regarding other pathogens and complications other than sepsis there are not enough studies conducted. Thus not enough evidence to make conclusions on the topic. The results of the studies on mortality rate are not uniform. Some claim an increased mortality while others claim the opposite due to presence of a low-case fatality serotype among smokers. Conclusion. The clinical course of CAP is affected by smoking. While active smoking contributes to development of CAP in all ages, passive smoking particularly targets children and elderly. The initial presentation of CAP is more severe in smokes with higher rate of sepsis and septic shock, especially when S.pneumoniae is present. However, mortality among smokers with CAP remains unclear due to equivocal results. Further research, preferably case-control studies, is thus justified on the topics of complications and mortality before my hypothesis can be accepted or disregarded.
Background. Community-acquired pneumonia (CAP) is a global issue with substantial mortality especially in children, elderly and the population of developing countries. Tobacco smoke, another global killer, is one of the most harmful but modifiable risk factors in the development of CAP. Aim. To find out what impact smoking has on the clinical course of communityacquired pneumonia including risk of acquiring pneumonia, severity of the clinical course, complications, mortality and possible differences between active and passive smoking. Methods. Organized searches of ScienceDirect, PubMed, BMJ (British Medical Journals), Dovepress and Wiley Online Library were carried out to find the 25 most suitable publications to include in the literature review. 120 articles were initially identified but later on outsourced based on topicality. The publications included in this literature review are based on relevant and recent data since 2009. Results. Among smokers the risk of CAP is two-folded and follows a dose-dependent pattern according to the majority of the studies included. Passive smoking contributes to the development of CAP, especially in children and adults above 60 years of age. The mechanism is complex and includes local changes including destruction of the cilia, altered function alveolar macrophages and up-regulation of adhesion receptors. Also a defective systemic immune response and comorbidities contributes to the development of CAP in smokers. On admission smokers generally presents with a severe condition including sepsis and septic shock. They are also at higher risk for treatment in the ICU. S.pneumoniae is the most frequent isolated pathogen in smokers with pneumococcal sepsis. Regarding other pathogens and complications other than sepsis there are not enough studies conducted. Thus not enough evidence to make conclusions on the topic. The results of the studies on mortality rate are not uniform. Some claim an increased mortality while others claim the opposite due to presence of a low-case fatality serotype among smokers. Conclusion. The clinical course of CAP is affected by smoking. While active smoking contributes to development of CAP in all ages, passive smoking particularly targets children and elderly. The initial presentation of CAP is more severe in smokes with higher rate of sepsis and septic shock, especially when S.pneumoniae is present. However, mortality among smokers with CAP remains unclear due to equivocal results. Further research, preferably case-control studies, is thus justified on the topics of complications and mortality before my hypothesis can be accepted or disregarded.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Smēķēšana;
Pneimonija, Smoking; Pneumonia