BACK GROUND OF THE STUDY:

Smoking tobacco is both a psychological habit and a physical addiction. The act of smoking is ingrained as a daily ritual at the same time, the nicotine from cigarettes provides a temporary and addictive. Eliminating that regular fix of nicotine will cause our body to experience physical withdrawal symptoms and cravings. To quit smoking, it is essential to address both the habit and the addiction by changing our behavior and dealing with nicotine withdrawal symptoms. Smoking is increasing globally, though it is decreasing in some high-income and upper middle-income countries. More than six million people die from tobacco use and exposure to tobacco smoke, with one death occurring every six seconds. Unless urgent action is taken, the annual death toll could rise to more than eight million by 2030. Smoking is one of the major issues that plague the nation, with an increasing number dying each year. A 2007 report states that about 4.9 million people worldwide each year die as a result of smoking.^[1]

Cigarette smoking is the single most important risk factor for reduced lung functions in adults apart from being a major cause for heart diseases, bronchogenic carcinoma and stroke. It is responsible for the 90% of Chronic Obstructive Pulmonary Diseases (COPD) within 1-2 years of beginning of smoking.²It has been suggested that smoking-related disease kills one half of all long term smokers but these diseases may also be contracted by non-smokers. One-third of the world's adult population are smokers (57% of these are men, 43% are women) and each year, tobacco causes 3.5 million deaths a year, or about 10,000 deaths each day. It is predicted that in 20 years this yearly death rate from tobacco use will be more than 10 million people. Cigarette smoking continues to rise in developing countries and it predominates in urban areas, whereas beedi smoking is the commonest type of smoking in the lower income groups of illiterate and less educated people ^[3]. In India, smoking is a common habit in both the urban and rural areas in the form of cigarettes, beedies, pipes, cigar, hookah, etc^[4]

Smoking is known as the major cause of chronic obstructive pulmonary disease and other respiratory symptoms. There are many reviews available related to relationship between lung function test on smoking and benefits of spirometry test on cessation of smoking. Many of the results showed that most values of PFTS in smokers were significantly lower than those of non-smokers.^[5]Smoking is the primary cause of deterioration in forced expiratory volume (FEV₁). Respiratory risks increased with increasing number of cigarettes smoked per day. A deterioration of FEV₁ and the FEV₁/FVC ratio was also directly associated with the number of cigarettes smoked per day.Smoking confers a high risk of developing a number of respiratory symptoms and the deterioration of the ventilator function even among young adults.^[6]

Spirometric lung function test is a simple method to check how well the lung works. Pulmonary function tests are a broad range of tests that measure how well the lungs take in and exhale air and how efficiently they transfer oxygen into the blood. Spirometry measures how well the lungs exhale. The information gathered during this test is useful in diagnosing certain types of lung disorders, but is most useful when assessing for obstructive lung diseases. Knowledge on the response to the initial smoke exposure might enhance the understanding of changes due to smoking, since repetitive acute smoke effects may cumulate and lead to irreversible lung damage.^[7] Hence early detection of these changes will help in the prevention of permanent damage of lungs in apparently healthy young adult smokers.

OBJECTIVES:

1) Identify the spirometric lung function test among smokers.

2) Correlate the spirometric lung function test (FEV1, PEFR) with pack years among smokers.

HYPOTHESES:

H₁: There is a relationship between FEV1 and pack year among smokers.

H₂: There is a relationship between PEFR and pack year among smokers.

MATRIALS AND METHODS:

Research design:

The design adopted for the study was descriptive and correlation design.

Research setting:

The study was conducted among smokers in selected hospital, Bangalore

Study variable:

In this study it refers to studying the relationship between Spirometric lung function tests with pack years.

Sample size:

30 patients who smokes and who came to the therapeutic clinic for check-up.

Sampling technique:

Purposive sampling was used for the study

Tool:

PART 1. A structured questionnaire was developed for the study to collect the demographic variables.

PART 2. A computerized spirometer was used to assess the lung functions (FEV₁ and PEFR) among the respondents.

Content validity and Reliability:

Content validity of the tool was established based on experts’ opinion. Reliability of the tool was established prior to the study by the test-retest method r=0.93.

SCORING AND INTERPRETATIONS:

FEV₁ VALUE		PEFR VALUE
RANGE	DOMAINS	RANGE	DOMAINS
<35%	Very severe	<70	Curable
35-49%	Severe	61-70%	Mild smokers
50-59%	Moderately severe	51-60%	Moderate smokers
60-69%	Moderate	<50%	Heavy smokers
>70%	Mild

Data collection procedure:

A formal permission was obtained from the concerned authority. Samples were selected by purposive sampling based sample selection criteria. All patients falling under the inclusion criteria were given orientation regarding spirometric lung function test. Data collection procedure was explained to all participants. Consent was obtained from each subject after giving assurance of confidentiality. Demographic variables were obtained from the subjects. FEV₁ and PEFR values were obtained by using spirometer with pack years. Participants were thanked for their participation in the study.

Data analysis plan:

Descriptive statistics methods like numbers, percentage mean and standard deviation were used to assess the lung function test among smokers. Inferential statistical methods like correlation test were used to assess the PEFR, FEV1 values with pack years.

RESULTS AND DISCUSSION:

Table 1: Frequency distribution of FEV₁ values among smokers.

Range		FEV1	Percentage
<35%	Very severe	12	40
35-49%	Severe	9	30
50-59%	Moderately severe	6	20
60-69%	Moderate	3	10
>70%	Mild	0	0
TOTAL		30	100

The above table 1 reveals that 12(40%) were very severely affected by smoking 9(30%) were severely affected, 6(20%) were moderate severely affected and 3(10%) were moderately affected and none of them were under mild criteria

Table 2: Frequency distribution of PEFR values among smokers.

Range		PEFR	Percentage
<70%	Curable	0	0
61-70%	Mild smokers	0	0
51-60%	Moderate smokers	12	40
<50%	Heavy smokers	18	60
TOTAL		30	100

The above table 2 shows that 12(40%) were in moderate category of smokers and remaining 18(60%) were heavy smokers. None of the samples falls under the curable and mild smoker’s category.

Fig 1: Scatter diagram representing correlation between FEV₁ values with pack year.

From the above picture we can observe that, mean for FEV₁ value was 35.26 (SD= 11.305) and pack year mean was 37.06 (SD=6.363) with an ‘r’ value of -0.760 and it is in negative fairly high degree of correlation. The obtained P value is 0.000 and thus the correlation is highly significant at 0.05 level of significance. Hence the study proves that as the pack year increases there is decrease in the FEV₁ values.

Fig 2: Scatter diagram representing correlation between PEFR values with pack year

In the above picture, the mean value for PEFR was 30.86 (SD=7.31) and the mean of pack year was 37.06 (SD=6.363) with an ‘r’ value of - 0.792 and it is negative fairly high degree of correlation. The P value obtained is 0.000 and thus the correlation obtained is highly significant at 0.05 level of significance. Hence the study concludes that as the pack year increases there is decline in the PEFR values.

CONCLUSION:

Hence the study concludes that as the pack year increases there is a decrease in the FEV₁ values and PEFR values in smokers. These findings highlight the importance of smoking cessation to improve the lung function.

REFERENCES:

1. Smoking: Available URL:http://en.wikipedia.org/wiki/Smoking

2. Sumangala M Patil1, Mahesh J Patil, Manjunath Aithal and Nilima N. Dongre. Reduction of Spirometric Lung Function Tests. JKIMSU. 2012 Jan-June; Vol. 1 (1):89-94. Available URL: http://www.jkimsu.com/ volume1no1/jkimsu-2012-volume1-no1-p-89-94.pdf

3. K. M. Padmavathy. Comparative study of pulmonary function variables. Indian J Physiol Pharmacol.2008;52(2):193-196. Available URL:http:// www.ijpp.com/IJPP%20archives/2008_52_2/193-196.pdf

4. Sunita nighute, Abhijit aWaRi. A Study of the Pulmonary Function Test among Smokers and Non Smokers. Journal of Clinical and Diagnostic Research. 2011 November; Vol5(6): 11511153.

5. Mohammad Hossein Boskabady, Hamideh Dehghani, Mehdi Esmaeilzadeh. Pulmonary Function Tests and Their Reversibility. National Research Institute of Tuberculosis and Lung Disease. (2003) 2(8), 23-30. Available URL: http://www.tanaffosjournal.ir/files_site/paperlist/r_556_120927093922.pdf

6. Urrutia Isabel, Capelastegui Alberto, Quintana José María,Muñiozguren Nerea, Basagana Xavier, Sunyer Jordi. Smoking habit, respiratory symptoms and lung function. European journal of public health. 2005-April;15(2):160-165. Available URL: http://eurpub .oxfordjournals .org/content/15/2/160

7. Hester van der Vaart, Dirkje S Postma, Wim Timens, Machteld N Hylkema, Brigitte WM Willemse, H Marike Boezen,et.al. Acute effects of cigarette smoking.Respiratory research. 2005; 6(1): 22. Available URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC554761/

Received on 21.02.2018 Modified on 19.03.2018

Int. J. Nur. Edu. and Research. 2018; 6(3):318-320.

DOI: 10.5958/2454-2660.2018.00077.7