这项工作是对Dorothy (Dotty) Beecham夫人的个案研究分析，她今年74岁，是一个慢性吸烟者，目前每天吸烟多达5支，在过去(2012年之前)，她习惯每天吸烟约20支。她因DVT入院，她的医疗记录显示她患有COPD和CVD。2012年，她患上了心肌梗塞，至今仍无法戒烟。她的酒精摄入量相当有限，但她的独居生活可能是吸烟的一个压力源。她的心血管和呼吸系统疾病，加上吸烟，对她的健康和死亡构成了明显的风险。
对于患有心血管和呼吸系统疾病的人来说，以主动吸烟和被动吸烟的形式持续接触吸烟会导致心血管事件的易感性增强(King et al .， 2012)。一些与吸烟有关的心血管疾病是与炎症相关的疾病，急性血栓形成导致住院和立即医疗护理，氧化对低密度脂蛋白胆固醇和更多(Pope et al .， 2011)。
目前的研究表明，吸烟会导致氧化应激，氧化应激会导致心血管事件。在心血管危险因素方面，患者会出现葡萄糖耐受不良(Talukder et al, 2011)。Mrs Beecham的空腹血糖水平为7.8 mmol/L，正常水平为3.9-6.4。胆固醇水平为7.1 mmol/L，理想水平小于5.2。随着她的持续使用，她将遭受低血清水平的形式(Menon et al .， 2011)。吸烟不仅是一个独立的危险因素，因为它的心血管效应CVD;对增加冠心病、外周动脉疾病PAD、主动脉瘤及脑血管疾病的风险具有多重交互作用。与同龄的正常人相比，比查姆夫人的吸烟会导致同时发生多种动脉粥样硬化变化。血管腔会变窄，形成高凝状态，这就是急性血栓形成的原因。吸烟后心肌梗死(MI)风险降低，说明吸烟会增加动脉粥样硬化斑块形成的风险。CVD和冠心病的风险通常以相对风险RR和过度风险的形式来解释(Menon et al .， 2011)。这两个估计值是用来理解风险随着年龄增长而增加的。
猝死是吸烟和有心血管疾病高风险史的人的危险因素之一。目前吸烟者的猝死风险高于长期戒烟者。即使是没有心血管疾病病史的人，研究表明，单独吸烟也可能是猝死的一个重要风险因素，而在比查姆女士的案例中，她既有心血管疾病病史，也有吸烟史(Zuo et al, 2014)。由于心律不齐和左心室功能障碍，患者有猝死的危险。除了心血管风险，脑血管风险也会增加。有CVD病史的吸烟者中风的风险更高。在meta分析中，观察到存在剂量反应关系(Zuo et al, 2014)。吸烟的数量被认为与风险升高成正比(Shinton & Beevers 1989)。当吸烟者在两年内戒烟时，这种风险就降低了。现在，尽管比查姆女士并没有完全戒烟，但她已经减少了吸烟的剂量，因此根据现有的研究，她的风险水平将会下降。然而，她并没有完全戒烟，除非做到这一点，否则她仍然有风险。
This work is a case study analysis of Mrs Dorothy (Dotty) Beecham who is 74 years old and is a chronic smoker who has been smoking up to five cigarettes a day currently, and in the past (before 2012) she was used to smoking around 20 cigarettes per day. She has been admitted for DVT and her medical records indicate both COPD and CVD. She has a myocardial infarction in 2012 and still has not been able to quit her smoking. Her alcohol intake is quite limited, but her solitary life could be a stressor for smoking. Her cardiovascular and respiratory disease combined with smoking poses clear risks for her health and mortality.
Given this context, this research essay will analyse and identify why her smoking poses a threat to her health by using the existing literature evidences. Discussions on pathophysiology will be brought into context. The challenges in smoking cessation and how evidence based strategies could be helpful for aiding Mrs Beecham in smoking cessation would be discussed as well. Throughout the discussions, the risks and potential outcomes to Beecham are presented. This forms the core discussion.
Pathophysiology of a Chronic Smoker (Risks and Potential Outcomes)
For a person with cardiovascular and respiratory diseases, continuous exposure to smoking in the form of active and passive smoking would result in an enhanced predisposition for cardiovascular events (King et al, 2012). Some of the smoking related cardio vascular conditions are that of inflammation related conditions for the patient, acute thrombosis resulting hospitalization and immediate medical care, oxidation on low density lipoprotein cholesterols and more (Pope et al, 2011).
Current research studies show that cigarette smoking would lead to oxidative stress and the oxidative stress would lead cardiovascular events. In terms of cardiovascular risk factors, the patient would suffer from glucose intolerance (Talukder et al, 2011). The fasting glucose levels in the case of Mrs Beecham was seen to be in the range of 7.8 mmol/L and the normal levels have to be in the range of 3.9–6.4. The cholesterol levels are 7.1 mmol/L and the desired levels are less than 5.2. With her continued usage, she will suffer in the form of lower serum levels (Menon et al, 2011). Smoking is also not just an independent risk factor as attributed to its cardiovascular effects CVD; it also has multiple interactive effects on increasing the risks of Coronary Heart Disease CHD, peripheral arterial disease PAD, aortic aneurysm and also cerebrovascular diseases. Mrs Beecham’s smoking will result in the development of multiple atherosclerotic changes at the same time, compared to that of normal people at her age. The vascular lumen would narrow and a hypercoagulable state would be created and this is where the situation of acute thrombosis is created. The risks of myocardial infarction (MI) will decrease after smoking which indicates that smoking will increase the risks by the atherosclerotic plaque development. Risks in the case of CVD and CHD are usually explained in the form of relative risks RR and excess risk (Menon et al, 2011). These two estimates are what are used to understand the increase in risks occurrence with advancing age.
Sudden death is one of the risk factors suffered by a person who smokes and who has a high risk history of CVD. The sudden death risk is higher for current smokers than they are with smokers who are abstaining for a longer time. Even with people who had no history of CVD, it was established in research that smoking alone could be a significant risk factor for sudden death, and in the case of Mrs Beecham, she has both a history of CVD and also smokes (Zuo et al, 2014). Patients were at a risk of sudden death because of cardiac arrhythmia and the dysfunction of the left ventricle. In addition to the cardiovascular risks, the cerebrovascular risks also get added on. Cigarette smokers with a history of CVD are at a higher risk for stroke. In a meta-analysis, it was observed that a dose response relationship existed (Zuo et al, 2014). The number of cigarettes that were smoked were seen to correspond proportionally to the risk elevations (Shinton & Beevers 1989). When cigarette smokers stopped smoking, within two years, the risk declined. Now although Mrs Beecham has not stopped smoking completely, she has reduced the dose of smoking and hence her risk levels would go down according to the existing research. However, she has not stopped smoking completely and unless this is achieved she would still be risk prone.