Chest
Volume 123, Issue 6, June 2003, Pages 1916-1923
Journal home page for Chest

Clinical Investigations
Pulmonary Function Tests
Diagnosis of Airflow Limitation Combined With Smoking Cessation Advice Increases Stop-Smoking Ratea

https://doi.org/10.1378/chest.123.6.1916Get rights and content

Objectives

To assess how the diagnosis of airflow limitation (AL) combined with advice to stop smoking in middle-aged smokers influence the smoking cessation rate and to identify predictors of successful outcome.

Design

Prospective, single-center, comparative study of the effects of smoking intervention in smokers with diagnosed AL and in smokers with normal lung function (NLF).

Setting

University hospital, out-patient clinic.

Participants

Of 659 smokers participating in a population spirometric screening for COPD combined with smoking cessation advice, 558 (AL, 297 smokers; NLF, 261 smokers) were invited for a follow-up after 1 year.

Intervention

At follow-up, spirometry was repeated and smoking status was assessed. Nonsmoking status was validated with carbon monoxide measurements in exhaled air. Patients who did not come for the follow-up visit were considered to be smokers.

Results

Of 558 smokers invited, 368 (66%) presented for the follow-up visit. All had tried to reduce their smoking habit. The number of cigarettes smoked per day (cpd) at 1 year was − 5.2 (p < 0.01) in patients with AL and − 2.7 (not significant [NS]) in those with NLF. The 1-year cessation rate in smokers with AL was 10.1% vs 8.4% in smokers with NLF (NS). After stratifying the patients according to AL severity, the highest cessation rate was observed in smokers with moderate and severe AL (16.5%) compared to smokers with mild AL (6.4%; p < 0.001) and smokers with NLF (8.4%; p < 0.05). In a univariate analysis, the cessation of smoking was correlated with older age (p < 0.001), later age when starting smoking (p < 0.005), lower tobacco exposure (in pack-years; p < 0.01), fewer cpd (p < 0.001), and lower lung function (p < 0.05). No interaction effect was observed for any of the studied variables using two-way analysis of variance. In a stepwise logistic regression analysis, age (p < 0.001), tobacco exposure (in pack-years; p < 0.001), and FEV1 percent predicted (p < 0.01) proved to be significant predictors of success in stopping smoking.

Conclusion

All smokers, irrespective of their lung function, tried to modify their habit as the result of screening for COPD combined with smoking cessation advice. The diagnosis of AL motivated smokers to attempt to quit smoking. Older age, lower tobacco exposure, and lower lung function were the predictors of success in quitting smoking.

Section snippets

Materials and Methods

The study was performed at the outpatient clinic of the Institute of Tuberculosis and Lung Diseases in Warsaw, Poland.

The methods of the spirometric screening have been described previously.1In brief, since 1999 pulmonary physicians in Poland have been performing screenings for COPD in pulmonary outpatient clinics. Local television, radio, and newspapers spread information on the causes and symptoms of COPD. Free-of-charge spirometry testing was offered to smokers who were aged ≥ 40 years with

Results

The trial profile is presented in Figure 1. Of a total of 1,158 subjects screened in 1999, a restrictive pattern of ventilatory impairment was diagnosed in 43. Of the remaining 1,115 subjects, 659 were current smokers, 322 were ex-smokers, and 34 were never smokers. AL was diagnosed in 478 subjects (41.3%).

Of 558 subjects invited for a follow-up (AL, 297 subjects; NLF, 261 subjects [acting as controls]), 368 subjects attended (66%). A similar proportion of those invited (53%) and those who

Discussion

In a population spirometric screening of 11,027 subjects who were at risk for COPD in 12 Polish cities, AL was detected in 30.6% of smokers who were > 39 years of age who had a smoking history of > 10 pack-years.1Of the patients with AL, 40% had moderate airflow obstruction and 20% had severe airflow obstruction. In our study, AL was diagnosed in 41% of patients who were at risk for COPD, most of whom (63%) were in a mild stage of COPD. It is worth mentioning that these subjects had spirometry

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    This research was supported by the National Program for Early Diagnosis and Prevention of COPD.

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