Design and Results of the Initial Intervention Program for the Lung Health Study

O’Hara, Peggy; Grill, Joseph P.; Rigdon, Michael A.; Connett, John E.; Lauger, Gary A.; Johnston, Janet J.

doi:10.1006/pmed.1993.1025

Cited by 58 publications

(24 citation statements)

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“…14 The LHS compared an intensive, 5-year smoking cessation counseling and relapse prevention program that included weight management (special intervention [SI]) with only brief advice (usual care [UC]) in 5,887 smokers with mild to moderate airflow obstruction. 6,33 In addition, nicotine replacement therapy (NRT) (nicotine gum) was offered to SI group participants. Biochemically verified smoking abstinence at 1 year was 39% in the SI group versus 9% in the UC group, and sustained abstinence over 5 years was 22 versus 4% in the SI and UC groups, respectively.…”

Section: Confronting Smokers With Results Of Spirometrymentioning

confidence: 99%

Smoking Cessation in Chronic Obstructive Pulmonary Disease

Tashkin

2015

Semin Respir Crit Care Med

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Smoking cessation is the most effective strategy for slowing down the progression of chronic obstructive pulmonary disease (COPD) and reducing mortality in the approximately 50% of patients with diagnosed COPD who continue to smoke. While behavioral interventions (including simple advice) have modest efficacy in improving smoking quit rates, the combination of counseling and pharmacotherapy is more effective than either alone. When combined with even brief counseling, nicotine replacement therapy (NRT), bupropion SR, and varenicline have all been shown to be effective in promoting smoking cessation and sustained abstinence in smokers with COPD to a degree comparable to that observed in the general smoking population. However, the recidivism rate is high after initial quitting so that at the end of 1 year, approximately 80% or more of patients are still smoking. Thus, new approaches to smoking cessation are needed. One approach is to combine different pharmacotherapies, for example, nicotine patch plus rapidly acting NRT (e.g., gum or nasal spray) and/or bupropion or even varenicline plus either NRT or bupropion, in a stepwise approach over a varying duration depending on the severity of nicotine dependence and nicotine withdrawal symptoms during the quit attempt, as proposed in the American College of Chest Physicians Tobacco Dependence Took Kit. Electronic (e)-cigarettes, which deliver vaporized nicotine without most of the noxious components in the smoke from burning tobacco cigarettes, also has potential efficacy as a smoking cessation aid, but their efficacy and safety as either substitutes for regular cigarettes or smoking cessation aids require additional study. This task is complicated because e-cigarettes are currently unregulated and hundreds of different brands are currently available.

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Section: Confronting Smokers With Results Of Spirometrymentioning

confidence: 99%

Smoking Cessation in Chronic Obstructive Pulmonary Disease

Tashkin

2015

Semin Respir Crit Care Med

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“…SI participants (n53,923) were entered into an intensive smoking cessation programme [7]. SI participants were also randomised to receive either an ipratropium bromide metered-dose inhaler (18 mg?puff -1 , Atrovent TM ; Boehringer Ingelheim, Ridgefield, CT, USA) or an identically appearing placebo inhaler.…”

Section: Methodsmentioning

confidence: 99%

Smoking reduction and the rate of decline in FEV₁: results from the Lung Health Study

Connett²,

et al. 2005

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Previous findings from the Lung Health Study have shown that smoking cessation and sustained abstinence substantially reduce the rate of decline in forced expiratory volume (FEV1) among smokers with early chronic obstructive pulmonary disease (COPD) when compared with continuing smoking. Intermittent quitters demonstrated rates of FEV1 decline intermediate between those of sustained quitters and continuing smokers.In this study, data from 1,980 participants were analysed from 10 centres of the Lung Health Study in the USA and Canada. All participants were smokers with mild-to-moderate COPD who were unable to quit smoking at any time during the 1st yr of the study.No linear relationship was found between reduction in cigarettes per day and changes in FEV1 during the 1st yr of the study. However, examination of the data revealed that this relationship was nonlinear. Further analysis found that smokers who reduced their cigarettes per day to very low amounts had smaller declines in FEV1 than those who did not. Reduction in cigarettes per day was associated with only minimal changes in the presence of chronic respiratory symptoms.In conclusion, compensatory changes in smoking behaviour may account for the limited and unpredictable impact of smoking reduction on lung function decline and symptom prevalence when compared with smoking cessation.KEYWORDS: Forced expiratory volume in one second, smoking cessation, smoking reduction S ustained smoking cessation substantially reduces the smoking-related accelerated rate of decline in forced expiratory volume in one second (FEV1) and decreases the frequency of chronic respiratory symptoms among smokers with early chronic obstructive pulmonary disease (COPD) when compared with continuing smokers [1][2][3]. Intermittent quitting is associated with rates of FEV1 decline intermediate between those observed in sustained quitters and continuing smokers [4]. Conversely, it is not known whether partial reduction in the number of cigarettes smoked per day among continuing smokers is associated with improvement in the subsequent course of lung function decline when compared with that observed when daily consumption remains unchanged. For smokers with COPD who find it difficult to quit smoking entirely this is an important issue, since they may assume that smoking reduction is an effective alternative strategy for slowing disease progression. In the only previous long-term prospective study of smoking reduction (from o15 to ,15 cigarettes?day -1 ) on the rate of FEV1 decline, smokers ,55 yrs showed a significant reduction in FEV1 decline, although older smokers did not [5]. In that study, only two measurements of lung function were performed at an interval of 5 yrs and details of changes in the smoking rate, including the timing of changes in smoking amount relative to the measurement of lung function, were not reported.The present analysis examines the relationship between smoking reduction and change in FEV1 in a subset of the participants in the Lung Health Study, a large...

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“…For the present study, the two intervention groups were combined and referred to as the SI group, as use of the ipratropium bromide inhaler was not associated with any changes in cessation rates or measures of long-term change in lung function. The smoking intervention program is described in detail elsewhere [11].…”

Section: Samplementioning

confidence: 99%

Predictors of attendance and dropout at the Lung Health Study 11-year follow-up

Snow

Connett

Sharma

et al. 2007

Contemporary Clinical Trials

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Participant attrition and attendance at follow-up were examined in a multicenter, randomized, clinical trial. The Lung Health Study (LHS) enrolled a total of 5, 887 adults to examine the impact of smoking cessation coupled with the use of an inhaled bronchodilator on chronic obstructive pulmonary disease (COPD). Of the initial LHS 1 volunteers still living at the time of enrolment in LHS 3 (5,332), 4,457 (84%) attended the LHS 3 clinic visit, a follow-up session to determine current smoking status and lung function. The average period between the beginning of LHS 1 and baseline interview for LHS 3 was 11 years. In univariate analyses, attenders were older, more likely female, more likely to be married, smoked fewer cigarettes per day, and were more likely to have children who smoked at the start of LHS 1 than non-attenders. Attenders were also less likely to experience respiratory symptoms, such as cough, but had decreased baseline lung function compared with non-attenders. Volunteers recruited via mass mailing were more likely to attend the long-term follow-up visit. Those recruited by public site, worksite, or referral methods were less likely to attend. In multivariate models, age, gender, cigarettes smoked per day, married status, and whether participants' children smoked were identified as significant predictors of attendance versus non-attendance at LHS 3 using stepwise logistic regression. Treatment condition (smoking intervention or usual care) was not a significant predictor of attendance at LHS 3. Older females who smoked less heavily were most likely to participate. These findings may be applied to improve participant recruitment and retention in future clinical trials.

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Design and Results of the Initial Intervention Program for the Lung Health Study

Cited by 58 publications

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Smoking Cessation in Chronic Obstructive Pulmonary Disease

Smoking Cessation in Chronic Obstructive Pulmonary Disease

Smoking reduction and the rate of decline in FEV₁: results from the Lung Health Study

Predictors of attendance and dropout at the Lung Health Study 11-year follow-up

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Design and Results of the Initial Intervention Program for the Lung Health Study

Cited by 58 publications

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Smoking Cessation in Chronic Obstructive Pulmonary Disease

Smoking Cessation in Chronic Obstructive Pulmonary Disease

Smoking reduction and the rate of decline in FEV1: results from the Lung Health Study

Predictors of attendance and dropout at the Lung Health Study 11-year follow-up

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Smoking reduction and the rate of decline in FEV₁: results from the Lung Health Study