Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers

Willemse, Brigitte; Hacken, Nick H. T. ten; Rutgers, Bea; Lesman‐Leegte, Ivonne; Postma, Dirkje S.; Timens, Wim

doi:10.1016/j.rmedu.2006.03.019

Cited by 93 publications

(134 citation statements)

References 25 publications

(41 reference statements)

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“…26,27 Smoking cessation is the only approach that can effectively slow the progression of COPD and mitigate its clinical course. 26,28 It can delay the impairment of pulmonary function and significantly alleviate the symptoms of coughing, excess phlegm, and asthma, thereby improving patient health status. [29][30][31] Long-term smoking cessation has been found to improve the natural course of COPD and to mitigate the deterioration of lung function in patients with COPD.…”

Section: Discussionmentioning

confidence: 99%

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

Lou¹,

Chen²,

Zhang³

et al. 2014

Respir Care

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BACKGROUND: A number of effective strategies have been developed to improve the quality of life in patients with COPD. However, few have been implemented in patients with COPD at all stages in a community setting. This study evaluated the efficacy of a complex COPD health management intervention in rural communities in China. METHODS: A randomized controlled trial including 8,217 subjects with COPD was implemented from May 2008 to May 2012 in 14 community health-care centers. The control group of subjects received usual care, whereas the management group of subjects participated in a health management program that included assessing the subjects' health status, giving regular health lectures, smoking cessation counseling, encouraging regular exercise, providing rehabilitative training and psychological counseling, and regular followup. As a primary outcome, we examined the changes in the BODE index. Secondary outcomes included depression and anxiety rates, current smoking rate, awareness of COPD, mortality, risk factors, respiratory medication use, hospital admissions, and emergency department visits. RESULTS: After 4 y, the mean cumulative value of the BODE index increased by 0.7 per subject in the control group and decreased by 0.4 per subject in the health management group (difference of 1.1, 95% CI 0.2-2.0, P < .001). Health management reduced anxiety symptoms by 4.8%, depression symptoms by 6.6%, current smoking by 14.3%, mortality due to all causes by 9.0%, hospitalizations due to all causes by 16.1%, and emergency department visits due to all causes by 18.1% (P < .05 for all). However, it increased immunomodulator use by 58.9%, respiratory medication use by 14.1-21.9%, and awareness scores for COPD by 57.2% (P < .05 for all). CONCLUSIONS: The health management program is an effective community-based strategy for the prevention and management of COPD in China, increasing awareness and knowledge among patients and practitioners and improving management within the limitations of access to pharmacotherapy.

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Section: Discussionmentioning

confidence: 99%

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

Lou¹,

Chen²,

Zhang³

et al. 2014

Respir Care

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“…[22][23][24] Inhaled corticosteroids that modify these markers of inflammation have been demonstrated to reduce the risk of COPD exacerbation. 25 Interestingly, among patients with severe COPD, inflammation has been demonstrated to persist years after smoking cessation, 26,27 and there are few data about whether modification in the rate of airflow obstruction is similar to those individuals with mild to moderate disease.…”

Section: 12mentioning

confidence: 99%

The Effects of Smoking Cessation on the Risk of Chronic Obstructive Pulmonary Disease Exacerbations

et al. 2009

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BACKGROUND:Smoking cessation has been demonstrated to reduce the rate of loss of lung function and mortality among patients with mild to moderate chronic obstructive pulmonary disease (COPD). There is a paucity of evidence about the effects of smoking cessation on the risk of COPD exacerbations. OBJECTIVE:We sought to examine whether smoking status and the duration of abstinence from tobacco smoke is associated with a decreased risk of COPD exacerbations. DESIGN:We assessed current smoking status and duration of smoking abstinence by self-report. Our primary outcome was either an inpatient or outpatient COPD exacerbation. We used Cox regression to estimate the risk of COPD exacerbation associated with smoking status and duration of smoking cessation. PARTICIPANTS:We performed a cohort study of 23,971 veterans who were current and past smokers and had been seen in one of seven Department of Veterans Affairs (VA) primary care clinics throughout the US. MEASUREMENTS AND MAIN RESULTS:In comparison to current smokers, ex-smokers had a significantly reduced risk of COPD exacerbation after adjusting for age, comorbidity, markers of COPD severity and socioeconomic status (adjusted HR 0.78, 95% CI 0.75-0.87). The magnitude of the reduced risk was dependent on the duration of smoking abstinence (adjusted HR: quit<1 year, 1.04; 95% CI 0.87-1.26; 1-5 years 0.93, 95% CI 0.79-1.08; 5-10 years 0.84, 95% CI 0.70-1.00; ≥10 years 0.65, 95% CI 0.58-0.74; linear trend<0.001). CONCLUSIONS:Smoking cessation is associated with a reduced risk of COPD exacerbations, and the described reduction is dependent upon the duration of abstinence.

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“…forced expiratory volume in 1 s [FEV 1 ]) and COPD-related mortality [4][5][6][7]. Cigarette smoking is thought to exert its effects via increased inflammation, airway wall fibrosis, destruction of alveolar attachments, and inhibition of repair mechanisms [2,8].…”

Section: Introductionmentioning

confidence: 99%

Tiotropium improves FEV1 in patients with COPD irrespective of smoking status

Moita¹,

Bárbara²,

Cardoso³

et al. 2008

Pulmonary Pharmacology & Therapeutics

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This study evaluated whether the effect of tiotropium on the change in trough forced expiratory volume in 1 s (FEV 1 ), vs. placebo, is affected by smoking status. In a 3-month, double-blind study in 31 centres in Portugal, 311 (289 completed) patients were randomised to tiotropium 18 mg once daily or placebo. Baseline mean (standard deviation (SD)) FEV 1 was 1.11 (0.39) l in the tiotropium group and 1.13 (0.39) l in the placebo group. Patients had an average smoking history of 55 (25.7) pack-years; 80 (26%) were smokers and 224 (74%) were ex-smokers. The primary end-point was change in morning pre-dose (i.e. trough) FEV 1 after 12 weeks. Trough FEV 1 at 12 weeks was significantly improved with tiotropium vs. placebo: the difference in means was 102 ml, P ¼ 0.0011, 95% confidence interval (CI) (41, 164). The difference in means in smokers was 138 ml, P ¼ 0.0105, CI (32, 244); in ex-smokers it was 66 ml, P ¼ 0.0375, CI (3, 129). The difference between smokers and ex-smokers was not statistically significant (P ¼ 0.6982) and may be due to greater variability and differences in disease severity. The significant improvement in lung function in patients treated with tiotropium vs. placebo in both smokers and ex-smokers suggests that tiotropium is an effective and well-tolerated therapy in chronic obstructive pulmonary disease (COPD), regardless of smoking status. r

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Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers

Cited by 93 publications

References 25 publications

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

The Effects of Smoking Cessation on the Risk of Chronic Obstructive Pulmonary Disease Exacerbations

Tiotropium improves FEV1 in patients with COPD irrespective of smoking status

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