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Copyright ©ERS Journals Ltd 2006
Smoking cessation: a critical investigative tool in COPD
Dipartimento di Medicina Interna e Specialistica, Università di Catania, Catania, Italy.
To the Editors:
The recent longitudinal assessment of airway inflammation in chronic obstructive pulmonary disease (COPD) patients, before and after 1-yr smoking cessation 1, is a perfect example of what clinical researchers should do in order to expand the current knowledge base in the area of smoke-related disorders. As Ind 2 appropriately points out in his ancillary editorial to the previously mentioned paper, the findings are not conclusive due to the lack of study controls, together with the small number of COPD subjects studied.
Nevertheless, the effect of smoking cessation on COPD is an important topic and further efforts should be devoted towards high-quality longitudinal studies of smoking cessation. International guidelines for COPD (British Thoracic Society, American Thoracic Society, Global Initiative for Chronic Obstructive Lung Disease) recommend smoking cessation interventions for smokers with COPD that are equivalent to interventions for healthy smokers. However, the available evidence in the medical literature indicates that, in disagreement with smokers in the general population, COPD patients who smoke typically respond poorly to smoking cessation efforts for a number of reasons. They have a greater degree of physical nicotine dependence 3, 4 and appear to be less motivated in relation to quitting smoking 5, 6. Furthermore, patients with COPD have repeatedly been characterised as a population of chronically ill patients with a higher than normal prevalence of psychiatric disorders such as depression 7, 8. It is well known that for smokers with depression, or a history of depression, it is far more difficult to quit smoking.
Hence, it is somewhat surprising to note that the 1-yr smoking cessation rate of 
50% achieved in a population of COPD outpatients by these authors' counselling programme is one of the highest ever reported in smoking cessation literature. This is outstanding in consideration of the fact that this result was accomplished without the support of recommended cessation treatments (such as bupropion or nicotine replacement therapy), which are known to appreciably improve quit rates even in patients with COPD 9. In consideration of this, the authors' decision to study only 28 COPD smokers in this intervention trial appears not to be supported by the logic of powering the sample size for the current study, in that the excellent outcomes rates of their smoking cessation programme could not be predicted in COPD patients.
Smoking cessation is a dynamic process and full cessation is typically obtained after a few attempts; for this reason, a rescue component for relapse is generally integrated into most smoking cessation programmes. There is little information about this as it seems that full cessation was attained in all quitters at 2 months and sustained, thereafter, until conclusion of the 1-yr smoking cessation trial with no documented withdrawals or late relapsing.
Finally, drop-outs from smoking cessation trials are common (attrition rates of 20–50% are generally reported). In the present study, it appeared that all participants (this includes not only relapsers/continuing smokers, but also quitters) completed all time points in the study. This is most unusual and requires an explanation.
High quit rates would be desirable in a population that generally respond poorly to smoking cessation efforts, so as to simplify recruitments into research studies of chronic obstructive pulmonary disease smoking cessation and to make the most of healthcare resources. Hence, it is crucial to know more details about recruitment modalities, patients' characteristics (particularly in terms of social, economical and demographical factors), incentive plans and intervention schemes of the smoking cessation programme used in the study. Perhaps this would be the first time that evidence with regard to smoking cessation interventions that are specifically developed for smokers with chronic obstructive pulmonary disease is provided.
REFERENCES
- Willemse BW, ten Hacken NH, Rutgers B, Lesman-Leegte IG, Postma DS, Timens W. Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers. Eur Respir J 2005;26:835–845.
[Abstract/Free Full Text] - Ind PW. COPD disease progression and airway inflammation: uncoupled by smoking cessation. Eur Respir J 2005;26:764–766.
[Free Full Text] - Sach K, Hall R, Sachs B. Success of rapid smoking therapy in smokers with pulmonary and coronary heart diseases. Am Rev Respir Dis 1981;123:111–116.
- Jimenez-Ruiz CA, Masa F, Miravitlles M, et al. Smoking characteristics: differences in attitudes and dependence between healthy smokers and smokers with COPD. Chest 2001;119:1365–1370.
[Abstract/Free Full Text] - Walters N, Coleman T. Comparison of the smoking behaviour and attitudes of smokers who attribute respiratory symptoms to smoking with those who do not. Br J Gen Pract 2002;52:132–134.[Medline] [Order article via Infotrieve]
- Clark MA, Hogan JW, Kviz FJ, Prohaska TR. Age and the role of symptomatology in readiness to quit smoking. Addictive Behav 1999;24:1–16.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
- Dudley DL, Glaser EM, Jorgenson BN, et al. Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease. Part I. Psychosocial and psychological considerations. Chest 1980;77:413–420.
[Free Full Text] - Isoaho R, Keistinen T, Laippala P, Kivela SL. Chronic obstructive pulmonary disease and symptoms related to depression in elderly persons. Psychol Rep 1998;76:287–297.
- van der Meer RM, Wagena EJ, Ostelo RW, Jacobs JE, van Schayck CP. Smoking cessation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2003;2:CD002999
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