RT Journal Article
SR Electronic
T1 Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1602114
DO 10.1183/13993003.02114-2016
VO 49
IS 5
A1 Lynn Josephs
A1 David Culliford
A1 Matthew Johnson
A1 Mike Thomas
YR 2017
UL http://erj.ersjournals.com/content/49/5/1602114.abstract
AB Smoking cessation in chronic obstructive pulmonary disease (COPD) reduces accelerated forced expiratory volume in 1 s decline, but impact on key health outcomes is less clear. We studied the relationship of smoking status to mortality and hospitalisation in a UK primary care COPD population.Using patient-anonymised routine data in the Hampshire Health Record Analytical Database, we identified a prevalent COPD cohort, categorising patients by smoking status (current, ex- or never-smokers). Three outcomes were measured over 3 years (2011–2013): all-cause mortality, respiratory-cause unplanned hospital admission and respiratory-cause emergency department attendance. Survival analysis using multivariable Cox regression after multiple imputation was used to estimate hazard ratios for each outcome by smoking status, adjusting for measured confounders (including age, lung function, socioeconomic deprivation, inhaled medication and comorbidities).We identified 16 479 patients with COPD, mean±sd age 70.1±11.1 years. Smoking status was known in 91.3%: 35.1% active smokers, 54.3% ex-smokers, 1.9% never-smokers. Active smokers predominated among younger patients. Compared with active smokers (n=5787), ex-smokers (n=8941) had significantly reduced risk of death, hazard ratio (95% confidence interval) 0.78 (0.70–0.87), hospitalisation, 0.82 (0.74–0.89) and emergency department attendance, 0.78 (0.70–0.88).After adjusting for confounders, ex-smokers had significantly better outcomes, emphasising the importance of effective smoking cessation support, regardless of age or lung function.Many COPD patients smoke: better outcomes in ex-smokers suggest many deaths and admissions avoidable if smokers quit http://ow.ly/l85u30aizmK