Who Should Be Treated
Of course, all smokers should stop smoking, but patients who are
developing airflow obstruction have an absolutely critical need to really
stop smoking. Methods of smoking cessation and other therapies useful in
early stages of COPD can change the course of the disease.
In the Lung Health Study, for example, patients with airflow
obstruction who stopped smoking actually had an improvement in FEV1 followed by only a slight decline over a five-year
follow-up period. By contrast, those patients who continued to smoke had a
much more rapid deterioration (see Figure 3). However, in the Lung Health
Study, no patient died of COPD within the first five years of follow-up.
The most common cause of death was lung cancer, followed by heart attack,
and stroke (see Table 2). Thus, finding spirometric abnormalities in heavy
smokers is a strong signal to look for other diseases, such as lung cancer
and to institute therapies, such as the control of blood pressure and
abnormal lipid,s to reduce the risk of heart attack and stroke.
Effect of smoking cessation on FEV1 over time, as seen in the Lung Health Study. Mean
postbronchodilator forced expiratory volume at 1 second (FEV1) for participants in the smoking intervention and
placebo group who are sustained quitters (o), and those who
continued to smoke (•). The two curves diverge sharply after
TABLE 2 Causes of Death Within
Five Years in the Lung Health Study.
|Cause of Death
|Adapted from: Anthonisen NR,
Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, et al: Effects
of smoking intervention and the use of an inhaled anti-cholinergic
bronchodilator on the rate of decline of FEV1 .
The Lung Health Study. JAMA 1994;272:1501. Total enrolled: 5,887