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Prevent Emphysema Now!

Information for Physicians on the Diagnosis and Treatment of COPD

Making the Diagnosis of COPD
How to Test for Emphysema
Who Should Be Treated
Suggested Treatment Emphysema
Other Therapy for Emphysema
Appendix A
Pulmonary Function Reimbursement (as of 6/03)

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 baseline.

Figure 3 graph

TABLE 2 Causes of Death Within Five Years in the Lung Health Study.
Cause of Death SmokingIntervention& Ipratropium SmokingIntervention& Placebo UsualCare Total
Lung cancer 18 20 19 57
Cardiovascular disease 18 7 12 37
Other 18 17 20 55
Total 54 44 51 149
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 persons.