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.

FIGURE 3 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.

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