Smoking cessation in chronic obstructive pulmonary disease

Summary 

Chronic obstructive pulmonary disease (COPD) is increasing in prevalence, and is predicted to become the third leading cause of deaths worldwide by 2020. The precise prevalence of COPD is not known, as many individuals with the disease are left undiagnosed, despite the requirement of only simple spirometry testing for disease detection. The major risk factor for the development of COPD is cigarette smoking, with 90% of deaths from COPD directly attributable to smoking. Therefore smoking cessation is the most effective means of halting or slowing the progress of this disease.

This review summarizes and compares the differential characteristics of smokers with COPD vs. those without COPD in relation to their smoking behavior and quitting attempts, and discusses the various strategies that can be used to help patients quit and improve their likelihood of long-term smoking cessation. Of the various behavioral interventions available that can increase the likelihood of smoking cessation, one of the simplest and most effective strategies that physicians can use is simply to advise their patients to quit, particularly if this advice is combined with informing the patients of their “lung age”. We also discuss the pharmacologic therapies used to enhance the likelihood of quitting, including nicotine replacement, bupropion SR and varenicline, along with novel nicotine vaccines, which are currently undergoing clinical trials.

Keywords: Smoking, Smoking cessation, Chronic obstructive pulmonary disease, Lung age

Abbreviations: CI, confidence interval, COPD, chronic obstructive pulmonary disease, DALYs, disability-adjusted life years, FEV₁, forced expired volume in 1s, FVC, forced vital capacity, GOLD, Global Initiative for Chronic Obstructive Lung Disease, LHS, Lung Health Study, LRI, lower respiratory illness, NHANES, National Health and Nutrition Examination Survey, NRT, nicotine replacement therapy, OR, odds ratio, SD, standard deviation, SR, sustained release