The Effects of a Smoking Cessation Program on Long-Term Survival in Smokers with Mild Lung Disease

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The summary below is from the full report titled "The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality. A Randomized Clinical Trial." It is in the 15 February 2005 issue of Annals of Internal Medicine (volume 142, pages 233-239). The authors are N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, and J.E. Connett, PhD, for the Lung Health Study Research Group.

What is the problem and what is known about it so far?

Smoking cigarettes increases a person's risk for many health problems, including cancer, heart disease, and lung disease. Several studies have shown many benefits for smokers who quit. However, no studies have proven that smoking cessation programs lead to better long-term survival. Chronic obstructive pulmonary disease (COPD), a disease of the air sacs and air passages of the lungs, is one of the many health problems to which smoking contributes. People with COPD are short of breath and sometimes cough and wheeze. Damage to the lungs and symptoms slowly worsen over time, especially if people do not stop smoking. Smoking cessation is particularly important for people with COPD who want to slow the worsening of their disease.

Why did the researchers do this particular study?

To see if a smoking cessation program improved long-term survival in people with mild COPD.

Who was studied?

5887 middle-aged people with early COPD (they had abnormal results on lung tests but did not consider themselves to be sick). The people were participating in a large study called the Lung Health Study, which examined whether a smoking cessation program and treatment with a drug called ipratropium could prevent worsening of disease in people with mild COPD.

How was the study done?

The researchers assigned participants to attend a special smoking cessation program or to receive usual care. The smoking cessation program included 12 two-hour group sessions over a 10-week period. The sessions used behavior modification and nicotine gum. The researchers followed study participants for up to 14.5 years and collected information about smoking status and death from heart disease, lung disease, cancer, or any other cause.

What did the researchers find?

After 5 years, 21.7% of the people in the special program had completely stopped smoking compared with only 5.4% of people in the usual care group. However, despite the relatively small proportion of participants who stopped smoking, the death rate in the group that received the smoking cessation program was lower, by about 15%, than the rate in the group that received usual care. Not surprisingly, the benefit with respect to survival was largest among participants who actually stopped smoking: Their death rates were 46% lower than those of the people who continued to smoke.

What were the limitations of the study?

This study involved only people with early signs of COPD on lung tests. It is unknown whether the survival benefits of a smoking cessation program would also exist among people without such signs.

What are the implications of the study?

Intensive smoking cessation programs can improve long-term survival, even when successful in only a minority of patients.