Smoking cessation can improve survival among patients with severe COPD

Smoking intensity and current smoking status strong predictors of mortality -


Patients with severe chronic obstructive pulmonary disease (COPD) who stop smoking may be able to improve their rate of
survival, despite the severity of their lung disease. A new study in the November issue of CHEST, the peer-reviewed journal
of the American College of Chest Physicians (ACCP), showed that patients with severe, early-onset COPD who continued to smoke
had a risk of mortality that was almost three times that of patients who stopped smoking. The study also reported that
greater smoking intensity increased the risk of mortality among COPD patients, with patients who had the greatest smoking
intensity having the highest risk of mortality.


"Lifetime smoking intensity and current smoking status independently increased mortality in our patients with severe COPD,"
said Craig P. Hersh, MD, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA. "However,
patients who continued smoking significantly reduced their survival rate, which confirms the importance of smoking cessation
even in patients with the most advanced stages of lung disease."


Dr. Hersh and colleagues utilized data from the Boston Early-Onset COPD Study to determine the natural history of severe,
early onset COPD and the survival rates of patients under age 53 during a follow-up period of 2 months to 8 years. Of the 139
patients (72.7 percent women) studied, 37 patients died within the study period, with the majority of deaths due to
cardiorespiratory illness. Overall survival rates were 85 percent at 3 years and 72 percent at 5 years. Patients who smoked
during the study period had a risk of mortality that was almost three times that of patients who stopped smoking. In
addition, greater smoking intensity was associated with decreased survival, and the risk of mortality increased by 20 percent
for each 10 pack-years of smoking.


"As age increases, so does the risk of mortality in patients with COPD," added Dr. Hersh. "Yet, the relatively young patients
in our study had a high rate of mortality, despite their young age."


Although women made up the majority of patients in the study, both groups had similar rates of survival. In addition to age
and gender, symptoms of chronic bronchitis, bronchodilator responsiveness, underweight, home oxygen use, pulmonary
rehabilitation, and lung volume reduction surgery were not significant predictors of survival.


"The large number of female patients with severe, early-onset COPD has been an interesting finding of our study that we have
not yet been able to explain fully," said Edwin K. Silverman, MD, PhD, the Principal Investigator of the Boston Early-Onset
COPD Study and senior author of this manuscript. "It is possible that women are more susceptible to the harmful effects of
cigarette smoke and that this increased susceptibility has not been appreciated due to the historically higher rates of
smoking among men."


COPD is the fourth leading cause of death in the United States, with mortality rates significantly increasing among women
each year. COPD is currently diagnosed in at least 10 million Americans, and the majority of cases are attributed to
long-term cigarette smoking.


"As seen in this study and many others, the most effective treatment for COPD is smoking cessation," said Paul A. Kvale, MD,
FCCP, President of the American College of Chest Physicians. "Regardless of a patient's age or disease severity, physicians
should ask all patients about smoking status. Physicians also should encourage smoking cessation in all patients who smoke
and continue to motivate their patients throughout the cessation process."


CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at chestjournal. ACCP
represents 16,000 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the
United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the
chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP
Web site at chestnet.


Contact: Jennifer Stawarz

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847-498-8306

American College of Chest Physicians