How smoking cessation affects the progression of COPD

Quitting smoking is beneficial for everyone, at every age, and this is especially true for people suffering from chronic obstructive pulmonary disease (COPD), an illness that occurs when a patient has chronic bronchitis and/or emphysema. Quitting smoking is the main treatment, and that applies at all stages. Here is a summary of the latest knowledge on the topic.

Smoking cessation – the main treatment for COPD

Studies carried out since the 1990s, which remain relatively few despite the widespread nature of COPD, show that smoking cessation brings numerous benefits to smokers suffering from this disease. In less serious forms of COPD, it leads to an improvement in symptoms such as coughing and wheezing. In severe cases of the illness, smoking cessation enables loss of breath to be stabilized, and reduces the frequency of coughing and expectoration. (1) Smoking cessation slows down the decline in the forced expiratory volume of air expelled in one second (FEV1). A study from 2000 showed that smoking cessation restored the annual decline of breath capacity to a level approaching normal: the annual decrease of FEV1 was -30ml/year for a non-smoker, -31ml/year for an ex-smoker and -62ml/year for a smoker. (2) In addition, smoking cessation reduces bronchial bacterial colonization and allows some recovery of the body's natural defences, which in turn reduces the risk of aggravation. If the patient's symptoms do become aggravated, long periods of antibiotic treatment, or even hospitalization, may be necessary. Lastly, smoking cessation improves the effectiveness of medication, especially corticoids, which do not work if the patient smokes. (3) Smoking cessation produces a considerable decrease in the COPD mortality rate. On the whole, the studies carried out support the notion that even in severe cases of COPD, smoking cessation improves the chances of survival compared to a smoker who continues smoking. The benefits of smoking cessation on the effects of the illness appear quickly: a study showed that participants who stopped smoking saw their FEV1 improve in the following year, including heavy smokers, elderly smokers, and smokers with weak lung capacity or bronchial hyperreactivity. (4) The Lung Health Study came to the same conclusions – from one year in, people who had stopped smoking presented fewer symptoms of COPD, namely chronic coughing, expectorations, dyspnea and wheezing. Note: it would seem that women benefit even more than men from smoking cessation from the point of view of lung function. Smoking cessation is therefore the primary treatment for COPD. It is also the only treatment that stops the continued obstruction of the bronchi and increasing shortness of breath.

Smoking cessation is difficult for COPD sufferers

It is difficult for someone who suffering from COPD to quit smoking. Why exactly is that? Reasons include that the person often smokes a large quantity of tobacco, has been smoking for a long time, has a strong addiction, is usually quite inactive, and may have a difficult socio-economic or educational background. Women seem to find it harder to quit than men, and have an increased risk of developing anxiety or depression. (5) Reducing the amount of tobacco smoked can be the first goal, even if complete cessation is the ultimate objective. In fact, reducing the amount smoked can produce some positive effects. It is enough to curb the reduction of FEV1. The Lung Health Study showed, among other things, that smokers who hovered between quitting and re-starting smoking experienced less decline in lung function than persistent smokers (-63ml/year for smokers, -34/year if the person successfully quit and -44ml/year if the person stopped smoking for a while). Another advantage of reducing the quantity of tobacco smoked is that it encourages people who did not aim to quit full stop to think about doing so.

COPD and emphysema – smoking cessation in practice

COPD sufferers must without a doubt receive help in order to quit smoking. The first treatment is nicotine replacement (patches, gum, lozenges, and so on). The Lung Health Study carried out for 11 years on 5887 patient suffering from COPD showed that allowing people to chew 2mg nicotine gum during group support sessions achieved three times more success in enabling smokers to quit than the placebo used on the control group. The rate of smoking cessation was 22% in the group that used nicotine replacement, a good result. Nicotine replacement was handled well by all the participants, with no notable side effects. The Lung Health Study was also able to show that this treatment reduces the mortality rate. (8) Bupropion also seems to be an effective aid which is handled well. A study carried out in 2011 showed that taking bupropion on a continual basis practically doubled the number of smokers in the early or medium phases of COPD who succeeded in quitting for more than 12 weeks. The effects lasted until 3 months after quitting. (6) Bupropion appears to be particularly useful in cases where nicotine replacement therapy has failed, especially for women who have a history of depression. Recent studies have highlighted that bupropion may lead to a reduction in the amount of tobacco smoked and an increase in the success rate when cessation is later attempted (7). Another medicine which has been the subject of a study on smoking cessation among COPD sufferers is varenicline. A study conducted in 2011 on 504 smokers suffering from slight-to-moderate COPD revealed that between weeks 9 to 12, the rate of abstinence obtained was much higher in the group who used varenicline than in the placebo group. Long programs of cognitive behavioral therapies must be combined with medication for best results.

References

(1) Pr Bertrand Dautzenberg, Arrêt du tabac traitement de première et de deuxième intention de la BPCO, présentation à la SFT, 2010

(2) Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS, Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease, Am J Respir Crit Care Med. 2000 Feb;161(2 Pt 1):381-90.

(3) Lazarus SC, Chinchilli VM, Rollings NJ, Boushey HA, Cherniack R et al. Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. Am J Respir Crit Care Med 2007;175:783-90

(4) Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS, Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease, Am J Respir Crit Care Med. 2000 ;161(2 Pt 1):381-90.

(5) J. Perriot, Sevrage tabagique des patients atteints de BPCO - État des connaissances et propositions en vue de l'optimisation de leur prise en charge tabacologique, Le Courrier des Addictions, N° 4 Décembre 2004

(6) Tashkin D, Kanner R, Bailey W, Buist S, Anderson P, Nides M, Gonzales D, Dozier G, Patel MK, Jamerson B., Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial, Lancet. 2001 ;357(9268):1571-5.

(7) Hatsukami DK, Rennard S, Patel MK, Kotlyar M, Malcolm R, Nides MA, Dozier G, Bars MP, Jamerson BD., Effects of sustained-release bupropion among persons interested in reducing but not quitting smoking. Am J Med. 2004;116(3):151-7.

(8) Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE; Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142(4):233-9.

• J. Perriot, Sevrage tabagique des patients atteints de BPCO - État des connaissances et propositions en vue de l'optimisation de leur prise en charge tabacologique, Le Courrier des Addictions, N° 4 Décembre 2004

• Pr Bertrand Dautzenberg, Arrêt du tabac traitement de première et de deuxième intention de la BPCO, présentation à la SFT, 2010

• Willemse BW, ten Hacken NH, Rutgers B, Lesman-Leegte IG, Postma DS, Timens W., Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers, Eur Respir J. 2005 Nov;26(5):835-45.

• Godtfredsen NS, Lam TH, Hansel TT, Leon ME, Gray N, Dresler C, Burns DM, Prescott E, Vestbo J., COPD-related morbidity and mortality after smoking cessation: status of the evidence, Eur Respir J. 2008 Oct;32(4):844-53.

• Godtfredsen NS, Vestbo J, Osler M, Prescott E, Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study, Thorax 2002;57:967–972

• TS Lapperre, DS Postma, MME Gosman, J B Snoeck-Stroband, N H T ten Hacken, P S Hiemstra, W Timens, P J Sterk, T Mauad, Relation between duration of smoking cessation and bronchial inflammation in COPD, Thorax 2006;61:115-121

• Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS, Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease, Am J Respir Crit Care Med. 2000 Feb;161(2 Pt 1):381-90.

• Willemse BW, Postma DS, Timens W, ten Hacken NH., The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation, Eur Respir J. 2004 Mar;23(3):464-76.

• Kanner RE, Connett JE, Williams DE, Buist AS; Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease: the Lung Health Study, Am J Med. 1999 Apr;106(4):410-6.

• Wagena EJ, van der Meer RM, Ostelo RJ, Jacobs JE, van Schayck CP. The efficacy of smoking cessation strategies in people with chronic obstructive pulmonary disease: results from a systematic review, Respir Med. 2004 Sep;98(9):805-15.

• Tashkin D, Kanner R, Bailey W, Buist S, Anderson P, Nides M, Gonzales D, Dozier G, Patel MK, Jamerson B., Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial, Lancet. 2001 May 19;357(9268):1571-5.

• Tashkin DP, Murray RP., Smoking cessation for chronic obstructive pulmonary disease, Respir Med. 2009 Jul;103(7):963-74. Epub 2009 Mar 14.

• Hatsukami DK, Rennard S, Patel MK, Kotlyar M, Malcolm R, Nides MA, Dozier G, Bars MP, Jamerson BD., Effects of sustained-release bupropion among persons interested in reducing but not quitting smoking. Am J Med. 2004 Feb 1;116(3):151-7.

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