Long-term effectiveness of smoking cessation approaches among COPD patients

A new study published in the August edition of the journal Thorax reviews the success rates of different smoking cessation approaches among COPD patients. In doing so, the results of the study seem to indicate that quitting smoking is more challenging for COPD patients than the general population of smokers. In fact, in the two most aggressive approaches evaluated, COPD patients were 27-40% less likely to achieve continuous 12-month smoking abstinence than the general smoking population. The article authors further noted a previous study which showed that COPD patients who are successful in quitting smoking are 30% more likely to relapse than the general smoking population.

Overall, the average continuous 12-month smoking cessation success rates for COPD patients in the nine studies reviewed by the article authors were very low – ranging from 1.4% abstinence among those who received no medical intervention to 12.3% abstinence for COPD patients who received the most aggressive approach (intensive counseling plus pharmacotherapy). (Hoogendoom M, et al. Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD. Thorax. 2010 Aug; 65(8):711-718)

In their study, the Dutch research team examined the results of nine previous COPD patient smoking cessation studies conducted over the past 25 years in which continuous smoking abstinence was biochemically verified after 12 months (versus self-reporting by patients). The purpose of their study was to determine the potential patient benefits and health care cost savings among the Netherlands smoking population for each of the smoking cessation options explored.

To be clear, the studies they examined were not exclusively Dutch population studies (meaning the results are not applicable only to smokers in the Netherlands). The researchers took the average results of the nine studies and extrapolated their implications across 50% of the Dutch COPD smoking population (the percentage of the Netherlands COPD smoking population that annually expresses a willingness to quit smoking).

The smoking cessation approaches evaluated were as follows:

1. Usual care – no smoking cessation counseling or pharmacotherapy (control group)
2. Minimal counseling – less than 90 minutes in total and no pharmacotherapy
3. Intensive counseling – 90 minutes or more of counseling and no pharmacotherapy
4. Intensive counseling plus pharmacotherapy – more than 90 minutes of smoking cessation counseling plus any type of pharmacotherapy (meaning they did not distinguish between types of pharmacotherapy).

The results showed that COPD patients who followed usual care had a 1.4% success rate in achieving continuous 12-month smoking abstinence. Those who pursued minimal counseling reached 2.6% while the intensive counseling group reported 6.0% success. The COPD patients who chose the combination of intensive counseling and pharmacotherapy reported the highest average 12-month continuous abstinence at 12.3%. By comparison, general smoking population studies have shown 10% success among those opting for intensive counseling and 17% abstinence among those who received both intensive counseling and pharmacotherapy.

The article authors did not speculate on reasons why COPD patients have lower success rates than smokers who have not yet developed COPD. One would think those who are suffering the greatest adverse health effects of long-term smoking would be more motivated to quit than those who are not yet exhibiting symptoms of lung disease. But regardless of the reasons, the results appear to highlight that long-term smoking cessation is a particularly tough proposition for COPD patients.

The article’s reported results reinforce our belief that respiratory care professionals should provide COPD patients greater access to pulmonary rehabilitation programs regardless of their smoking status. For those who are unaware, in the U.S. (and likely in many other countries around the globe) a very high percentage of pulmonary rehabilitation programs do not admit COPD patients who are active smokers unless they first successfully complete a smoking cessation program (meaning those unwilling to commit to quit are either denied entry or simply decide not to pursue entry).

Given that COPD patients find it harder to quit smoking (and to stay abstinent long-term) than the general smoking population, isn’t it misguided to deny those patients who can’t quit smoking a highly effective therapy for improving physical conditioning, reducing shortness of breath, improving patient quality of life, reducing COPD exacerbations, reducing COPD related hospital admissions and health costs? It’s not like smokers don’t benefit from pulmonary rehab – a number of other studies have demonstrated this fact.

We think it is misguided and it is one of the reasons we created the Breathe Better for Life guidebook and companion CD-ROM…to provide smokers and COPD patients with the knowledge and tools to begin a pulmonary rehab style exercise and nutrition program at home or at a local fitness center in the event they are unable or unwilling to gain entry to a rehab program in their area. To learn more about the Breathe Better for Life, please visit our web site at www.breathebetterforlife.com.