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The Effects of Smoking Cessation on the Risk of Chronic Obstructive Pulmonary Disease Exacerbations

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Abstract

BACKGROUND

Smoking cessation has been demonstrated to reduce the rate of loss of lung function and mortality among patients with mild to moderate chronic obstructive pulmonary disease (COPD). There is a paucity of evidence about the effects of smoking cessation on the risk of COPD exacerbations.

OBJECTIVE

We sought to examine whether smoking status and the duration of abstinence from tobacco smoke is associated with a decreased risk of COPD exacerbations.

DESIGN

We assessed current smoking status and duration of smoking abstinence by self-report. Our primary outcome was either an inpatient or outpatient COPD exacerbation. We used Cox regression to estimate the risk of COPD exacerbation associated with smoking status and duration of smoking cessation.

PARTICIPANTS

We performed a cohort study of 23,971 veterans who were current and past smokers and had been seen in one of seven Department of Veterans Affairs (VA) primary care clinics throughout the US.

MEASUREMENTS AND MAIN RESULTS

In comparison to current smokers, ex-smokers had a significantly reduced risk of COPD exacerbation after adjusting for age, comorbidity, markers of COPD severity and socio-economic status (adjusted HR 0.78, 95% CI 0.75–0.87). The magnitude of the reduced risk was dependent on the duration of smoking abstinence (adjusted HR: quit <1 year, 1.04; 95% CI 0.87–1.26; 1–5 years 0.93, 95% CI 0.79–1.08; 5–10 years 0.84, 95% CI 0.70–1.00; ≥10 years 0.65, 95% CI 0.58–0.74; linear trend <0.001).

CONCLUSIONS

Smoking cessation is associated with a reduced risk of COPD exacerbations, and the described reduction is dependent upon the duration of abstinence.

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Acknowledgments

David Au had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study was funded by the Department of Veterans Affairs: IAC 05–206 and IIR-99-376. Dr. Bryson is funded by a VA Career Development Award (RCS 03-177).

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Health Services Research and Development, VA Puget Sound Health Care System, 1660 S. Columbian Way (152), Seattle, WA, 98108, USA

    David H. Au MD, MS, Christopher L. Bryson MD, MPH, Haili Sun PhD, Edmunds M. Udris MPH & Katharine A. Bradley MD, MPH

  2. Department of Medicine, University of Washington, Seattle, WA, USA

    David H. Au MD, MS, Christopher L. Bryson MD, MPH, Jason W. Chien MD, MS & Katharine A. Bradley MD, MPH

  3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Jason W. Chien MD, MS

  4. Department of Medicine, New York University, New York, NY, USA

    Laura E. Evans MD, MS

Authors
  1. David H. Au MD, MS
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  2. Christopher L. Bryson MD, MPH
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Corresponding author

Correspondence to David H. Au MD, MS.

Additional information

The views expressed in the manuscript reflect those of the authors and not necessarily those of the Department of Veterans Affairs.

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Au, D.H., Bryson, C.L., Chien, J.W. et al. The Effects of Smoking Cessation on the Risk of Chronic Obstructive Pulmonary Disease Exacerbations. J GEN INTERN MED 24, 457–463 (2009). https://doi.org/10.1007/s11606-009-0907-y

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  • DOI: https://doi.org/10.1007/s11606-009-0907-y

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