Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2003;2003(2):CD002999.
doi: 10.1002/14651858.CD002999.

Smoking cessation for chronic obstructive pulmonary disease

R M van der Meer  1 , E J Wagena, R W J G Ostelo, J E Jacobs, C P van Schayck
Affiliations

Smoking cessation for chronic obstructive pulmonary disease

R M van der Meer et al. Cochrane Database Syst Rev. 2003.

Abstract

Background: Smoking cessation is the most important treatment for smokers with chronic obstructive pulmonary disease (COPD), but little is known about the effectiveness of different smoking cessation interventions for this particular group of patients.

Objectives: To determine the effectiveness of smoking cessation interventions in people with COPD.

Search strategy: Electronic searches were undertaken on MEDLINE (from 1966 to March 2002), EMBASE (from 1989 to March 2002) and Psyclit (from 1971 to March 2002), and CENTRAL (Issue 1, 2002).

Selection criteria: Randomised controlled trials in which smoking cessation was assessed in participants with confirmed COPD.

Data collection and analysis: Two authors extracted the data and performed the methodological quality assessment independently for each study, with disagreements resolved by consensus. High-quality was defined, based on pre-set criteria according to the DelphiList.

Main results: Five studies were included in this systematic review, two of which were of high-quality. The high-quality studies show the effectiveness of psychosocial interventions combined with pharmacological intervention compared to no treatment: psychosocial interventions combined with nicotine replacement therapy (NRT) and a bronchodilator versus no treatment at a 5 year follow-up (RD = 0.16, 95% CI 0.14 to 0.18), (RR = 4.0, 95% CI 3.25 to 4.93), psychosocial interventions combined with NRT and placebo versus no treatment at a 5 year follow-up (RD = 0.17, 95% CI 0.14 to 0.19), (RR = 4.19, 95% CI 3.41 to 5.15). Furthermore the results show the effectiveness of various combinations of psychosocial and pharmacological interventions at a 6 months follow-up (RD = 0.07, 95% CI 0.0 to 0.13), (RR = 1.74, 95% CI 1.01 to 3.0). Unfortunately, none of the included studies compared psychosocial interventions with no treatment. Therefore we found no evidence with regard to the effectiveness of these interventions.

Reviewer's conclusions: Based on this systematic review, the authors found evidence that a combination of psychosocial interventions and pharmacological interventions is superior to no treatment or to psychosocial interventions alone. Furthermore we conclude that there is no clear or convincing evidence for the effectiveness of any psychosocial intervention for patients with COPD due to lack of a sufficient number of high-quality studies.

PubMed Disclaimer

Conflict of interest statement

Annelies Jacobs is coordinator of a project, which is partly financed by GlaxoSmithKline. Her involvement does not seem to be a source of conflict of interest because scientific autonomy is guaranteed.

Figures

2.1
2.1. Analysis
Comparison 2 Comparison among various psychosocial interventions, Outcome 1 12 months (point prevalence).
2.2
2.2. Analysis
Comparison 2 Comparison among various psychosocial interventions, Outcome 2 6 months (point prevalence).
3.1
3.1. Analysis
Comparison 3 Psychosocial and pharmacological interventions vs no intervention, Outcome 1 5 years (sustained abstinence): experimental 1 vs control.
3.2
3.2. Analysis
Comparison 3 Psychosocial and pharmacological interventions vs no intervention, Outcome 2 5 years (sustained abstinence): experimental 2 vs control.
3.3
3.3. Analysis
Comparison 3 Psychosocial and pharmacological interventions vs no intervention, Outcome 3 1 year (sustained abstinence) experimental 1 vs control.
3.4
3.4. Analysis
Comparison 3 Psychosocial and pharmacological interventions vs no intervention, Outcome 4 1 year (sustained abstinence) experimental 2 vs control.
4.1
4.1. Analysis
Comparison 4 Comparison among various combinations of psychosocial and pharmacological interventions, Outcome 1 6 months (continuous abstinence).
See this image and copyright information in PMC

References

References to studies included in this review

Anthonisen 1994 {published data only}
    1. Anthonisen. Epidemiology and the Lung Health Study. European Respiratory Review 1997;7(45):202‐5.
    1. Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994;272(19):1497‐1505. - PubMed
    1. Buist AS. The US Lung Health Study. Respirology 1997;2:303‐7. - PubMed
    1. Buist AS, Connett JE, Miller RD, Kanner RE, Owens GR, Voelker HT. Chronic Obstructive Pulmonary Disease Early Intervention (Lung Health Study). Baseline Characteristics of Randomized Participants. Chest 1993;103(6):1863‐72. - PubMed
    1. Connett JE, Bjornson‐Benson WM, Daniels K. Recruitment of participants in the Lung Health Study, II Assesment of recruiting strategies. Controlled Clinical Trials 1993a;14:38S‐51S. - PubMed
Brandt 1997 {published data only}
    1. Brandt CJ, Ellegaard H, Joensen M, Kallan FV, Sorknaes AD, Tougaard L. Effect of diagnosis of "smokers's lung". The Lancet 1997;349(January 25):253. - PubMed
    1. Kallan FV, Brandt CJ, Ellegaard H, Baltzer Joensen MB, Sorknoes AD, et al. The diagnosis of 'smokers lung' encourages smoking cessation [Diagnosen 'rygerlunger' fremmer rygeophor]. Ugeskrift for Laeger 1997;159(44):6528‐30. - PubMed
Crowley 1995 {published data only}
    1. Crowley TJ, Macdonald MJ, Walter MI. Behavioral anti‐smoking trial in chronic obstructive pulmonary disease patients. Psychopharmacology 1995;119:193‐204. - PubMed
Pederson 1991 {published data only}
    1. Pederson LL, Wanklin JM, Lefcoe NM. The effects of counselling on smoking cessation among patients hospitalized with chronic obstructive pulmonary disease: a randomized clinical trial. The International Journal of the Addictions 1991;20(1):107‐19. - PubMed
Tashkin 2001 {published data only}
    1. Tashkin DP, Kanner R, Bailey W, Buist S, Anderson P, Nides MA, et al. Smoking cessation in patients with chronic obstructive pulmonary disease: a double‐blind, placebo‐controlled, randomised trial. The Lancet 2001;357(May 19):1571‐5. - PubMed

References to studies excluded from this review

Ames 1985 {published data only}
    1. Ames RG, Hall DS. Smoking cessation among coal miners as predicted by baseline respiratory function and symptoms: a 5 year prospective study. Preventive Medicine 1985;14:181‐6. - PubMed
BTS 1983 {published data only}
    1. Subcommittee of the Research Committee of the British Thoracic Society. Comparison of four methods of smoking withdrawal in patients with smoking related diseases. British Medical Journal 1983;286:595‐7. - PMC - PubMed
    1. Subcommittee of the Research Committee of the British Thoracic Society. Smoking withdrawal in hospital patients: factors associated with outcome. Thorax 1984;39:651‐6. - PMC - PubMed
BTS 1990a {published data only}
    1. Research Committee of the British Thoracic Society. Smoking cessation in patients: two further studies by the British Thoracic Society. Thorax 1990;45:835‐40. - PMC - PubMed
BTS 1990b {published data only}
    1. Research Committee of the British Thoracic Society. Smoking cessation in patients: two further studies by the British Thoracic Society. Thorax 1990;45:835‐40. - PMC - PubMed
Buist 1976 {published data only}
    1. Buist AS, Sexton GJ, Nagy JM, Ross BB. The effect of smoking cessation and modification on lung function. American Review of Respiratory Disease 1976;114:115‐22. - PubMed
Camilli 1987 {published data only}
    1. Camilli AE, Burrows B, Knudson RJ, Lyle SK, Lebowitz MD. Longitudinal changes in forced expiratory volume in one second in adults. American Review of Respiratory Disease 1987;135:794‐9. - PubMed
Cheng 1997 {published data only}
    1. Cheng XS, Li JZ, Zhang ZX, et al. The preliminary results of prevention and treatment in the population of patients with COPD and Cor Pulmonale [Chung‐Hua Liu Hsing ping Hsueh Tsa Chih]. Chinese Journal of Epidemiology 1997;18(5):282‐5. - PubMed
Daughton 1980 {published data only}
    1. Daughton DM, Fix AJ, Kass I, Patil KD. Smoking cessation among patients with chronic obstructive pulmonary disease (COPD). Addictive Behaviors 1980;5:125‐8. - PubMed
Davis 1984 {published data only}
    1. Davis AL, Faust R, Ordentlich M. Self‐help smoking cessation and maintenance programs: a comparative study with 12‐month follow‐up by the American Lung Association. American Journal of Public Health 1984;74(11):1212‐7. - PMC - PubMed
Glover 1997 {published data only}
    1. Glover ED, Glover PN, Abrons HL, Franzon M. Smoking cessation among COPD and chronic bronchitis patients using nicotine nasal spray. American Journal of Health Behavior 1997;21(4):310‐7.
Gourlay 1996 {published data only}
    1. Gourlay SG, Benowitz NL. The benefits of stopping smoking and the role of nicotine replacement therapy in older patients. Drugs & Aging 1996;9(1):8‐23. - PubMed
Hall 1983 {published data only}
    1. Hall SM, Bachman J, Henderson JB, Barstow R, Jones RT. Smoking cessation in patients with cardiopulmonary disease: an initial study. Addictive Behaviors 1983;8:33‐42. - PubMed
Hall 1984 {published data only}
    1. Hall RG, Sachs DPL, Hall SM, Benowitz NL. Two‐year efficacy and safety of rapid smoking therapy in patients with cardiac and pulmonary disease. Journal of Consulting and Clinical Psychology 1984;52(4):574‐81. - PubMed
Humerfelt 1998 {published data only}
    1. Humerfelt S, Eide GE, Kvale G, Aaro LE, Gulsvik A. Effectiveness of postal smoking cessation advice: a randomized controlled trial in young men with reduced FEV1 and asbestos exposure. European Respiratory Journal 1998;11:284‐90. - PubMed
Lewis 1998 {published data only}
    1. Lewis SF, Piasecki TM, Fiore MC, Anderson JE, Baker TB. Transdermal nicotine replacement for hospitalized patients: a randomized clinical trial. Preventive Medicine 1998;27:296‐303. - PubMed
Li 1984 {published data only}
    1. Li VC, Kim YJ, Ewart CK, Terry PB, Cuthie JC, Wood J, et al. Effects of physician counselling on the smoking behavior of asbestos‐exposed workers. Preventive Medicine 1984;13:462‐76. - PubMed
Loss 1979 {published data only}
    1. Loss RW, Hall WJ, Speers DM. Evaluation of early airway disease in smokers: cost effectiveness of pulmonary function testing. The American Journal of the Medical Sciences 1979;278(1):27‐37. - PubMed
Paoletti 1993 {published data only}
    1. Paoletti P, Tonnesen P, Rodriguez‐Roisin R. CEASE (Collaborative European Anti‐smoking Evaluation): a challenging multicentre trial organized by the European Respiratory Society. European Respiratory Journal 1993;6:719‐21. - PubMed
Rose 1978 {published data only}
    1. Rose G, Hamilton PJS. A randomised controlled trial of the effect on middle‐aged men of advice to stop smoking. Journal of Epidemiology and Community Health 1978;32:275‐81. - PMC - PubMed
Sachs 1988 {published data only}
    1. Sachs DPL, Benowitz NL, Silver KJ. Effective use of nicotine polacrilex (nicorette) in patients with chronic obstructive pulmonary disease. In: Aoki M, et al. editor(s). Smoking and health. Amsterdam: Elsevier Science Publishers, 1987:793‐795.
Sirota 1985 {published data only}
    1. Sirota AD, Curran JP, Habif V. Smoking cessation in chronically ill medical patients. Journal of Clinical Psychology 1985;41(4):575‐9. - PubMed
Soulier 1999 {published data only}
    1. Soulier‐Parmeggiani L, Griscom S, Bongard O, Avvanzino R, Bounameaux H. One‐year results of a smoking‐cessation programme. Schweizerische Medizinische Wochenschrift 1999;129:395‐8. - PubMed
Tonnesen 1988 {published data only}
    1. Tonnesen P, Fryd V, Hansen M, Helsted J, Gunnersen AB, Forchammer H, et al. Effect of nicotine chewing gum in combination with group counseling on the cessation of smoking. The New England Journal of Medicine 1988;318(1):15‐8. - PubMed
Tonnesen 1996 {published data only}
    1. Tonnesen P, Mikkelsen K, Markholst C, Ibsen A, Bendixen M, Pedersen L, et al. Nurse‐conducted smoking cessation with minimal intervention in a lung clinic: a randomized controlled study. European Respiratory Journal 1996;9:2351‐5. - PubMed

Additional references

ALA 1999
    1. American Lung Association. Trends in chronic bronchitis and emphysema: morbidity and mortality. 1999.
ATS 1995
    1. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Journal of Respiratory & Critical Care Medicine 1995;152:S77‐S121. - PubMed
Barnes 2000
    1. Barnes PJ. Medical progress: chronic obstructive pulmonary disease. New England Journal of Medicine 2000;343(4):269‐80. - PubMed
Burrows 1979
    1. Burrows B, Knudson RJ, Cline MG, Lebowitz MD. Quantitative relationships between cigarette smoking and ventilatory function. American Review of Respiratory Disease 1979;115:195‐205. - PubMed
Clark 1999
    1. Clark MA, Hogan JW, Kviz FJ, Prohaska TR. Age and the role of symptomatology in readiness to quit smoking. Addictive Behaviors 1999;24(1):1‐16. - PubMed
Doll 1994
    1. Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years observations on male British doctors. BMJ 1994;309:901‐10. - PMC - PubMed
Dudley 1980
    1. Dudley DL, Glaser EM, Jorgenson BN, et al. Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease. Part I. Psychosocial and psychological considerations. Chest 1980;77:413‐20. - PubMed
Fletcher 1976
    1. Fletcher CM, Peto R, Tinker CM, Speizer FE. The natural history of chronic bronchitis and emphysema. Oxford: Oxford University Press, 1976.
Hatsukami 1999
    1. Hatsukami DK, Mooney ME. Pharmacological and behavioral strategies for smoking cessation. Journal of Clinical Psychology in Medical Settings 1999;6(1):11‐38.
Isoaho 1995
    1. Isoaho R, Keistinen T, Laippala P, et al. Chronic obstructive pulmonary disease and symptoms related to depression in elderly persons. Psychological Reports 1995;76(287‐97). - PubMed
Jimenez‐Ruiz 2001
    1. Jimenez‐Ruiz CA, Masa F, Miravitlles M, Gabriel R, Viejo JL, Villasante C, et al. Smoking Characteristics. Differences in attitudes and dependence between healthy smokers and smokers with COPD. Chest 2001;119(5):1365‐70. - PubMed
Lancaster 2000
    1. Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ 2000;321:355‐8. - PMC - PubMed
Lopez 1998
    1. Lopez AD, Murray CC. The global burden of disease, 1990‐2020. Nature Medicine 1998;4:1241‐3. - PubMed
Pauwels 2001a
    1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI / WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. American Journal of Respiratory & Critical Care Medicine 2001a;163(5):1256‐76. - PubMed
Pauwels 2001b
    1. Pauwels RA, Buist AS, Ma P, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. Respiratory Care 2001b;46(8):798‐825. - PubMed
Sach 1981
    1. Sach K, Hall R, Sachs B. Success of rapid smoking therapy in smokers with pulmonary and coronary heart diseases. American Review of Respiratory Disease 1981;123:111‐6.
Sachs 1984
    1. Sachs D. Treatment of cigarette dependence: what American pulmonary physicians do. American Review of Respiratory Disease 1984;129(1010‐3). - PubMed
Traver 1979
    1. Traver GA, Cline MG, Burrows B. Predictors of mortality in chronic obstructive pulmonary disease. A 15‐year follow‐up study. American Review of Respiratory Disease 1979;119(6):895‐902. - PubMed
US DHHS 2000
    1. U.S. Department of Health and Human Services. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Public Health Service. June 2000.
Van Tulder 2001
    1. Tulder MW van, Ostelo RW, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ. Behavioral treatment for chronic low back pain: A systematic review within the framework of the Cochrane Back Review Group. Spine 2001;26:270‐81. - PubMed
Velicer 1992
    1. Velicer WF, Prochaska JO, Rossi JS, Snow MG. Assessing Outcome in Smoking Cessation Studies. Psychological Bulletin 1992;111(1):23‐41. - PubMed
Verhagen 1998
    1. Verhagen AP, Vet HCW, Bie RA, Kessels AGH, Boers M, Bouter LM, Knipschild PG. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of Clinical Epidemiology 1998;51(12):1235‐41. - PubMed
Walters 2002
    1. Walters N, Coleman T. Comparison of the smoking behaviour and attitudes of smokers who attribute respiratory symptoms to smoking with those who do not. British Journal of General Practice 2002;52(475):132‐4. - PMC - PubMed

Publication types