Improved patient outcome with smoking cessation: when is it too late?

Abstract

Smoking is the leading modifiable risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and lung cancer. Smoking cessation is the only proven way of modifying the natural course of COPD. It is also the most effective way of reducing the risk for myocardial infarction and lung cancer. However, the full benefits of tobacco treatment may not be realized until many years of abstinence. All patients with COPD, regardless of severity, appear to benefit from tobacco treatment. Similarly, patients with recent CVD events also benefit from tobacco treatment. The risk of total mortality and rate of recurrence of lung cancer is substantially lower in smokers who manage to quit smoking following the diagnosis of early stage lung cancer or small cell lung cancer. Together, these data suggest that tobacco treatment is effective both as a primary and a secondary intervention in reducing total morbidity and mortality related to COPD, CVD, and lung cancer. In this paper, we summarize the evidence for tobacco treatment and the methods by which smoking cessation can be promoted in smokers with lung disease.

Keywords: COPD; lung cancer; smoking cessation; tobacco treatment.

Figure 1

The relation of lung function and lung cancer mortality in men according to smoking status in the MRFIT Study. At all FEV₁ values, the risk of lung cancer mortality is higher in smokers than in intermittent smokers/quitters and sustained quitters. In quitters and intermittent smokers, the risk of lung cancer mortality in men rises substantially below FEV₁ of 80% of predicted. Abbreviations: FEV₁, forced expiratory volume in one second; MRFIT, Multiple Risk Factor Intervention Trial.

Figure 2

Effectiveness of various pharmacotherapies in promoting complete smoking cessation at one year of follow-up. Data derived from Beasley. Abbreviation: NRT, nicotine replacement therapy.

Figure 3

Incremental cost-effectiveness ratio of various pharmacotherapies in promoting smoking cessation according to age group of smokers. Data derived from Beasley. The cost-effectiveness ratios of varenicline and bupropion are nearly identical. Abbreviation: QALY, quality adjusted life-years.