Scientific publications

Changes and clinical consequences of smoking cessation in COPD patients: a prospective analysis from the CHAIN cohort

Feb 21, 2018 | Magazine: Chest

Martínez C (1), Casanova C (2), de-Torres JP (3), Marín JM (4), de Lucas P (5), Fuster A (6), Cosío BG (7), Calle M (8), Peces-Barba G (9), Solanes I (10), Agüero R (11), Feu-Collado N (12), Alfageme I (13), Romero Plaza A (14), Balcells E (15), de Diego A (16), Marín Royo M (17), Moreno A (18), Llunel Casanova A (19), Galdiz JB (20), Golpe R (21), Lacárcel Bautista C (22), Cabrera C (23), Marin A (24), Soriano JB (25), Lopez-Campos JL (26); CHAIN study investigators.

(1) Department of Respiratory Medicine Hospital Central de Asturias, Oviedo, Spain.
(2) Department of Respiratory Medicine, Hospital Ntra. Sra. de Candelaria, Tenerife, Spain.
(3) Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
(4) Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
(5) Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain.
(6) Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain.
(7) Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Mallorca, Spain.
(8) Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain. Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Spain.
(9) Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain.
(10) Respiratory Department , Hospital de la Santa Creu y San Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.
(11) Pulmonary Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
(12) Pulmonary Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain.
(13) Pulmonary Department, Hospital Universitario de Valme, Sevilla, Spain.
(14) Pulmonary Department, Hospital de Manacor, Baleares, Spain.
(15) Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Pulmonary Department, Hospital del Mar, Barcelona, Spain.
(16) Pulmonary Department, Hospital Universitario y Politécnico de la Fe, Valencia.
(17) Pulmonary Department, Hospital General de Castellón, Castellón Spain.
(18) Pulmonary Department, Hospital Parc Tauli, Barcelona, Spain.
(19) Pulmonary Department, Hospital de Tarrasa, Tarrasa, Spain.
(20) Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitario de Cruces, Bilbao. Spain.
(21) Pulmonary Department, Hospital General de Calde, Lugo, Spain.
(22) Pulmonary Department, Hospital Ciudad de Jaén, Jaén, Spain.
(23) Pulmonary Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria.
(24) Pulmonary Department, Hospital Universitario German Trias y Pujol, Barcelona, Spain.
(25) Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.
(26) Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.

BACKGROUND:
Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real-life are still low among COPD patients. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of COPD patients.

METHODS:
CHAIN is a Spanish multicenter study carried out at pulmonary clinics including active and former smokers with COPD. Smoking status was certified by clinical history and co-oximetry. Clinical presentation and disease impact were recorded via validated questionnaires, including the London Chest Activity of Daily Living (LCADL) and the Hospital Anxiety and Depression Scale (HADS).

No specific smoking cessation intervention was carried out. Clinical consequences of smoking cessation were analyzed by multivariate regression and decision tree analyses.

RESULTS:
One thousand and eighty-one COPD patients were included (80.8% males, 65.2 (SD 8.9) years of age, FEV1 60.2 (20.5)%). During the two-year follow-up time (visit 2: 906 patients; visit 3: 791 patients), the majority of patients maintained the same smoking habit.

Decision tree analysis detected chronic expectoration as the most relevant variable to identify persistent quitters, followed by a LCADL questionnaire score > 9. Total anxiety HADS score being the most relevant clinical impact associated with giving tobacco up, followed by LCADL questionnaire with a cut-off value of 10 points.

CONCLUSIONS:
In this real-life prospective COPD cohort with no specific anti-smoking intervention, the majority of patients did not change their smoking status. Our study also identifies baseline expectoration, anxiety and dyspnea with daily activities, as the major determinants of smoking status in COPD.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01122758.

CITATION  Chest. 2018 Feb 21. pii: S0012-3692(18)30265-4. doi: 10.1016/j.chest.2018.02.007

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