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