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Smoking reduction and the rate of decline in FEV₁: results from the Lung Health Study

¹ David Geffen School of Medicine, University of California (UCLA), and ³ Los Angeles Clinical Trials, Los Angeles, CA, ² Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, and ⁵ Oregon Health Sciences University, Portland, OR, USA. ⁴ Dept of Community Health Sciences, University of Manitoba, Winnipeg, Canada

CORRESPONDENCE: M. S. Simmons, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA. Fax: 1 3102065088. E-mail: msimm@ucla.edu

Keywords: Forced expiratory volume in one second, smoking cessation, smoking reduction

Received: July 23, 2004
Accepted February 22, 2005

Previous findings from the Lung Health Study have shown that smoking cessation and sustained abstinence substantially reduce the rate of decline in forced expiratory volume (FEV₁) among smokers with early chronic obstructive pulmonary disease (COPD) when compared with continuing smoking. Intermittent quitters demonstrated rates of FEV₁ decline intermediate between those of sustained quitters and continuing smokers.

In this study, data from 1,980 participants were analysed from 10 centres of the Lung Health Study in the USA and Canada. All participants were smokers with mild-to-moderate COPD who were unable to quit smoking at any time during the 1st yr of the study.

No linear relationship was found between reduction in cigarettes per day and changes in FEV₁ during the 1st yr of the study. However, examination of the data revealed that this relationship was nonlinear. Further analysis found that smokers who reduced their cigarettes per day to very low amounts had smaller declines in FEV₁ than those who did not. Reduction in cigarettes per day was associated with only minimal changes in the presence of chronic respiratory symptoms.

In conclusion, compensatory changes in smoking behaviour may account for the limited and unpredictable impact of smoking reduction on lung function decline and symptom prevalence when compared with smoking cessation.

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