aDepartment of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, SpainbDepartment of Respiratory Medicine, Hospital Universitario Nuestra Señora de Candelaria/Universidad de La Laguna, Tenerife, SpaincDepartment of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, SpaindDepartment of Respiratory Medicine, Hospital Universitario Miguel Servet-IISAragon, Zaragoza, SpaineCentro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, SpainfDepartment of Respiratory Medicine, Hospital Gregorio Marañon, Fundación de Investigación Biomédica Gregorio Marañón, Madrid, SpaingDepartment of Respiratory Medicine, Hospital Son Llàtzer, Palma de Mallorca, SpainhDepartment of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa-CIBERES, Palma de Mallorca, SpainiDepartment of Respiratory Medicine, Hospital Clínico San Carlos, Madrid, SpainjDepartment of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, SpainkDepartment of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, Madrid, SpainlRespiratory Department, Hospital de la Santa Creu y San Pau, Universidad Autónoma de Barcelona, Barcelona, SpainmPulmonary Department, Hospital Universitario Marqués de Valdecilla, Santander, SpainnPulmonary Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, SpainoPulmonary Department, Hospital Universitario de Valme/Universidad de Sevilla, Seville, SpainpPulmonary Department, Hospital de Manacor, Manacor, Islas Baleares, SpainqPulmonary Department, Hospital del Mar, Barcelona, SpainrPulmonary Department, Hospital Universitario y Politécnico de la Fe, Valencia, SpainsPulmonary Department, Hospital General de Castellón, Castellón, SpaintPulmonary Department, Hospital Parc Taulí, Barcelona, SpainuPulmonary Department, Hospital de Tarrasa, Tarrasa, SpainvPulmonary Department, Hospital Universitario de Cruces, Bilbao, SpainwPulmonary Department, Hospital Universitario Lucus Augusti, Lugo, SpainxPulmonary Department, Hospital Ciudad de Jaén, Jaén, SpainyPulmonary Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, SpainzPulmonary Department, Hospital Universitario German Trias y Pujol, Barcelona, SpainaaInstituto de Investigación, Hospital Universitario de la Princesa (Instituto de Investigación Sanitaria del Hospital de la Princesa), Universidad Autónoma de Madrid, Madrid, SpainbbUnidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS)/ CIBERES, Seville, Spain
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BackgroundDespite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real life are still low among patients with COPD. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of patients with COPD.MethodsCHAIN (COPD History Assessment in Spain) 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. Factors associated with and clinical consequences of smoking cessation were analyzed by multivariate regression and decision tree analyses.ResultsOne thousand and eighty-one patients with COPD were included (male, 80.8%; age, 65.2 [SD 8.9] years; FEV1, 60.2 [20.5]%). During the 2-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 in the future, followed by an LCADL questionnaire (cutoff 9 points). Total anxiety HADS score was the most relevant clinical impact associated with giving up tobacco, followed by the LCADL questionnaire with a cutoff value of 10 points.ConclusionsIn this real-life prospective COPD cohort with no specific antismoking 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.Trial RegistryClinicalTrials.gov; No. NCT01122758; URL: www.clinicaltrials.gov.