- 5 COPD Myths That Can Actually Make You Sicker
- Myth 2: It’s Too Late for Me to Quit Smoking
- Myth 3: COPD Is the Same Thing as Asthma
- Myth 4: People With COPD Shouldn’t Exercise
- Myth 5: If I Have to Go on Oxygen, It Means I’m Dying
- Social Security Disability Claims for COPD
- Getting Disability Benefits for COPD
- Having Multiple Medical Problems
- Which Smokers Have Highest Risk Of COPD?
- Quitting Smoking as a COPD Treatment
- Smoking and COPD: what really are the risks?
- Why do smokers diagnosed with COPD not quit smoking? – a qualitative study
- Theme 1. Life is governed by a long smoking history that is difficult to break
- Theme 2. Being aware and enlightened and having a need for autonomy
- Which Smokers Develop COPD?
5 COPD Myths That Can Actually Make You Sicker
Myth 2: It’s Too Late for Me to Quit Smoking
Adams hears many COPD patients say that it won’t do them any good to quit smoking since their lungs are already too damaged. “That’s absolutely false,” she says. Quitting smoking is the most important thing you can do to live better with COPD. If you have COPD and you’re still smoking, you’re not giving your treatments a chance to work. “The fact is, smoking makes COPD worse, but quitting prolongs life and delays the decline in lung function that occurs in those who continue to use cigarettes,” furthers Nicola Hanania, MD, an associate professor in the pulmonary, critical care, and sleep medicine departments at Baylor College of Medicine in Houston.
You will never be able to undo the damage you’ve done to your lungs; but if you have COPD and smoke, you won’t be able to slow the progression of your disease, and you will find it harder to breathe. If you have COPD and quit smoking, you will feel better almost immediately. According to research published in the International Journal of Chronic Obstructive Pulmonary Disease, sustained quitters had a 42 percent lower total mortality rate than those with COPD who continued to smoke.
While smoking is the most common cause of COPD, environmental factors may also contribute, explains John Carl, MD, a pulmonologist at Cleveland Clinic Center for Pediatric Pulmonary Medicine in Ohio. “And the reason some smokers never develop COPD and some never-smokers get the condition is not fully understood, but genetic factors probably play a role in who develops it,” he adds.
Myth 3: COPD Is the Same Thing as Asthma
While both are inflammatory conditions that cause coughing and wheezing, asthma and COPD are very different diseases, Adams says. About 15 percent of people can have both asthma and COPD, she notes. Dr. Carl agrees. “It’s not uncommon for people with COPD to also have some degree of asthma. While asthma can develop at any age, most people get asthma as children or teens. COPD develops slowly over time, and most people are 40 or older when symptoms become noticeable.
Asthma can flare if you’re exposed to allergens such as dust, pollen, or pet dander, but you can be symptom-free between episodes. People with COPD experience flares or exacerbations when they get a cold or an upper respiratory infection or are exposed to smoke or other lung irritants. Asthma is treated with long-term medications to reduce airway inflammation and quick-relief or “rescue” bronchodilators, as needed, for symptoms such as wheezing. “COPD patients need to be on long-lasting inhalers as opposed to rescue medications,” Adams says. “Along with bronchodilators to widen the airways, some with COPD patients may benefit from anti-inflammatory drugs, such as steroids or anticholinergic agents to decrease mucus secretion and antibiotics to treat interval infections,” adds Carl.
RELATED: Your Breathe-Better Checklist for COPD Flares
Myth 4: People With COPD Shouldn’t Exercise
Many people with COPD are afraid to exercise for fear it is unsafe and will make them short of breath. The fact is that people with COPD need to exercise, explains Kathrin Nicolacakis, MD, a pulmonologist at the Cleveland Clinic. “Exercise is important when you have COPD because it decreases your chances of having infections and being admitted to the hospital,” she says. Exercise doesn’t drain your energy. Rather, it energizes you and helps you feel less tired. Talk to your COPD doctor about appropriate exercises and breathing techniques in pulmonary rehabilitation, and maintain that level of exercise going forward, Dr. Nicolacakis says. “Activity and exercise are encouraged in patients with COPD and formal programs, sometimes with the aid of oxygen, may benefit those with severe disease,” notes Dr. Hanania. “Walking in particular is strongly encouraged, but stretching the upper and lower extremities is another type of exercise that can be helpful,” he adds.
RELATED: 10 Habits That Can Worsen COPD
Myth 5: If I Have to Go on Oxygen, It Means I’m Dying
People with COPD often fear oxygen therapy, but “many patients can live 10 years or more with oxygen,” Nicolacakis says. COPD patients need oxygen when the oxygen level in their blood is low. Low oxygen can strain your heart, cause blood clots to form, and harm your brain. When you go on oxygen therapy, you will feel less tired and healthier, and you’ll have that out-of-breath feeling less often. If you need oxygen therapy, know that it can help you manage your COPD and live longer.
Additional reporting by Jennifer Geddes.
Social Security Disability Claims for COPD
Chronic obstructive pulmonary disease, or COPD, is a general term for several lung diseases, mainly chronic bronchitis and emphysema. These diseases are characterized by obstructed airflow through the airways in and out of the lungs. Both cause excessive inflammatory processes that eventually lead to abnormalities in lung structure and limited airflow. Both are progressive conditions that worsen over time.
The primary cause of COPD is cigarette smoking. A small percentage of COPD sufferers have alpha-1-antitrypsin (AAT) deficiency, also called familial emphysema. Air pollution and occupational dusts may also contribute to COPD, especially if the person exposed to these substances is a smoker. In addition, a recent study shows that adults with asthma are 12 times more likely to develop COPD than those who do not have the condition.
COPD symptoms include shortness of breath, wheezing, and coughing. In addition, COPD adds to the work of the heart, and can cause pulmonary heart disease, or “cor pulmonale.” Treatment for COPD can include oxygen therapy, pulmonary rehabilitation, and various medications. The only known successful cure for emphysema is a lung transplant, but very few patients with emphysema are healthy enough to survive the surgery. (For those patients who do receive a lung transplant, Social Security disability benefits are automatically granted for a period of three years.)
Getting Disability Benefits for COPD
The Social Security Administration (SSA) has a disability “listing” laying out the requirements for getting automatically approved for disability for various chronic respiratory disorders, including COPD. If you meet the requirements of this listing, you automatically qualify for benefits. If your condition isn’t severe enough to meet the requirements of the official listing, you may still be able to prove that your COPD reduces your capacity to breathe and exert yourself so much that you can’t work at any type of job.
Disability Listing for COPD
To qualify for benefits, you must first be diagnosed with chronic obstructive pulmonary disease. In addition, a lung function test performed by a consulting doctor hired by the SSA must show very limited airflow. Specifically, the SSA wants to see results from one of the following tests:
- a spirometry test documenting your FEV1 value (your forced expiratory volume in one second, meaning the amount of air you can exhale in one second) or (FVC) forced vital capacity
- a DLCO test (which measures how much oxygen passes into the blood)
- an ABG test (which measures the partial pressure of oxygen, PaO2, and carbon dioxide, PaCO2, in the blood), or
- an oxygen saturation test (SpO2).
The SSA’s listing for chronic pulmonary insufficiency includes several tables based on gender, age, and height that state the lung function value for the various tests that’s necessary to meet the standard of disability; the values used represent a severe obstruction in breathing. For instance, Table I-A in the listing states that a man under 20 years old who is 6 feet tall meets the requirements of the listing if he has an FEV1 of 2.10 or below. Table 1-B states that a woman over 20 who is 5’4″ meets the requirements if she has an FEV1 of 1.25 or below.
Alternatively, if you have had at least three hospitalizations due to exacerbations or complications of your COPD in the last year, each lasting at least 48 hours and occurring at least 30 days apart, you will be approved for disability.
Reduced Capacity for Work
If your breathing test results are higher than the above listing requirements, you might still be able to qualify for disability benefits if you can show that your COPD has reduced your breathing capacity to such an extent that there are no jobs you can do, or at least no jobs that you know how to do or can learn to do, given your age, education, and experience.
To show that your breathing capacity and ability to exert yourself are so low that you can’t work, you should ask your doctor to send the SSA a medical opinion on what kinds of activities you can and cannot do (such as lifting no more than 20 pounds, walking no more than one hour at a time, and no exposure to dust or fumes). The SSA will use your medical records to give you a residual functional capacity (RFC) assessment stating the type of work you can do (sedentary work, light work, medium work, or heavy work) based on your breathing test results and your doctors’ restrictions.
If your FEV1 value is almost as low as what’s required for the official disability listing, above, you should be assigned a sedentary RFC, meaning that you can only do a desk job. But if the SSA determines that you can’t do a desk job given your experience, your education, and your age (the older you are, the less likely it is that Social Security expects you to learn a new job), you’ll be approved for disability benefits. For more information, see our section on how Social Security decides if you can work.
Having Multiple Medical Problems
The vast majority of patients with COPD have other serious medical problems as well. Many people with COPD suffer from coronary artery disease, high blood pressure, diabetes, and/or obesity, as well as mental issues such as depression. When you have multiple medical conditions that affect your ability to work, you have a better chance of getting benefits. For more information, see our article on combining medical impairments to get disability and how moderate depression or anxiety affects your disability claim.
Which Smokers Have Highest Risk Of COPD?
Researchers at Weill Cornell Medical College were awarded a $6.5 million grant from the National Heart, Lung, and Blood Institute to conduct a 5-year long research project into metabolic changes that occur in the lungs epithelial cells’ in patients with chronic obstructive pulmonary disease (COPD) patients due to cigarette smoking. The team will also aim to investigate which cigarette smokers have the highest risk of developing COPD and try to identify new biomarkers that will be of benefit in developing new therapies for the disease.
Even though smoking is a major cause of disease, such as COPD, and is the fourth highest cause of mortality, one-fifth of the adult population still continue to smoke, and with each inhalation, the lungs are burdened with a hundred trillion oxidants and over 4,000 chemical compounds. There is still no cure for COPD, and no biomarkers that can diagnose the disease early. The only treatment available for those suffering from COPD is oxygen therapy.
Leading researcher, Dr. Ronald G. Crystal, chairman of genetic medicine at Weill Cornell Medical College, declares:
“Twenty percent of smokers get COPD, so it is vital that we identify who is at the highest risk and why. Gaining a better understanding of COPD’s underlying biology and the metabolic changes forced by cigarette smoke to airway epithelial cells will help us effectively deal with this major health problem. We can use this information to develop new ways to protect the lungs.”
Patients that developed COPD due to smoking are often short of breath and the severe narrowing of the airways within the lung results in loss of lung function. COPD is also linked to the progression of “ciliopathy.”
Most epithelial cells in the lung’s airway consist of cilia, i.e. important cells to maintain a healthy lung, which are vital in transporting mucus and any inhaled pathogens like bacteria, up the airway and out of the lungs to prevent infection. Ciliopathy is a cellular dysfunction within the airway epithelial cells, which leads to mucus accumulation, shortened cilia cells, and impaired defenses against infection.
Co-principal researcher, Dr. Steven S. Gross, professor of pharmacology and director of the Mass Spectrometry Facility at Weill Cornell explains:
“Ciliopathy occurs long before there are any clinical signs of smoking-induced COPD. However, the underlying genesis of smoking-induced airway ciliopathy is unknown. The goal of our study is to fill this knowledge gap and identify what exactly drives ciliopathy in smokers with COPD.”
According to the researchers, hypothesis ciliopathy is associated with oxidant stress that smoking deposits on airway epithelium cells and smoking-induced COPD is linked to a changed metabolism in lung tissue and serum. They believe that profiling metabolites in COPD patients’ biofluids will offer a better understanding of the underlying molecular mechanisms of developing ciliopathy as well as COPD’s pathogenics.
Dr. Crystal says: “A biomarker for COPD would be useful to identify smokers that will develop COPD. Success of this study would be a major step in developing new approaches for the screening and treatment of COPD patients.”
For their new research project, the team will for the first time use metabolomics to broadly identify, examine and profile abnormal variations in cell metabolism and metabolites for COPD in the airway of epithelial lung cells. They will examine thousands of small molecules, measuring changes in metabolite expression by using the most advanced technology based on mass spectrometry to help in global metabolite profiling COPD patients’ lung serum and tissue samples. Cell metabolism is various chemical reactions that occur within the cell, whilst metabolites are their small molecule products, which are involved all aspects of cellular function.
Dr. Gross states: “The use of metabolomics is a powerful new approach to discover how airway epithelial cells are disturbed by smoking and how this may lead to COPD. Global metabolite profiling represents an untapped route for defining which biochemical pathways are specifically altered in smokers with COPD.”
The researchers will also combine metabolic profiling with in vitro studies of human subjects and murine airway epithelium. In the study they will analyze serum, lung epithelial lining fluid and airway epithelium samples from human research subjects, as well as an extensive cohort of banked human clinical trial samples and compare these to different types of populations, including smokers, non-smokers, smokers with and without COPD smokers and smokers with COPD who stopped smoking.
Written by Petra Rattue
As twists of fate go, this one is particularly twisted. It was announced over the weekend that Allen Carr, who gave up his 100-a-day habit 23 years ago and became one of the world’s best-known anti-smoking campaigners, has been diagnosed with lung cancer. “This has come as a shock but I remain very upbeat,” the 73-year-old told a Sunday newspaper. Those who hope that quitting smoking will mean they avoid such diseases will probably not be feeling quite so defiant: they will want to know whether there is any point giving up at all.
The link between lung cancer and smoking was first made by Richard Doll in the British Medical Journal; on June 26 1954, he launched a 50-year study, funded by the Medical Research Council, Cancer Research UK and the British Heart Foundation, of exactly how many years smokers were lopping off their lives. On June 26 2004, he announced that it was, on average, 10. However, he also discovered that quitting at age 50 – the age Carr was when he stopped – nearly halves that. Stopping at ages 60, 50, 40 or 30 gains, respectively, about three, six, nine or 10 years of life expectancy.
“It’s obviously very sad that Allen Carr has now got lung cancer,” says Amanda Sandford, research manager at Action on Smoking and Health (Ash), “but if he hadn’t quit, he would probably have died years ago. He has certainly extended his life.”
But it’s not just a question of staying alive – quality of life is also a factor.
“It’s not just about death,” says Professor Robert West, director of tobacco studies at Cancer Research UK, “because obviously we’ve all got to die sometime. It’s about disability. The reason people should stop smoking is not to stop them dying, but to stop them living a horrible, disabled life.”
Smoking, like any addiction, consists in large part of the triumph of hope over observable fact. For example, it is comforting to believe that when you finally quit, the body will heal itself; a popular belief is that, by a certain length of time after quitting – five years, say – your lungs will be back to normal. Unfortunately, that is not the case. “When you stop smoking, your lung cancer risk does not go down,” says West. “What happens is that it stops going up. It’s like a sort of escalator of death – you want to try and get off on the lowest floor possible.”
As well as writing Allen Carr’s Easy Way to Stop Smoking, which has been published in 45 countries, the give-it-up guru has established Easyway clinics in over 30 countries. His business partner, John Dicey, said at the weekend that Carr had “spent many years in smoke-filled rooms delivering his method to smokers; it is part of the clinic process that people actually smoke while there. He is not drawing any conclusions, but Allen feels that if that did contribute, it is a price worth paying, as we estimate he has cured around 10m smokers.”
West is unconvinced. “It’s more likely that he got it from his own smoking than from passive exposure.” Carr was a very heavy smoker, for a long time, he points out. “Lung cancer is a multi-stage disease – it doesn’t require just one event, but a succession of events eventually to become malignant and break through the body’s immune system,” he explains. “It’s entirely possible that he sowed the seeds of this in early to middle age because if you stop at 50, you carry with you a greatly increased risk of lung cancer until the day you die.”
The other major smoking-related killer is chronic obstructive pulmonary disease (COPD), a progressive, degenerative condition which eventually results in an inability to breathe; emphysema is a subset, as it were, of COPD. In emphysema, the alveolar sacs which surround the alveoli merge into each other; they lose their elasticity and breathing in becomes more and more difficult. People don’t often realise how affected they are – 80% of COPD goes undiagnosed. Sufferers simply assume that they are a little breathless, which comes with age, or perhaps lack of exercise – and don’t do anything about it. In fact, they are probably on a steep decline. By the time a smoker reaches 60, they can have a similar lung function to someone who has had asthma since childhood. Giving up smoking may halt that downward trend, but it can’t reverse it.
“You never recover the lung function you have lost,” says West.
After about 35, lung capacity and lung health decline anyway, so if they are already damaged, the decline is simply faster. “People shouldn’t be fooled into thinking that they can smoke for years and then, by stopping, remove all risk of smoking-related disease,” says Sandford. “There will always be some residual risk.”
It is true that not all smoking-related damage is irreversible. The risk of coronary heart disease drops by 50% in the first year after quitting smoking. Skin health improves surprisingly fast.
“It is extraordinary how resilient the body is,” says West. “It can put up with this insult day after day, year after year, and it forgives you – until about the age of 35. After that, the clock is ticking, quite quickly. It’s much more urgent than people realise.”
All warn, however, that none of this counts as a reason not to stop smoking, and to do it as soon as possible. “No matter how long you’ve smoked,” says Sandford, “it’s always worth quitting”.
The gurus who failed to fix themselves
As Scott Ian, lead guitarist of the thrash metal band Anthrax, said, after stocking up on antidote during the 2001 anthrax-in-the-mail scare: “I will not die an ironic death.” And who would? You want your death to provoke weeping in the streets, not wry chuckles.
One of life’s more grimly enjoyable ironies is the misfortune that rebukes the principles of a life devoted to some form of self-improvement – particularly if those principles have been sold to consumers at considerable profit. Schadenfreude is not one of humanity’s more appealing traits, but for those who feel preached at by faddists, some feeling of poetic justice is hard to resist whenever a lifestyle guru turns out to be fallible.
The example of Robert Coleman Atkins comes to mind. Dr Atkins, the man responsible for halitosis across six continents, had, on April 18 2002, eaten a carb-free, high-protein, Atkins-diet breakfast as usual, before his morning routine was interrupted by a sudden, non-fatal heart attack. A year later, after he slipped on an icy New York pavement, fell into a coma and died, medical records confirmed that he was suffering from heart disease.
And what was God trying to tell us with the fate of Jim Fixx, author of the Complete Book of Running, which sold more than 1m copies in the 1970s? It rapidly stopped selling when the 52-year-old New Yorker died while out jogging in 1984. Or of Euell Gibbons, who became famous in the US in the 1960s for his series of books about healthy eating (including Stalking the Healthful Herb)? Despite never knowingly ingesting a single toxin, Gibbons ascended to the Ironic Death Hall of Fame at the age of 64 by dying of a heart attack.
Another health champion floored by a bad heart was Jerome “JI” Rodale. An early evangelist for organic farming in the US, Rodale founded a successful publishing empire on a range of health food books and Prevention magazine, which advised readers on nutritious eating. Appearing on the Dick Cavett Show in 1971, he boasted to the audience about how healthy he was, before slumping in his chair and appearing to go to sleep. “Are we boring you, Mr Rodale?” bantered the host. Having died of a heart attack, Rodale declined to reply. The show was never aired.
Demonstrating closer to home that conviction in one’s lifestyle plan confers no immunity is Carole Caplin’s mother, Sylvia. Caplin senior, herself a health guru, has none the less suffered endless problems with her health including a chest infection, diseased colon and the removal of half her bladder. But the fact that she is still gamely in business after all that might serve to advertise, rather than diminish, her skills.
Quitting Smoking as a COPD Treatment
According to statistics reported by the CDC for 2015, nearly 7 out of 10 adult smokers in the United States wanted to quit. Many have difficulty actually kicking the habit. However, several strategies are available to help you quit for good.
Healthcare provider intervention
This isn’t the classic kind of intervention, where your loved ones plead with you to quit. A healthcare provider intervention is a brief, more casual conversation with your nurse or doctor. They calmly explain how smoking interacts with your current health problems to lower your quality of life. They also explain how smoking puts you at risk of life threatening complications.
People who’ve had this type of interaction have a small but significant advantage when it comes to quitting smoking. If you want to quit, ask your doctor about the benefits of stopping smoking and the risks of continuing. Learning the facts may give you the motivation you need to become tobacco-free.
Group counseling gives you the best of both worlds. You can listen to experienced speakers who offer advice and techniques for quitting and managing relapses. You can also take advantage of the group setting to give and receive support from others who are in your shoes. Seeing others in your group stop smoking successfully can help strengthen your own resolve.
If group counseling doesn’t appeal to you, ask your doctor about one-on-one counseling options. The CDC offers free help in the form of a helpline (800-QUIT-NOW, or 800-784-8669) and an online guide.
The most popular kind of medication regimens for people who want to stop smoking are nicotine replacement therapies. Nicotine replacement therapies can help you manage your withdrawal symptoms and control your cravings. You can get nicotine replacement from chewing gum, patches that adhere to your skin, lozenges, and even sprays.
If the replacement therapy isn’t helping as much as you’d like, you might want to talk to your doctor about adding an antidepressant. This type of combined therapy has been shown to help some people quit.
Some people are able to put the cigarettes down and walk away without any medications or support groups. This suggests the cold turkey approach can work, but you have a better chance of succeeding if you know what you’re getting yourself into.
Whether you use counseling or medications or try to quit cold turkey, these tips can help:
- Set a “quit date” and stick to it.
- Avoid stressful situations or situations that lead to cravings.
- Expect withdrawal symptoms, such as anxiety, irritability, depression, and food cravings. Plan in advance how you will handle the symptoms, and remember they won’t last forever.
- Make a list of the things you want from life. It’s not enough to simply stop a behavior. For lasting change to occur, it’s important to replace the negative behavior with a healthier one.
- Seek support from friends and family. Turn to them when you feel close to relapse.
- Surround yourself with people you trust and who will give you support. Support others who are trying to quit.
Smoking and COPD: what really are the risks?
To the Editors:
Chronic obstructive pulmonary disease (COPD) is rapidly becoming a global public health crisis, with around three million people predicted to die from the disease in 2006 1, 2. There is growing awareness of the increasing global burden of COPD not only in terms of mortality, but also its prevalence, morbidity and economic costs 2. In response to these concerns, there has been a renewed research effort to understand the causes of COPD and to develop public health and pharmacological interventions that may reduce the burden.
Smoking is recognised as the most important causative factor for COPD, with an individual’s susceptibility being a continuous, rather than a categorical characteristic that can interact synergistically with other risk factors. There is now evidence that most smokers develop some respiratory impairment due to COPD 3. One of the most informative recent studies addressing this issue is the Obstructive Lung Disease in North Sweden (OLIN) study 4. From this cohort study, it was reported that ∼50% of smokers eventually develop COPD, as defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2. This finding is of major clinical significance, in that it provides a scientific basis for the advice that can now be given to smokers that if they continue smoking lifelong, they have at least a one in two chance of developing COPD. Importantly, the study also provides evidence that the risk of developing COPD falls by about half with smoking cessation.
The OLIN study also allowed determination of the proportion of COPD cases that is due to smoking 4. Utilising the GOLD criteria for the diagnosis of COPD, the population attributable risk of COPD for smoking was 45% (95% confidence interval (CI) 29–58%) in the 46–77-yr age group. Utilising the British Thoracic Society criteria 5, which are considerably more stringent than the GOLD criteria for the diagnosis of COPD, the population attributable risk was 50% (95% CI 28–67%). This population attributable risk is considerably less than current dogma suggests, with a figure of 80–90% commonly quoted 6–8. A comparable population attributable risk of 44% (95% CI 38–50%) can be calculated from the third National Health and Nutrition Examination Survey (NHANES III) 9. However, this figure is qualified by the lack of post-bronchodilator lung function measurements in the NHANES III, which means that the COPD criteria employed were more inclusive of cases with asthma.
If only about half of all cases of COPD are due to smoking, what factors are responsible for the other half and what can be done to reduce their impact? It is not widely recognised that up to 20% of cases of COPD worldwide can be attributed to indoor air pollution from exposure to smoke from cooking and heating with biomass fuels in poorly ventilated dwellings 10, 11. This is likely to explain the similar prevalence of COPD in females and males in developing countries, despite markedly lower rates of smoking in females 2. Greater recognition of the role of indoor air pollution is a necessary prerequisite for the development of strategies to lessen its impact, and to reduce the occurrence of COPD.
A comparable example, which is amenable to public health and government interventions, is workplace exposure to a wide variety of dusts, chemicals and fumes. Given that up to 20% of cases of COPD may be attributed to occupational exposures 12, the potential benefit of preventive measures are apparent. As with indoor air pollution, the greatest burden of COPD due to occupational exposures is in the developing world. Other risk factors that could potentially be modified at an individual or population level are outdoor air pollution, marijuana smoking, chronic respiratory infection, diet, childhood asthma and factors associated with lung growth in utero and infancy.
We suggest that a greater understanding of the causation of chronic obstructive pulmonary disease is a research priority to provide the basis for the development of primary and secondary intervention programmes. This recommendation does not lessen the significance of tobacco smoking as the most important cause of chronic obstructive pulmonary disease, or the public health importance of measures to reduce tobacco consumption internationally. Smoking remains an important cause of global mortality, being accountable for around five million premature deaths in the world every year, including about one million due to chronic obstructive pulmonary disease 13.
Why do smokers diagnosed with COPD not quit smoking? – a qualitative study
The interview text was analyzed using qualitative content analysis and resulted in two themes and five categories (Table2). Quotations from the participants are integrated in the text below in order to emphasize the content.
Table 2 Results of qualitative content analyses presented as themes and categories
Theme 1. Life is governed by a long smoking history that is difficult to break
This theme describes the difficulty of breaking a habitual behavior. Different circumstances and habits affected the participants’ ability to find an appropriate time to stop smoking. Smoking was associated with specific events and feelings that gave positive as well as negative experiences, which made it even more difficult to quit smoking.
Breaking a lifelong pattern is very difficult
The participants had begun smoking when they were 12 to 13 years old. Most of them saw a connection between smoking and their life patterns. Smoking was perceived to give pleasure which was strongly associated with specific situations, such as smoking during meals, and coffee or alcohol intake. Such pleasure was a positive experience in their life, and it was an very difficult habit to break. Some of the participants described that smoking was a reward in life, for instance, after hard work. Half of the participants described that the cigarette was a companion and dear friend, even best friend, and a part of their community. The habit of holding something between the fingers made them light a cigarette even though there was no craving to smoke.
“It’s in the morning with coffee… the first two cigarettes… That’s great.”
It is never the right time in life to stop
The participants described incidents in their lives as reasons for never finding the time to focus on smoking cessation. Their hectic everyday life led to continued smoking, although smoking was not always something they longed to do. Some participants felt that the cigarette was comforting and suppressed worries. Other participants felt that the stress associated with the illness or death of a relative justified that they could not stop smoking, and so the occasion to quit was postponed.
“First my sister-in-law died, four weeks later my husband died, and four months later my dad died.”
Although the participants realized the benefits of quitting smoking, they expected life without smoking to be ascetic. The participants had often thought about giving up smoking but always as something to be done in the future; now is not the right time.
“we discuss, my brother, my sister and her daughter to agree on a date when we must … but all slip on that … on date … we’ll see.”
Some of the participants had stopped smoking but had experienced weight gain, which led them to start smoking again.
“Yes, I’m just saying if I would not put on extra weight then I would certainly make an effort to try to quit, but it’s the weight I’m afraid of.”
Other reasons that were given for not quitting were the risks of dizziness, hypotension, or depression.
Plans to stop do not lead to results
Several of the participants expressed that the reason why it was impossible to quit smoking was “all in the brain.” They had a hard time explaining what they really meant by this, one participant said:
“Perhaps one has to get lobotomized … it is in the brain.’
Some of the participants seemed to have control over most things in their life, except smoking. They considered their being addicted to the cigarette as a scourge, which led to their plans to stop smoking never becoming realized. The participants realized that it was necessary to have the motivation to quit smoking, but such motivation was missing, and their plans to quit did not lead to any results.
“I would like to have a verdict … if you don’t stop smoking, you will die now or in a year … a slap in the face.”
Having close relatives with poor lung capacity and the knowledge that smoking is connected with high costs, impaired physical condition, or even death increased their motivation to quit, but even these were not enough. Half of the participants had decreased their smoking but had not been able to stop completely.
“So I have smoked, perhaps twenty cigarettes a day earlier and now maybe four … so I’ve reduced it over a long time, so to speak.”
Some of them believed that it is easy to refrain from smoking when being in specific environments, doing specific chores, or in areas where smoking is forbidden. It was important to remove distractions, to be in control, and to have peace and quiet. Furthermore, while there were positive factors that contributed to a smoking cessation plan, such as if nobody was smoking in their environment, if cigarettes were not available, various activities, travel, and exercise, plans to quit entirely were never accomplished.
“One day, I will make the decision … but it has been that way for many years … in terms of reasoning, and darn it …I am still smoking.”
Theme 2. Being aware and enlightened and having a need for autonomy
This theme describes an awareness of the risks of smoking and the consequences of COPD. It was difficult to deal with the surrounding demands of smoking cessation since the decisions had to be taken independently in order to keep their autonomy. Support should be given after the individual has made his or her own decision.
Being aware of the consequences of continued smoking
The participants were aware of the consequences of continued smoking and had knowledge of COPD. They knew that people with the disease never regained their health but that the progression of the disease halted after smoking cessation. The annual lung function test performed within their participation in the OLIN studies showed the extent of the disease. For some participants, it was a good help to start thinking about quitting, while others felt that it was not important. For a number of participants, the lung function test showed beyond all doubt that they needed to make the decision to quit smoking.
“To get information about lung function impairment … that’s when one got the feeling … now I really have to fix it.”
“My father-in-law has lung cancer and is dying, and my mom had COPD and had no good days at the end of her life … so I know what it’s like … for no use.”
To receive help and support without being patronized
Some participants wanted help in the same way that alcoholics were given help, such as through a twelve-step program. Other participants said that support was needed after setbacks.
“That one would get support because there will be a big downfall and especially if there is any adversity that I run into…then you feel like… No, I do not give a damn.”
The best support was found among relatives. It was easier to be open and talk to their loved ones because of the close relation. Several of the participants felt that it would be easier to quit smoking if their smoking relatives also thought about quitting.
“I probably have the best support among my friends … I think so anyhow.”
The participants wanted help and support, but they did not want to be patronized. The participants experienced demands about smoking cessation, in some cases daily, from spouses, family, friends, employers, and physicians. Nagging from people in their environment could lead to continued smoking or get them started again after smoking cessation.
“When they say…shouldn’t you stop smoking?… never… just because they say so…one thinks never.”
Quitting smoking was a personal choice, and therefore it was the person who decided when or if smoking cessation would happen. Some of the participants experienced having people in their environment who were ignorant of their situation. Telling someone about their situation could result in experiencing pressure to quit, so the participants had not informed anyone about quitting smoking.
“Then I think to myself … this is none of your business … it’s my own choice.”
Participants described that while smoking was previously fully accepted and considered fashionable, nowadays it is no longer so. In fact, smoking can be considered as a weakness, and being a smoker can be regarded as bad as being an alcoholic. Smoking was considered shameful since the act is prohibited in public places in Sweden.
“That in recent years I have felt myself being chased by a blowtorch,and the kids think we are totally worthless because we smoke.”
Almost all the participants had tried smoking cessation drugs of various kinds. Their experiences with treatments were both positive and negative. Several of the participants said they had experienced side effects that made them cancel the treatment.
“I’ve tried to use plasters … and then I felt … that I became dizzy … dizzy.”
Some participants used snus (Swedish moist ground tobacco placed under the upper lip) as a substitute for cigarettes. Several participants had experienced temporary help from drugs. Some had been involved in smoking cessation groups at the medical center, but they did not think that group meetings were helpful because all the participants in the group had not decided to quit smoking. Furthermore, one participant who had attempted smoking cessation said that it was easier to refrain from smoking as long as he was involved in the weaning group. In earlier attempts to quit, several participants had not used any aids. Almost all the participants were critical of the information and support they had gotten from health care professionals.
Which Smokers Develop COPD?
Background: Overall, lifelong smokers die about 10 years earlier than comparable non-smokers, and at least one fourth of the excess mortality is caused by chronic obstructive pulmonary disease (COPD) and lung cancer. About 10 to 15 percent of smokers develop COPD, but the optimal strategy to identify those most at risk is unknown. Geijer and colleagues conducted a prospective cohort study of men living in a small Dutch town to better understand the rate of progression to COPD and the factors that influence this change in smokers.
The Study: In 1998, baseline spirometry was performed on 702 male smokers 40 to 65 years of age who had no known lung disease. Participants also completed the Airways Questionnaire, a short questionnaire on health-related quality of life and the impact of respiratory symptoms such as cough and dyspnea. The average age at enrollment was 50 years. Participants had smoked an average of 30 years and had an individual average of 24 pack-years. The predicted forced vital capacity and forced expiratory volume in one second were 111 and 102 percent, respectively.
Results: During the mean follow-up period of 5.2 years, the cumulative incidence of moderate COPD was 8.3 percent, equivalent to 1.6 percent per year. No participant developed severe or very severe COPD during the study. The strongest predictor of COPD was abnormal spirometry at baseline. One out of five participants who had mild COPD on entry to the study progressed to moderate COPD compared with one out of 25 smokers with normal spirometry at baseline. Developing moderate COPD was also significantly associated with age older than 55 years, heavier smoking, onset of smoking before 15 years of age, consultation for lower respiratory tract infection, and self-reported cough. A family history of COPD was not significantly associated with development of COPD in smokers. In multivariate analysis, age, early initiation of smoking, and symptoms (cough and consultations for lower respiratory tract conditions) were independently associated with development of moderate COPD.
Conclusion: The authors conclude that in a primary care practice, about 8 percent of middle-age male smokers progress to moderate COPD over five years. Those most at risk are older, began smoking at an early age, and have contacts with their physician because of cough and other respiratory problems. Smoking cessation can normalize lung function and decrease morbidity and mortality, even in smokers with early COPD.
April 6, 2010 — As many as two in three people with known risk factors for COPD (chronic obstructive pulmonary disease) don’t know that they have the disease.
A new study finds that about one in five heavy smokers over age 40 have findings of COPD, but only one-third have been previously diagnosed with the common lung disease.
“Underdiagnosis of COPD was frequent, which suggests a greater need for screening at-risk individuals,” write researcher Kylie Hill, PhD, of the University of Toronto, and colleagues in the Canadian Medical Association Journal.
COPD is a progressive and incurable disease that affects the lungs, making it more difficult to breathe. Advancing age and being a heavy smoker or having a history of cigarette smoking significantly increases the risk of developing COPD.
Recent studies have estimated that about 10% of people worldwide over the age of 40 are affected by COPD. In this study, researchers looked at the prevalence of the disease among people with known risk factors.
Researchers screened 1,003 people aged 40 and over who were current or former heavy smokers who visited a primary care clinic for any reason for signs of COPD using spirometry testing. Heavy smoking was defined as a smoking history of 20 pack-years or more. A pack-year is the number of packs smoked per day multiplied by the number of years smoked.
The results showed that 20.7% of the people screened met the criteria for a diagnosis of COPD but only 32.7% had previously been diagnosed with the disease or were aware of their COPD diagnosis.
Researchers say underdiagnosis of COPD has been reported in previous studies, but the extent of it in this study was especially striking given that all of the participants had two major risk factors for COPD.
They say early detection of COPD by screening people at risk, such as older heavy smokers, could offer more effective treatment options and reduce health care costs.
Former smokers and people who smoke relatively few cigarettes per day may experience a faster decline in lung function than people who have never smoked, although they still have a slower decline in lung function than current smokers, a new study suggests.
The study, “Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study,” was published in The Lancet Respiratory Medicine.
Smoking is well-established as being detrimental to lung health. In fact, smoking is known to cause the development of chronic obstructive pulmonary disease (COPD). And light smokers are not exempt from causing damage to their lungs, according to the researchers.
“Many people assume that smoking a few cigarettes a day isn’t so bad,” Elizabeth Oelsner, MD, study co-author and a professor at Columbia University Vagelos College of Physicians and Surgeons, said in a news release.
“But it turns out that the difference in loss of lung function between someone who smokes five cigarettes a day versus two packs a day is relatively small,” she said.
In the study, Oelsner and her colleagues analyzed data from the NHLBI Pooled Cohorts Study, which included data from 25,352 people (17–93 years old) who had multiple assessments of lung function, as measured via forced expiratory volume (FEV), the amount of air a person can exhale.
With a median follow-up time of seven years, and at a median age of 57, people who had never smoked experienced a FEV decrease at an average rate of 31.01 mL per year. This was expected, as FEV is known to decrease throughout life starting when people are in their 20s.
In former smokers, the rate of FEV decline was higher at 34.97 mL per year, while in current smokers, it was 39.92 mL per year. This suggests that smoking results in a rapid decline in lung function long after a person has quit.
“That’s consistent with a lot of biological studies,” Oelsner said. “There are anatomic differences in the lung that persist for years after smokers quit, and gene activity also remains altered.”
Using statistical analyses, the researchers calculated effect estimates (how much an activity, in this case smoking, is predicted to have an impact on a measurement, in this case FEV) for current smokers who smoked many or a few cigarettes per day. Among current smokers who smoked 30 or more cigarettes per day, the effect estimate was the loss of 11.24 mL per year, while for those who smoked less than five cigarettes per day, it was a loss of 7.65 mL per year.
“Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage,” the researchers wrote.
The data also suggested that light smokers may be at a higher risk of COPD than previously thought. Of note, COPD is diagnosed when FEV decreases below a certain point, and most studies assessing the link between COPD and smoking focused on smokers with heavier habits.
“We probably need to expand our notions of who is at risk,” Oelsner said. “In the future, if we find therapies that reduce the risk of developing COPD, everyone at increased risk should benefit.”
Overall, the results re-emphasize that smoking causes real, long-term damage to the lungs, and so smoking (at all levels) should be avoided, the researchers said.
“Smoking a few cigarettes a day is much riskier than a lot of people think,” Oelsner said. “Everyone should be strongly encouraged to quit smoking, no matter how many cigarettes per day they are using.”
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Marisa holds an MS in Cellular and Molecular Pathology from the University of Pittsburgh, where she studied novel genetic drivers of ovarian cancer. She specializes in cancer biology, immunology, and genetics. Marisa began working with BioNews in 2018, and has written about science and health for SelfHacked and the Genetics Society of America. She also writes/composes musicals and coaches the University of Pittsburgh fencing club. Fact Checked By: Total Posts: 157 Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites. × Marisa holds an MS in Cellular and Molecular Pathology from the University of Pittsburgh, where she studied novel genetic drivers of ovarian cancer. She specializes in cancer biology, immunology, and genetics. Marisa began working with BioNews in 2018, and has written about science and health for SelfHacked and the Genetics Society of America. She also writes/composes musicals and coaches the University of Pittsburgh fencing club. Latest Posts