Article    Table of Contents                    Full Text of this article Free    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Video News Release    Related articles in Annals  Services    Send comment/rapid response letter    Published comments/rapid response letters    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Anthonisen, N. R.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality

A Randomized Clinical Trial

Nicholas R. Anthonisen, MD; Melissa A. Skeans, MS; Robert A. Wise, MD; Jure Manfreda, MD; Richard E. Kanner, MD; John E. Connett, PhD, for the Lung Health Study Research Group*

15 February 2005 | Volume 142 Issue 4 | Pages 233-239

Background: Randomized clinical trials have not yet demonstrated the mortality benefit of smoking cessation.

Objective: To assess the long-term effect on mortality of a randomly applied smoking cessation program.

Design: The Lung Health Study was a randomized clinical trial of smoking cessation. Special intervention participants received the smoking intervention program and were compared with usual care participants. Vital status was followed up to 14.5 years.

Setting: 10 clinical centers in the United States and Canada.

Patients: 5887 middle-aged volunteers with asymptomatic airway obstruction.

Measurements: All-cause mortality and mortality due to cardiovascular disease, lung cancer, and other respiratory disease.

Intervention: The intervention was a 10-week smoking cessation program that included a strong physician message and 12 group sessions using behavior modification and nicotine gum, plus either ipratropium or a placebo inhaler.

Results: At 5 years, 21.7% of special intervention participants had stopped smoking since study entry compared with 5.4% of usual care participants. After up to 14.5 years of follow-up, 731 patients died: 33% of lung cancer, 22% of cardiovascular disease, 7.8% of respiratory disease other than cancer, and 2.3% of unknown causes. All-cause mortality was significantly lower in the special intervention group than in the usual care group (8.83 per 1000 person-years vs. 10.38 per 1000 person-years; P = 0.03). The hazard ratio for mortality in the usual care group compared with the special intervention group was 1.18 (95% CI, 1.02 to 1.37). Differences in death rates for both lung cancer and cardiovascular disease were greater when death rates were analyzed by smoking habit.

Limitations: Results apply only to individuals with airway obstruction.

Conclusion: Smoking cessation intervention programs can have a substantial effect on subsequent mortality, even when successful in a minority of participants.

*For a list of members of the Lung Health Study Research Group, see the Appendix.

Editors' Notes Context Although there are many health benefits for smokers who stop smoking, we still lack evidence from randomized, controlled trials that smoking cessation programs reduce mortality. Contribution In this randomized, controlled trial of a 10-week-long smoking cessation intervention in 5887 smokers with asymptomatic airway obstruction, 14-year mortality rates were higher in the usual care group than in the smoking cessation group (hazard ratio, 1.18 [95% CI, 1.02 to 1.37]). The mortality benefit was greatest among the 21.7% of the intervention group who actually managed to quit smoking. Implications Smoking cessation programs substantially reduce mortality even when only a minority of patients stop smoking. –The Editors

 

Author and Article Information

From University of Manitoba, Winnipeg, Manitoba, Canada; University of Minnesota, Minneapolis, Minnesota; Johns Hopkins University, Baltimore, Maryland; and University of Utah, Salt Lake City, Utah.

Grant Support: Lung Health Study III was supported by a cooperative agreement with the National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI-1U10-HL59275).

Potential Financial Conflicts of Interest: Honoraria: J.E. Connett (National Institutes of Health/National Heart, Lung, and Blood Institute); Grants received: J.E. Connett (National Institutes of Health/National Heart, Lung, and Blood Institute).

Requests for Single Reprints: John E. Connett, PhD, Coordinating Centers for Biometric Research, University of Minnesota, 2221 University Avenue SE, Room 200, Minneapolis, MN 55414-3080; e-mail, john-c{at}ccbr.umn.edu.

Current Author Addresses: Dr. Anthonisen: University of Manitoba, Respiratory Hospital, 810 Sherbrook Street, Room 319, Winnipeg, Manitoba R3A 1R8, Canada.

Ms. Skeans and Dr. Connett: University of Minnesota, Coordinating Centers for Biometric Research, 2221 University Avenue SE, Room 200, Minneapolis, MN 55414-3080.

Dr. Wise: Johns Hopkins Asthma and Allergy Center, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224.

Dr. Manfreda: University of Manitoba, Respiratory Hospital RS 115, 810 Sherbrook Street, Winnipeg, Manitoba R3A 1R8, Canada.

Dr. Kanner: University of Utah Medical Center, Pulmonary Division, 701 Wintrobe Building, 50 North Medical Drive, Salt Lake City, UT 84132.

Author Contributions: Conception and design: N.R. Anthonisen, R.A. Wise, R.E. Kanner, J.E. Connett.

Analysis and interpretation of the data: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J.E. Connett.

Drafting of the article: N.R. Anthonisen, M.A. Skeans, J. Manfreda, R.E. Kanner.

Critical revision of the article for important intellectual content: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett.

Final approval of the article: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett.

Provision of study materials or patients: R.A. Wise, R.E. Kanner.

Statistical expertise: M.A. Skeans, J.E. Connett.

Obtaining of funding: R.A. Wise, R.E. Kanner, J.E. Connett.

Collection and assembly of data: R.A. Wise, J.E. Connett.

Related articles in Annals:

Editorials
Smoking Kills: Experimental Proof from the Lung Health Study
Jonathan M. Samet

Annals 2005 142: 299-301. [Full Text]  

Summaries for Patients
The Effects of a Smoking Cessation Program on Long-Term Survival in Smokers with Mild Lung Disease

Annals 2005 142: I-12. [Full Text]  

Letters
The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality
Milan C. Mathew

Annals 2005 143: 614-615. [Full Text]  

Letters
The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality
Gregory J. Bombassei

Annals 2005 143: 615. [Full Text]  

Letters
The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality
Nicholas R. Anthonisen

Annals 2005 143: 615. [Full Text]  

This article has been cited by other articles:

				P. Eickhoff, A. Valipour, D. Kiss, M. Schreder, L. Cekici, K. Geyer, R. Kohansal, and O. C. Burghuber Determinants of Systemic Vascular Function in Patients with Stable Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., December 15, 2008; 178(12): 1211 - 1218. [Abstract] [Full Text] [PDF]

				J. B. Soriano and A. Agusti The of COPD: or balancing repair (yang) and inflammation (yin) Eur. Respir. J., December 1, 2008; 32(6): 1426 - 1427. [Full Text] [PDF]

				M. Gerhardsson de Verdier The Big Three Concept: A Way to Tackle the Health Care Crisis? Proceedings of the ATS, December 1, 2008; 5(8): 800 - 805. [Abstract] [Full Text] [PDF]

				R. Rodriguez-Roisin and J. B. Soriano Chronic Obstructive Pulmonary Disease with Lung Cancer and/or Cardiovascular Disease Proceedings of the ATS, December 1, 2008; 5(8): 842 - 847. [Abstract] [Full Text] [PDF]

				F. Luppi, F. Franco, B. Beghe, and L. M. Fabbri Treatment of Chronic Obstructive Pulmonary Disease and Its Comorbidities Proceedings of the ATS, December 1, 2008; 5(8): 848 - 856. [Abstract] [Full Text] [PDF]

				S. F. P. Man, L. Xing, J. E. Connett, N. R. Anthonisen, R. A. Wise, D. P. Tashkin, X. Zhang, R. Vessey, T. G. Walker, B. R. Celli, et al. Circulating fibronectin to C-reactive protein ratio and mortality: a biomarker in COPD? Eur. Respir. J., December 1, 2008; 32(6): 1451 - 1457. [Abstract] [Full Text] [PDF]

				M. B. Drummond, E. C. Dasenbrook, M. W. Pitz, D. J. Murphy, and E. Fan Inhaled Corticosteroids in Patients With Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis JAMA, November 26, 2008; 300(20): 2407 - 2416. [Abstract] [Full Text] [PDF]

				Y.-M. Song, J. Sung, and H.-J. Cho Reduction and Cessation of Cigarette Smoking and Risk of Cancer: A Cohort Study of Korean Men J. Clin. Oncol., November 1, 2008; 26(31): 5101 - 5106. [Abstract] [Full Text] [PDF]

				N. S. Godtfredsen, T. H. Lam, T. T. Hansel, M. E. Leon, N. Gray, C. Dresler, D. M. Burns, E. Prescott, and J. Vestbo COPD-related morbidity and mortality after smoking cessation: status of the evidence Eur. Respir. J., October 1, 2008; 32(4): 844 - 853. [Abstract] [Full Text] [PDF]

				Y. R. B. M. van Gestel, S. E. Hoeks, D. D. Sin, G. M. J. M. Welten, O. Schouten, H. J. Witteveen, C. Simsek, H. Stam, F. W. Mertens, J. J. Bax, et al. Impact of Cardioselective {beta}-Blockers on Mortality in Patients with Chronic Obstructive Pulmonary Disease and Atherosclerosis Am. J. Respir. Crit. Care Med., October 1, 2008; 178(7): 695 - 700. [Abstract] [Full Text] [PDF]

				D. O. Wilson, J. L. Weissfeld, A. Balkan, J. G. Schragin, C. R. Fuhrman, S. N. Fisher, J. Wilson, J. K. Leader, J. M. Siegfried, S. D. Shapiro, et al. Association of Radiographic Emphysema and Airflow Obstruction with Lung Cancer Am. J. Respir. Crit. Care Med., October 1, 2008; 178(7): 738 - 744. [Abstract] [Full Text] [PDF]

				R. M v. Dam, T. Li, D. Spiegelman, O. H Franco, and F. B Hu Combined impact of lifestyle factors on mortality: prospective cohort study in US women BMJ, September 16, 2008; 337(sep16_2): a1440 - a1440. [Abstract] [Full Text] [PDF]

				M. B. Drummond, A. L. Blackford, J. O. Benditt, B. J. Make, F. C. Sciurba, M. C. McCormack, F. J. Martinez, H. E. Fessler, A. P. Fishman, R. A. Wise, et al. Continuous Oxygen Use in Nonhypoxemic Emphysema Patients Identifies a High-Risk Subset of Patients: Retrospective Analysis of the National Emphysema Treatment Trial Chest, September 1, 2008; 134(3): 497 - 506. [Abstract] [Full Text] [PDF]

				B. R. Celli Update on the Management of COPD Chest, June 1, 2008; 133(6): 1451 - 1462. [Abstract] [Full Text] [PDF]

				K. C. Chang, C. C. Leung, and C. M. Tam Inhaled Corticosteroids Might Not Protect against Lung Cancer Am. J. Respir. Crit. Care Med., June 1, 2008; 177(11): 1290 - 1290. [Full Text] [PDF]

				P. Albert and P. M. A. Calverley Drugs (including oxygen) in severe COPD Eur. Respir. J., May 1, 2008; 31(5): 1114 - 1124. [Abstract] [Full Text] [PDF]

				G. J. Criner, A. L. Sternberg, and for the National Emphysema Treatment Trial Researc A Clinician's Guide to the Use of Lung Volume Reduction Surgery Proceedings of the ATS, May 1, 2008; 5(4): 461 - 467. [Abstract] [Full Text] [PDF]

				M Bednarek, J Maciejewski, M Wozniak, P Kuca, and J Zielinski Prevalence, severity and underdiagnosis of COPD in the primary care setting Thorax, May 1, 2008; 63(5): 402 - 407. [Abstract] [Full Text] [PDF]

				D. H Au Use of {beta} blockers in patients with COPD Thorax, April 1, 2008; 63(4): 296 - 298. [Full Text] [PDF]

				M T Dransfield, S M Rowe, J E Johnson, W C Bailey, and L B Gerald Use of {beta} blockers and the risk of death in hospitalised patients with acute exacerbations of COPD Thorax, April 1, 2008; 63(4): 301 - 305. [Abstract] [Full Text] [PDF]

				L. A. Robinson, K. M. Emmons, E. T. Moolchan, and J. S. Ostroff Developing Smoking Cessation Programs for Chronically Ill Teens: Lessons Learned from Research with Healthy Adolescent Smokers J. Pediatr. Psychol., March 1, 2008; 33(2): 133 - 144. [Abstract] [Full Text] [PDF]

				M. Cazzola, W. MacNee, F. J. Martinez, K. F. Rabe, L. G. Franciosi, P. J. Barnes, V. Brusasco, P. S. Burge, P. M. A. Calverley, B. R. Celli, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers Eur. Respir. J., February 1, 2008; 31(2): 416 - 469. [Abstract] [Full Text] [PDF]

				M. Poulain, M. Doucet, V. Drapeau, G. Fournier, A. Tremblay, P. Poirier, and F. Maltais Metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease Chronic Respiratory Disease, February 1, 2008; 5(1): 35 - 41. [Abstract] [PDF]

				A. J. Karter, M. R. Stevens, E. W. Gregg, A. F. Brown, C.-W. Tseng, D. G. Marrero, O. K. Duru, T. L. Gary, J. D. Piette, B. Waitzfelder, et al. Educational Disparities in Rates of Smoking Among Diabetic Adults: The Translating Research Into Action for Diabetes Study Am J Public Health, February 1, 2008; 98(2): 365 - 370. [Abstract] [Full Text] [PDF]

				W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]

				J. P. de Torres, G. Bastarrika, J. P. Wisnivesky, A. B. Alcaide, A. Campo, L. M. Seijo, J. C. Pueyo, A. Villanueva, M. D. Lozano, U. Montes, et al. Assessing the Relationship Between Lung Cancer Risk and Emphysema Detected on Low-Dose CT of the Chest Chest, December 1, 2007; 132(6): 1932 - 1938. [Abstract] [Full Text] [PDF]

				P M A Calverley and J A Wedzicha Chronic obstructive pulmonary disease past, present and future Thorax, December 1, 2007; 62(12): 1026 - 1027. [Full Text] [PDF]

				I. Shrier, J.-F. Boivin, R. J. Steele, R. W. Platt, A. Furlan, R. Kakuma, J. Brophy, and M. Rossignol Should Meta-Analyses of Interventions Include Observational Studies in Addition to Randomized Controlled Trials? A Critical Examination of Underlying Principles Am. J. Epidemiol., November 15, 2007; 166(10): 1203 - 1209. [Abstract] [Full Text] [PDF]

				N. M. Stack and A. J. Zillich Implementation of inpatient and outpatient tobacco-cessation programs Am. J. Health Syst. Pharm., October 1, 2007; 64(19): 2074 - 2079. [Abstract] [Full Text] [PDF]

				P. M. Calverley Eur. Respir. Rev., September 1, 2007; 16(105): 89 - 90. [Full Text] [PDF]

				S. I. Rennard Inflammation in COPD: a link to systemic comorbidities Eur. Respir. Rev., September 1, 2007; 16(105): 91 - 97. [Abstract] [Full Text] [PDF]

				N. Roche Where current pharmacological therapies fall short in COPD: symptom control is not enough Eur. Respir. Rev., September 1, 2007; 16(105): 98 - 104. [Abstract] [Full Text] [PDF]

				L. van den Bemt, T. Schermer, and C. van Weel Rational monitoring of COPD: where do current clinical guidelines stand? Eur. Respir. J., June 1, 2007; 29(6): 1078 - 1081. [Full Text] [PDF]

				L. P McGarvey, M. John, J. A Anderson, M. Zvarich, and R. A Wise Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee Thorax, May 1, 2007; 62(5): 411 - 415. [Abstract] [Full Text] [PDF]

				Y. E. Miller and R. L. Keith Inhaled Corticosteroids and Lung Cancer Chemoprevention Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 636 - 637. [Full Text] [PDF]

				G. M. Leung, S. S. C. Chan, J. M. Johnston, S. K. K. Chan, P. P. S. Woo, I. Chi, and T.-H. Lam Effectiveness of an Elderly Smoking Cessation Counseling Training Program for Social Workers: A Longitudinal Study Chest, April 1, 2007; 131(4): 1157 - 1165. [Abstract] [Full Text] [PDF]

				T. Parimon, J. W. Chien, C. L. Bryson, M. B. McDonell, E. M. Udris, and D. H. Au Inhaled Corticosteroids and Risk of Lung Cancer among Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 712 - 719. [Abstract] [Full Text] [PDF]

				P. M.A. Calverley, J. A. Anderson, B. Celli, G. T. Ferguson, C. Jenkins, P. W. Jones, J. C. Yates, J. Vestbo, and the TORCH investigators Salmeterol and Fluticasone Propionate and Survival in Chronic Obstructive Pulmonary Disease N. Engl. J. Med., February 22, 2007; 356(8): 775 - 789. [Abstract] [Full Text] [PDF]

				W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]

				P. Tonnesen, L. Carrozzi, K. O. Fagerstrom, C. Gratziou, C. Jimenez-Ruiz, S. Nardini, G. Viegi, C. Lazzaro, I. A. Campell, E. Dagli, et al. Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy Eur. Respir. J., February 1, 2007; 29(2): 390 - 417. [Abstract] [Full Text] [PDF]

				J. B. Buse, H. N. Ginsberg, G. L. Bakris, N. G. Clark, F. Costa, R. Eckel, V. Fonseca, H. C. Gerstein, S. Grundy, R. W. Nesto, et al. Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus: A Scientific Statement From the American Heart Association and the American Diabetes Association Circulation, January 2, 2007; 115(1): 114 - 126. [Abstract] [Full Text] [PDF]

				J. B. Buse, H. N. Ginsberg, G. L. Bakris, N. G. Clark, F. Costa, R. Eckel, V. Fonseca, H. C. Gerstein, S. Grundy, R. W. Nesto, et al. Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus: A scientific statement from the American Heart Association and the American Diabetes Association Diabetes Care, January 1, 2007; 30(1): 162 - 172. [Abstract] [Full Text] [PDF]

				J. A. Tice, A. Kanaya, T. Hue, S. Rubin, D. S. M. Buist, A. LaCroix, J. V. Lacey Jr, J. A. Cauley, S. Litwack, L. A. Brinton, et al. Risk Factors for Mortality in Middle-aged Women Arch Intern Med, December 11, 2006; 166(22): 2469 - 2477. [Abstract] [Full Text] [PDF]

				D. D. Sin, N. R. Anthonisen, J. B. Soriano, and A. G. Agusti Mortality in COPD: role of comorbidities Eur. Respir. J., December 1, 2006; 28(6): 1245 - 1257. [Abstract] [Full Text] [PDF]

				T. L. Petty Harm from spirometry? Chest, November 1, 2006; 130(5): 1629 - 1630. [Full Text] [PDF]

				A Lokke, P Lange, H Scharling, P Fabricius, and J Vestbo Developing COPD: a 25 year follow up study of the general population. Thorax, November 1, 2006; 61(11): 935 - 939. [Abstract] [Full Text] [PDF]

				P M A Calverley Caring for the burden of COPD. Thorax, October 1, 2006; 61(10): 831 - 832. [Full Text] [PDF]

				D D Sin Inhaled corticosteroids and mortality in COPD Thorax, October 1, 2006; 61(10): 918 - 918. [Full Text] [PDF]

				S F P Man, J E Connett, N R Anthonisen, R A Wise, D P Tashkin, and D D Sin C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease Thorax, October 1, 2006; 61(10): 849 - 853. [Abstract] [Full Text] [PDF]

				D. M. G. Halpin and M. Miravitlles Chronic Obstructive Pulmonary Disease: The Disease and Its Burden to Society Proceedings of the ATS, September 1, 2006; 3(7): 619 - 623. [Abstract] [Full Text] [PDF]

				D. D. Sin and S. F. P. Man Pharmacotherapy for Mortality Reduction in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, September 1, 2006; 3(7): 624 - 629. [Abstract] [Full Text] [PDF]

				J.-F. Etter and J. A Stapleton Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tob. Control, August 1, 2006; 15(4): 280 - 285. [Abstract] [Full Text] [PDF]

				G. J. Kelloff, S. M. Lippman, A. J. Dannenberg, C. C. Sigman, H. L. Pearce, B. J. Reid, E. Szabo, V. C. Jordan, M. R. Spitz, G. B. Mills, et al. Progress in Chemoprevention Drug Development: The Promise of Molecular Biomarkers for Prevention of Intraepithelial Neoplasia and Cancer--A Plan to Move Forward Clin. Cancer Res., June 15, 2006; 12(12): 3661 - 3697. [Abstract] [Full Text] [PDF]

L. M. Fabbri, F. Luppi, B. Beghe, and K. F. Rabe Update in chronic obstructive pulmonary disease 2005. Am.