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Original Research: COPD |

Smoking Cessation in COPD Causes a Transient Improvement in Spirometry and Decreases Micronodules on High-Resolution CT ImagingSmoking Cessation in COPD

Jaideep Dhariwal, MD; Rachel C. Tennant, MD; David M. Hansell, MD; John Westwick, PhD; Christoph Walker, PhD; Simon P. Ward, BSc; Neil Pride, MD; Peter J. Barnes, MD, FCCP; Onn Min Kon, MD, PhD; Trevor T. Hansel, MD, PhD
Author and Funding Information

From the Chest and Allergy Department (Drs Dhariwal and Kon), St. Mary’s Hospital, Imperial College Healthcare NHS Trust, London; Departments of Thoracic Medicine, Radiology, and Lung Function and Clinical Studies Unit (Drs Tennant, Hansell, Pride, Barnes, and Hansel and Mr Ward), National Heart and Lung Institute at the Royal Brompton Hospital, Imperial College, London; and Novartis Pharmaceuticals UK Ltd (Drs Westwick and Walker), Horsham, England.

Correspondence to: Trevor T. Hansel, MD, PhD, Imperial Clinical Respiratory Research Unit, Imperial Biomedical Research Centre, St. Mary’s Hospital, Mint Wing, Entrance C, Paddington, London, W2 1NY, England; e-mail: t.hansel@imperial.ac.uk

Deceased.

Drs Dhariwal, Tennant, Kon, and Hansel contributed equally.


Funding/Support: This study received funding from Novartis Pharmaceuticals UK Ltd.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1006-1015. doi:10.1378/chest.13-2220
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Background:  Smoking cessation is of major importance for all smokers; however, in patients with COPD, little information exists on how smoking cessation influences lung function and high-resolution CT (HRCT) scan appearances.

Methods:  In this single-center study, we performed screening spirometry in a group of heavy smokers aged 40 to 80 years (N = 358). We then studied the effects of smoking cessation in two groups of selected subjects: smokers with COPD (n = 38) and smokers with normal spirometry (n = 55). In parallel to subjects undergoing smoking cessation, we studied a control group of nonsmokers (n = 19).

Results:  Subjects with COPD who quit smoking had a marked, but transient improvement in FEV1 at 6 weeks (184 mL, n = 17, P < .01) that was still present at 12 weeks (81 mL, n = 17, P < .05) and only partially maintained at 1 year. In contrast, we saw improvement in the transfer factor of lung for carbon monoxide at 6 weeks in both subjects with COPD who quit smoking (0.47 mmol/min/kPa, n = 17, P < .01) and subjects who quit smoking with normal spirometry (0.40 mmol/min/kPa, n = 35, P < .01). An upper-zone single HRCT image slice reliably identified emphysema at baseline in 74% of smokers with COPD (28 of 38) and 29% of healthy smokers (16 of 55). Smoking cessation had no significant effect on the appearances of emphysema but decreased the presence of micronodules on HRCT imaging.

Conclusions:  Cigarette smoking causes extensive lung function and HRCT image abnormalities, even in patients with normal spirometry. Smoking cessation has differential effects on lung function (FEV1 and gas transfer) and features on HRCT images (emphysema and micronodules). Cessation of smoking in patients with COPD causes a transient improvement in FEV1 and decreases the presence of micronodules, offering an opportunity for concomitant therapy during smoking cessation to augment these effects. Smoking cessation at the earliest possible opportunity is vital to minimize permanent damage to the lungs.

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