Chest
Clinical InvestigationsCOPDThe Effect of Smoking Intervention and an Inhaled Bronchodilator on Airways Reactivity in COPD*: The Lung Health Study
Section snippets
LHS Design
The study design, spirometric methodology, measurement of AR, and smoking intervention program all have been reported on in detail.3678 A total of 5,887 cigarette-smoking participants with an FEV1 of ≥ 50% of predicted and < 90% of predicted, and an FEV1/FVC ratio of < 0.70 were enrolled into the study and randomized into one of the following three groups: usual care (UC); smoking cessation plus a special intervention with an ipratropium bromide inhaler (SIA); and smoking cessation plus a
Demographics and Temporal Changes in Airways Reactivity
The clinical and demographic characteristics of the 4,201 participants in this study group are shown in Table 1. The reasons for the exclusion of the data for the remaining 1,686 LHS participants are given in Table 2. The study sample showed an overall increase in AR over the 5-year period, irrespective of treatment assignment, gender, or smoking status (Table 3). The increase in reactivity for the entire group was small, approximately 0.12 LMCR units. At randomization, 4.1% of the group
Discussion
The main finding of this study was that there was an overall tendency for AR to increase over a 5-year period in this group of long-term smokers with mild-to-moderate COPD. This increase in AR occurred in persons in all the analyzed subgroups except for those who quit smoking and subsequently improved their pulmonary function. Increasing AR was more pronounced in women, continuous smokers, and those participants with the largest declines in FEV1. The unifying theme of our analyses was that
Summary and Conclusions
In summary, we have found that a cohort of volunteers with mild-to-moderate COPD who enrolled in a clinical trial of smoking cessation and inhaled anticholinergic bronchodilator therapy showed continuing increases in AR. This progression was greater mainly in those who had the greatest decline in FEV1 but also occurred in older individuals and continuing smokers.
Appendix: List of Participants in the LHS Research Group
The principal investigators and senior staff of the clinical and coordinating centers, the National Heart, Lung, and Blood Institute, members of the Safety and Data Monitoring Board, and the Morbidity and Mortality Review Board are as follows.
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This research was supported by contracts NO1-HR46002 and NO1-46014 from the Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health. The following pharmaceutical companies supplied drugs used in this study: Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT (Atrovent and placebo inhalers); and Marion Merrell Dow Inc, Kansas City, MO (Nicorette). The Salt Lake City Center has been assisted by the Clinical Research Center, Public Health Research grant M01-RR00064 from the National Center for Research Resources.