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RESULTS

In this cohort of 18,206 outpatients with COPD, 6,932 (38%) smoked at baseline.
Smoking prevalence according to GOLD 1-4 was 38%, 40%, 37%, and 37%,
respectively. 3.233 smokers had ≥ 1 follow-up contact with smoking information
included in the analyses. During 3,569 person-years, observed 951 cases of smoking
cessation. The last observed exit was at 4.9 years, with a median follow-up of 320
days. During 1 and 5 years from first contact, the probability of quitting smoking was
19% and 45%, respectively.

Table 1 presents baseline characteristics and corresponding cases of smoking


cessation. The patients were characterized by advanced disease and a high degree of
dyspnea, with 33% having experienced ≥ 1 exacerbation during the previous year.
The prevalence of depression was 31%. More than half of patients had a lower level
of education and lived alone, and 62% were unemployed. Patients with no
informative follow-up contacts were younger, had milder COPD, and were more
likely to live alone.

Table 2 presents Effects of clinical factors. Patients appeared less likely to quit
smoking if they had a history of cancer (hazard ratio [HR], 0.79; 95% CI, 0.58-1.07)
or depression (HR, 0.91; 95% CI, 0.77-1.07) or if their physician refrained from
encouraging smoking cessation (HR, 0.82; 95% CI, 0.66-1.03) compared with
patients without a history of cancer or depression as well as those encouraged to quit
smoking.

Table 3 Patients with “other” comorbidities had a higher probability of quitting (HR,
1.31; 95% CI, 1.00-1.72) than other patients. Patients were less likely to quit if they
had milder COPD with an HR of 0.67 (95% CI, 0.53-0.84) for GOLD A, an HR of
0.61 (95% CI, 0.47-0.80) for GOLD B, and an HR of 0.86 (95% CI, 0.72-1.04) for
GOLD C compared with GOLD D. In analyses of GOLD A-D components, observed
a lower chance of quitting among patients with moderate (HR, 0.53; 95% CI, 0.42-
0.65) and severe (HR, 0.70; 95% CI, 0.57-0.85) COPD relative to very severe COPD,
among patients with a score on the MRC scale of < 4 (HR, 0.80; 95% CI, 0.68-0.95)
compared with a score on the MRC scale of ≥ 4, and in those with no history of
exacerbations (HR, 0.80; 95% CI, 0.68-0.93) relative to those with prior
exacerbations.

Table 4 The probability of quitting smoking was lower for younger patients with an
HR of 0.84 (95% CI, 0.71-0.99), for those aged 50 to 69 years and 0.53 (95% CI,
0.37-0.76), and for those aged 30 to 49 years, compared with those aged ≥ 70 years.
The probability was also lower for patients who had lower income (HR, 0.79; 95%
CI, 0.67-0.94) or lived alone (HR, 0.75; 95% CI, 0.64-0.88).

Table 5 Relative to those who were employed, unemployed patients were less likely
to quit smoking (HR, 0.70; 95% CI, 0.54-0.90). This association was more
pronounced for women (HR, 0.56; 95% CI, 0.40-0.79) than for men (HR, 0.92; 95%
CI, 0.64-1.34).