Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV

Nicholas R. Anthonisen, John E. Connett, James P. Kiley, Murray D. Altose, William C. Bailey, A. Sonia Buist, William A. Conway, Paul L. Enright, Richard E. Kanner, Peggy O'Hara, Gregory R. Owens, Paul D Scanlon, Donald P. Tashkin, Robert A. Wise

Research output: Contribution to journalArticle

1601 Citations (Scopus)

Abstract

Objective. - To determine whether a program incorporating smoking intervention and use of an inhaled bronchodilator can slow the rate of decline in forced expiratory volume in 1 second (FEV1) in smokers aged 35 to 60 years who have mild obstructive pulmonary disease. Design. - Randomized clinical trial. Participants randomized with equal probability to one of the following groups: (1) smoking intervention plus bronchodilator, (2) smoking intervention plus placebo, or (3) no intervention. Setting. - Ten clinical centers in the United States and Canada. Participants. - A total of 5887 male and female smokers, aged 35 to 60 years, with spirometric signs of early chronic obstructive pulmonary disease. Interventions. - Smoking intervention: intensive 12-session smoking cessation program combining behavior modification and use of nicotine gum, with continuing 5-year maintenance program to minimize relapse. Bronchodilator: ipratropium bromide prescribed three times daily (two puffs per time) from a metered-dose inhaler. Main Outcome Measures. - Rate of change and cumulative change in FEV1 over a 5-year period. Results. - Participants in the two smoking intervention groups showed significantly smaller declines in FEV1 than did those in the control group. Most of this difference occurred during the first year following entry into the study and was attributable to smoking cessation, with those who achieved sustained smoking cessation experiencing the largest benefit. The small noncumulative benefit associated with use of the active bronchodilator vanished after the bronchodilator was discontinued at the end of the study. Conclusions. - An aggressive smoking intervention program significantly reduces the age-related decline in FEV1 in middle-aged smokers with mild airways obstruction. Use of an inhaled anticholinergic bronchodilator results in a relatively small improvement in FEV1 that appears to be reversed after the drug is discontinued. Use of the bronchodilator did not influence the long-term decline of FEV1.

Original languageEnglish (US)
Pages (from-to)1497-1505
Number of pages9
JournalJournal of the American Medical Association
Volume272
Issue number19
StatePublished - Nov 16 1994
Externally publishedYes

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Bronchodilator Agents
Cholinergic Antagonists
Forced Expiratory Volume
Smoking
Smoking Cessation
Ipratropium
Obstructive Lung Diseases
Metered Dose Inhalers
Behavior Therapy
Airway Obstruction
Nicotine
Chronic Obstructive Pulmonary Disease
Canada
Randomized Controlled Trials
Placebos
Maintenance
Outcome Assessment (Health Care)
Recurrence
Control Groups
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Anthonisen, N. R., Connett, J. E., Kiley, J. P., Altose, M. D., Bailey, W. C., Buist, A. S., ... Wise, R. A. (1994). Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV. Journal of the American Medical Association, 272(19), 1497-1505.

Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV. / Anthonisen, Nicholas R.; Connett, John E.; Kiley, James P.; Altose, Murray D.; Bailey, William C.; Buist, A. Sonia; Conway, William A.; Enright, Paul L.; Kanner, Richard E.; O'Hara, Peggy; Owens, Gregory R.; Scanlon, Paul D; Tashkin, Donald P.; Wise, Robert A.

In: Journal of the American Medical Association, Vol. 272, No. 19, 16.11.1994, p. 1497-1505.

Research output: Contribution to journalArticle

Anthonisen, NR, Connett, JE, Kiley, JP, Altose, MD, Bailey, WC, Buist, AS, Conway, WA, Enright, PL, Kanner, RE, O'Hara, P, Owens, GR, Scanlon, PD, Tashkin, DP & Wise, RA 1994, 'Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV', Journal of the American Medical Association, vol. 272, no. 19, pp. 1497-1505.
Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV. Journal of the American Medical Association. 1994 Nov 16;272(19):1497-1505.
Anthonisen, Nicholas R. ; Connett, John E. ; Kiley, James P. ; Altose, Murray D. ; Bailey, William C. ; Buist, A. Sonia ; Conway, William A. ; Enright, Paul L. ; Kanner, Richard E. ; O'Hara, Peggy ; Owens, Gregory R. ; Scanlon, Paul D ; Tashkin, Donald P. ; Wise, Robert A. / Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV. In: Journal of the American Medical Association. 1994 ; Vol. 272, No. 19. pp. 1497-1505.
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abstract = "Objective. - To determine whether a program incorporating smoking intervention and use of an inhaled bronchodilator can slow the rate of decline in forced expiratory volume in 1 second (FEV1) in smokers aged 35 to 60 years who have mild obstructive pulmonary disease. Design. - Randomized clinical trial. Participants randomized with equal probability to one of the following groups: (1) smoking intervention plus bronchodilator, (2) smoking intervention plus placebo, or (3) no intervention. Setting. - Ten clinical centers in the United States and Canada. Participants. - A total of 5887 male and female smokers, aged 35 to 60 years, with spirometric signs of early chronic obstructive pulmonary disease. Interventions. - Smoking intervention: intensive 12-session smoking cessation program combining behavior modification and use of nicotine gum, with continuing 5-year maintenance program to minimize relapse. Bronchodilator: ipratropium bromide prescribed three times daily (two puffs per time) from a metered-dose inhaler. Main Outcome Measures. - Rate of change and cumulative change in FEV1 over a 5-year period. Results. - Participants in the two smoking intervention groups showed significantly smaller declines in FEV1 than did those in the control group. Most of this difference occurred during the first year following entry into the study and was attributable to smoking cessation, with those who achieved sustained smoking cessation experiencing the largest benefit. The small noncumulative benefit associated with use of the active bronchodilator vanished after the bronchodilator was discontinued at the end of the study. Conclusions. - An aggressive smoking intervention program significantly reduces the age-related decline in FEV1 in middle-aged smokers with mild airways obstruction. Use of an inhaled anticholinergic bronchodilator results in a relatively small improvement in FEV1 that appears to be reversed after the drug is discontinued. Use of the bronchodilator did not influence the long-term decline of FEV1.",
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AU - Connett, John E.

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AU - Bailey, William C.

AU - Buist, A. Sonia

AU - Conway, William A.

AU - Enright, Paul L.

AU - Kanner, Richard E.

AU - O'Hara, Peggy

AU - Owens, Gregory R.

AU - Scanlon, Paul D

AU - Tashkin, Donald P.

AU - Wise, Robert A.

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N2 - Objective. - To determine whether a program incorporating smoking intervention and use of an inhaled bronchodilator can slow the rate of decline in forced expiratory volume in 1 second (FEV1) in smokers aged 35 to 60 years who have mild obstructive pulmonary disease. Design. - Randomized clinical trial. Participants randomized with equal probability to one of the following groups: (1) smoking intervention plus bronchodilator, (2) smoking intervention plus placebo, or (3) no intervention. Setting. - Ten clinical centers in the United States and Canada. Participants. - A total of 5887 male and female smokers, aged 35 to 60 years, with spirometric signs of early chronic obstructive pulmonary disease. Interventions. - Smoking intervention: intensive 12-session smoking cessation program combining behavior modification and use of nicotine gum, with continuing 5-year maintenance program to minimize relapse. Bronchodilator: ipratropium bromide prescribed three times daily (two puffs per time) from a metered-dose inhaler. Main Outcome Measures. - Rate of change and cumulative change in FEV1 over a 5-year period. Results. - Participants in the two smoking intervention groups showed significantly smaller declines in FEV1 than did those in the control group. Most of this difference occurred during the first year following entry into the study and was attributable to smoking cessation, with those who achieved sustained smoking cessation experiencing the largest benefit. The small noncumulative benefit associated with use of the active bronchodilator vanished after the bronchodilator was discontinued at the end of the study. Conclusions. - An aggressive smoking intervention program significantly reduces the age-related decline in FEV1 in middle-aged smokers with mild airways obstruction. Use of an inhaled anticholinergic bronchodilator results in a relatively small improvement in FEV1 that appears to be reversed after the drug is discontinued. Use of the bronchodilator did not influence the long-term decline of FEV1.

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