The effectiveness of smoking cessation groups offered to hospitalised patients with symptoms of exacerbations of chronic obstructive pulmonary disease (COPD)

Introduction: Chronic obstructive pulmonary disease (COPD) is a major contributor to morbidity and mortality. Smoking is the leading cause of COPD. Results from randomised trials regarding smoking cessation in hospitalised patients with COPD are few. Objectives: To assess the effect of smoking cessation groups (SCG) in patients with COPD admitted to hospital. Methods: Two hundred and twenty‐three patients admitted to hospital were assigned to either a control group (n = 102) or an intervention group (n = 121) by matter of vacancy. The smokers in the intervention group were offered participation in an SCG. Smoking status and change in self‐reported symptoms were assessed after 1 year. Smoking status was self‐reported and verified with carbohemoglobin measurement. Survival and hospital admissions were assessed after 5 years through national registers. Results: Forty‐eight patients participated in an SCG. After 1 year, 36 (30%) patients in the intervention group were abstinent compared with 13 (13%) patients in the control group [odds ratio (95% confidence interval): 2.83 (1.40–5.74)]. There was a significant difference between the intervention group and the control group regarding change in self‐reported phlegm. There was a non‐significant tendency towards better survival in the intervention group (50.4%) compared with the control group (43.1%). After 3 years, the intervention group had a significantly fewer total number of days admitted to hospital and number of days hospitalised with COPD. Conclusion: This study shows that an intervention consisting of offering participation in an SCG to chronic patients makes it possible to obtain higher abstinence rates. Furthermore, this intervention showed impact on phlegm, survival and hospital readmissions. Please cite this paper as: Borglykke A, Pisinger C, Jørgensen T and Ibsen H. The effectiveness of smoking cessation groups offered to hospitalised patients with symptoms of exacerbations of chronic obstructive pulmonary disease (COPD). The Clinical Respiratory Journal 2008; 2: 158–165.     

The effect of adding group-based counselling to individual lifestyle counselling on changes in dietary intake. The Inter99 study – a randomized controlled trial

Background  

Few studies have investigated the specific effect of single intervention components in randomized controlled trials. The purpose was to investigate the effect of adding group-based diet and exercise counselling to individual life-style counselling on long-term changes in dietary habits.     

Does a population-based multi-factorial lifestyle intervention increase social inequality in dietary habits? The Inter99 study

Objective

To investigate whether the effect of an individualised multi-factorial lifestyle intervention on dietary habits differs across socioeconomic groups.

Methods

The study was an individualised multi-factorial lifestyle intervention study with a control group, Inter99 (1999-2006), Copenhagen, Denmark. Participants in the intervention group (n = 6 091) received lifestyle intervention during a five-year period. The control group (n = 3 324) was followed by questionnaires. Multilevel regression analyses were used, including interaction term between intervention effect and socioeconomic position (SEP) and analysed separately for men and women. SEP was measured as length of education and employment status and dietary habits were measured by a validated food frequency questionnaire.

Results

Men with a short education improved their dietary habits more (net-change [95% confidence interval]) (0.25 points [− 0.01;0.52]) than men with longer education (0.02 points [− 0.09;0.14]), (interaction: p = 0.02). Furthermore, unemployed women improved their dietary intake more (0.33 points [0.05;0.61]) than employed women (0.01 points [− 0.10;0.11]), (interaction: p = 0.03). Similar results were found for fruit intake, whereas no significant interactions were found for fish, fat and vegetable intake.

Conclusions

Individualised dietary interventions do not increase and may even decrease or hinder further widening of the social inequalities in health due to unhealthy dietary habits among socially disadvantaged individuals.     

Type 2 diabetes risk allele near <Emphasis Type="Italic">CENTD2</Emphasis> is associated with decreased glucose-stimulated insulin release

Aims/hypothesis  

By combining multiple genome-wide association (GWA) studies and comprehensive replication efforts, 12 novel type 2 diabetes associated loci have recently been discovered. Here we evaluate the effect of lead variants of these loci on estimates of insulin release and insulin resistance derived from an oral glucose tolerance test.     

Association of obesity and insulin resistance with asthma and aeroallergen sensitization

Background:  It has been hypothesized that obesity and insulin resistance may play a role in the development of asthma and allergy. The aim of the study was to examine the association of obesity and insulin resistance with asthma and aeroallergen sensitization.
Methods:  Cross-sectional population-based study of 3609 Danish men and women aged 30–60 years. Aeroallergen sensitization was defined as positive levels of specific IgE against a panel of inhalant allergens. Asthma was defined as self-reported physician diagnosed asthma. Allergic asthma was defined as the presence of both asthma and aeroallergen sensitization. The homeostasis model assessment of insulin resistance was used to estimate the degree of insulin resistance. Body mass index, waist-to-hip ratio, and waist circumference were used as measures of obesity. Data were analyzed by multiple logistic regression analyses.
Results:  Obesity was associated with increased risk of aeroallergen sensitization as well as allergic and nonallergic asthma. Insulin resistance was asssociated with aeroallergen sensitization and allergic asthma, but not nonallergic asthma. The associations of obesity with aeroallegen sensitization and allergic asthma became nonsignificant after adjustment for insulin resistance, whereas the association of obesity with nonallergic asthma was unaffected. No sex-differences were observed.
Conclusion:  Obesity may be related to an increased risk of aeroallergen sensitization and allergic asthma through mechanisms also involved in the development of insulin resistance.     

Waist circumference and weight following smoking cessation in a general population: the Inter99 study

OBJECTIVE: Central obesity is an independent risk factor of mortality. Change in waist circumference after smoking cessation has not been previously reported in a population-based prospective study of both sexes. METHODS: Population-based study, Inter99, 1999-2001 in Copenhagen, Denmark. 2408 daily smokers completed questionnaires and had their waist circumference and weight measured. Of these, 221 biochemically verified non-smokers and 1122 continuous smokers attended 1-year follow-up and had their waist circumference and weight measured. RESULTS: The mean increase in waist circumference was 3.88 cm (+/-5.4 cm) and 42% of the quitters had increased their waist circumference by > or = 5 cm. Quitters with high baseline tobacco consumption (OR 1.05, 95% CI=1.0-1.1) and quitters with self-reported reduced physical activity (OR 3.4, 95% CI=1.5-7.7) were more likely to have substantially increased waist circumference. The mean weight gain in quitters was 4.22 kg (+/-4.3 kg) and 41% had gained at least 5 kg. Female quitters gained more weight and had a higher increase in waist circumference than men. Abstinence from smoking was the most important predictor of substantial weight gain and substantial increase in waist circumference. CONCLUSIONS: Smoking cessation resulted in substantial increase in weight and central fat, which might attenuate some of the beneficial effects of smoking cessation. Quitters who reduced their physical activity and persons with high baseline tobacco consumption were more likely to have had a substantial increase in abdominal fat. Abstinence from smoking was the most important predictor of short-term weight gain and increase in waist circumference. It is a challenge for future smoking cessation interventions to achieve a combination of high quit rates and weight-control.     

Smoking reduction and cessation reduce chronic cough in a general population: the Inter99 study

Background: Chronic cough can be the first sign of chronic obstructive disease. A few, and mostly selected, studies exploring the effect of reduced daily tobacco consumption have shown a small effect on pulmonary symptoms. Aim: The aim of this study was to examine if smoking reduction (SR) (≥50% of daily tobacco consumption) or smoking cessation (SC) had an effect on chronic cough and phlegm. Methods: A total of 2408 daily smokers were included in a Danish population‐based intervention study, Inter99. In the analyses, we included smokers with self‐reported chronic cough or phlegm at baseline who also attended the 1‐year follow‐up. We investigated if SR or SC had improved the self‐reported pulmonary symptoms, using logistic regression analyses. Results: Almost 34% of the smokers had chronic cough at baseline and 24.5% had chronic phlegm. Thirty‐seven persons with cough at baseline and 24 with phlegm at baseline achieved substantial SR at 1‐year follow‐up. The corresponding numbers for SC were 63 and 39, respectively. In adjusted analyses, quitting or reducing smoking was associated with less reporting of cough [odds ratio (OR): 14.2; 95% confidence interval (CI): 5.9–34.4] and (OR: 3.7; 95% CI: 1.7–8.0), respectively, compared with unchanged smoking habits. It was also significantly more likely not to report phlegm at 1‐year follow‐up for those who had quit (OR: 7.1; 95% CI: 2.8–18.0), whereas SR was not significantly associated with termination of phlegm (OR: 2.5; 95% CI: 0.9–6.4) when compared with continuous smoking. Conclusion: SC significantly improved self‐reported chronic cough and phlegm as expected. Substantial SR was achieved by few smokers but had a significantly positive effect on chronic cough. Please cite this paper as: Pisinger C, Godtfredsen NS and Jørgensen T. Smoking reduction and cessation reduce chronic cough in a general population: the Inter99 study. The Clinical Respiratory Journal 2008; 2: 41–46.     

Low birthweight and premature birth are both associated with type 2 diabetes in a random sample of middle-aged Danes

Aims/hypothesis  

We studied the associations of size at birth and prematurity with type 2 diabetes, insulin sensitivity and beta cell function in the Danish population-based Inter99 study (ClinicalTrials.gov NCT00289237).     

Smoking reduction intervention in a large population-based study. The Inter99 study

BACKGROUND: Smoking reduction has been introduced as an alternative to smokers unable or unwilling to quit but has never been implemented in a population-based intervention. METHODS: Two thousand four hundred eight daily smokers in all motivational stages were included in a randomised population-based intervention study, in Copenhagen, Denmark. Smokers, unwilling or unable to quit, were encouraged to reduce their tobacco consumption. Furthermore, smokers in the high-intensity intervention were offered participation in smoking reduction groups. RESULTS: Twenty-three percent of those who attended both baseline and 1 year visit reported reduction by at least 5 g and 8% reported a halving or more. Halving of tobacco consumption was achieved significantly more often than in the background population, OR = 2.6 (1.6-4.4), even when assuming that non-participants had not reduced, OR = 1.7 (1.0-2.8). Reduction of at least 5 g doubled the probability of increased motivation to quit and a halving increased it more than four times. The reductions were not validated. Less than 2% attended the smoking reduction groups. CONCLUSION: The smoking reduction intervention was significant in self-reported reduction of tobacco consumption and subsequently increased motivation to quit. This may open new perspectives, with reduction as a first step towards cessation, a possible supplement to smoking cessation strategies.     

Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review

A review of the literature revealed high comorbidity of chronic obstructive pulmonary disease (COPD) and states of anxiety and depression, indicative of excess, psychiatric morbidity in COPD. The existing studies point to a prevalence of clinical significant symptoms of depression and anxiety amounting to around 50%. The prevalence of panic disorder and major depression in COPD patients is correspondingly markedly increased compared to the general population. Pathogenetic mechanisms remain unclear but both psychological and organic factors seem to play a role. The clinical and social implications are severe and the concurrent psychiatric disorders may lead to increased morbidity and impaired quality of life. Furthermore, the risk of missing the proper diagnosis and treatment of a concurrent psychiatric complication is evident when COPD patients are treated in medical clinics. Until now only few intervention studies have been conducted, but results suggest that treatment of concurrent psychiatric disorder leads to improvement in the physical as well as the psychological state of the patient. Panic anxiety as well as generalized anxiety in COPD patients is most safely treated with newer antidepressants. Depression is treated with antidepressants according to usual clinical guidelines. There is a need for further intervention studies to determine the overall effect of antidepressants in the treatment of anxiety and depression in this group of patients.