Smoking characteristics - Differences in attitudes and dependence between healthy smokers and smokers with COPD

Objective: To ascertain the differences in smoking characteristics between a group of smokers with COPD and another group of healthy smokers, both of which were identified in a population-based epidemiologic study. Design and participants: This is an epidemiologic, multicenter, population- based study conducted in seven areas of Spain. A total of 4,035 individuals , men and women aged 40 to 69 years, who were selected randomly from a targ et population of 236,412 subjects, participated in the study. Interventions: Eligible subjects answered the European Commission for Steel and Coal questionnaire. Spirometry was performed followed by a bronchodila tor test when bronchial obstruction was present. The Fagerstrom questionnai re was used for study of the degree of physical nicotine dependence, and th e Prochazka model was followed for analysis of the smoking cessation phase. Results: Of 1,023 active smokers, 153 (15%) met the criteria for COPD. Smok ers with COPD were more frequently men (odds ratio [OR], 2.18; 95% confiden ce interval [CI], 1.21 to 3.95), were greater than or equal to 46 years of age (OR, 1.97; 95% CI, 1.18 to 3.31), had a lower educational level (OB, 1. 96; 95% CI, 1.23 to 3.14), and had smoked > 30 pack-years (OR, 3.70; 95% CI , 2.42 to 5.65). Smokers with COPD showed a higher dependence on nicotine t han healthy smokers (mean [+/- SD] Fagerstrom test score, 4.77 +/- 2.45 vs 3.15 +/- 2.38, respectively; p < 0.001) and higher concentrations of CO in exhaled air (mean concentration, 19.7 +/- 16.3 vs 15.4 +/- 12.1 ppm, respec tively; p < 0.0001). Thirty-four percent of smokers with COPD and 38.5% of smokers without COPD had never tried to stop smoking. Conclusions: Smokers with COPD have higher tobacco consumption, higher depe ndence on nicotine, and higher concentrations of CO in exhaled air, suggest ing a different pattern of cigarette smoking. Cases of COPD among smokers p redominate in men and in individuals with lower educational levels. A signi ficant proportion of smokers have never tried to stop smoking; thus, advice on cessation should be reinforced in both groups of smokers.