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Objectives: Muscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA).Design and Setting: Participants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history.Participants: The primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits.Interventions: PMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys.Main Outcome Measures: Age-related and excess muscle loss over time.Results: Age, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, p<0.001) over 3 years and in COPDGene with an excess muscle area loss of 2.1% (95% CI 1.2 to 2.8, p<0.001) over 5 years. Excess muscle area decline was absent in 273 individuals who participated in pulmonary rehabilitation.Conclusions: Exacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target. [ABSTRACT FROM AUTHOR]

Background: We present the final results of the effect of lung cancer screening with low-dose CT on the smoking habits of participants in a 5-year screening trial. Methods: The Danish Lung Cancer Screening Trial (DLCST) was a 5-year screening trial that enrolled 4104 subjects; 2052 were randomised to annual low-dose CT (CT group) and 2052 received no intervention (control group). Participants were current and ex-smokers (=4 weeks abstinence from smoking) with a tobacco consumption of =20 pack years. Smoking habits were determined annually. Missing values for smoking status at the final screening round were handled using two different models. Results: There were no statistically significant differences in annual smoking status between the CT group and control group. Overall the ex-smoker rates (CT + control group) significantly increased from 24% (baseline) to 37% at year 5 of screening (p<0.001). The annual point prevalence quit rate increased from 11% to 24% during the five screening rounds; the ex-smokers' relapse rate remained stable, around 11%, across the same period. Conclusions: Screening with low-dose CT had no extra effect on smoking status compared with the control group, but overall the screening programme probably promoted smoking cessation. [ABSTRACT FROM AUTHOR]

Background: The functional effects of abnormal diffusing capacity for carbon monoxide (DLCO) in ex-smokers without chronic obstructive pulmonary disease (COPD) are not well understood. Objective: We aimed to evaluate and compare well established clinical, physiological and emerging imaging measurements in ex-smokers with normal spirometry and abnormal DLCO with a group of ex-smokers with normal spirometry and DLCO and ex-smokers with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I COPD. Methods We enrolled 38 ex-smokers and 15 subjects with stage I COPD who underwent spirometry, plethysmography, St George's Respiratory Questionnaire (SGRQ), 6 min Walk Test (6MWT), x-ray CT and hyperpolarised helium-3 (³He) MRI. The 6MWT distance (6MWD), SGRQ scores, ³He MRI apparent diffusion coefficients (ADC) and CT attenuation values below -950 HU (RA950) were evaluated. Results: Of 38 ex-smokers without COPD, 19 subjects had abnormal DLCO with significantly worse ADC ( p=0.01), 6MWD ( p=0.008) and SGRQ (p=0.01) but not RA950 ( p=0.53) compared with 19 ex-smokers with normal DLCO. Stage I COPD subjects showed significantly worse ADC (p=0.02), RA950 (p=0.0008) and 6MWD (p=0.005), but not SGRQ (p=0.59) compared with subjects with abnormal DLCO. There was a significant correlation for ³He ADC with SGRQ (r=0.34, p=0.02) and 6MWD (r=-0.51, p=0.0002). Conclusions: In ex-smokers with normal spirometry and CT but abnormal DLCO, there were significantly worse symptoms, 6MWD and ³He ADC compared with exsmokers with normal DLCO, providing evidence of the impact of mild or early stage emphysema and a better understanding of abnormal DLCO and hyperpolarised ³He MRI in ex-smokers without COPD. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To estimate the risk of dying from all causes and from specified smoking-related diseases in people who were ex-smokers at two consecutive examinations, compared with never smokers and with people who were ex-smokers at the first examination but who had resumed smoking at the following examination. DESIGN: A prospective cohort study. SETTING: Three counties in Norway. PARTICIPANTS: A total of 23 560 men and 25 122 women, aged 20–49, screened for cardiovascular disease risk factors in the mid 1970s, rescreened after 3–13 years and followed throughout 2005 participated in this study. OUTCOMES: Absolute mortality and relative risks adjusted for confounding variables, of dying from all causes, cardiovascular disease, ischaemic heart disease, stroke, lung cancer and other smoking-related cancer. RESULTS: With sustained never smokers as reference, the sustained ex-smokers had adjusted relative risk (95% CI), of dying from any cause, for men 0.97 (0.80 to 1.18), for women 0.98 (0.65 to 1.48). Corresponding risk for ex-smokers who resumed smoking was for men 1.59 (1.32 to 1.91), for women 1.40 (1.08 to 1.81). For the specified smoking-related diseases, the risk in sustained ex-smokers was not significantly different from the risk in sustained never-smokers, except for lung cancer in men. For ex-smokers who resumed smoking, the corresponding risk was on the whole significantly higher. CONCLUSIONS: A more valid and favourable picture of ex-smokers’ risk will be obtained if exposure is being based upon people with two consecutive examinations, years apart. The study confirms clearly the large health benefit of quitting smoking for good. [ABSTRACT FROM AUTHOR]

Background: Although several epidemiological studies have examined the mortality among users of spit tobacco, none have compared mortality of former cigarette smokers who substitute spit tobacco for cigarette smoking ("switchers") and smokers who quit using tobacco entirely. Methods: A cohort of 116 395 men were identified as switchers (n=4443) or cigarette smokers who quit using tobacco entirely (n= 111 952) when enrolled in the ongoing US American Cancer Society Cancer Prevention Study II. From 1982 to 31 December 2002, 44 374 of these men died. The mortality hazard ratios (HR) of tobacco-related diseases, including lung cancer, coronary heart disease, stroke and chronic obstructive pulmonary disease, were estimated using Cox proportional hazards regression modelling adjusted for age and other demographic variables, as well as variables associated with smoking history, including number of years smoked, number of cigarettes smoked and age at quitting. Results: After 20 years of follow-up, switchers had a higher rate of death from any cause (HR 1.08, 95% confidence interval (CI) 1.01 to 1.15), lung cancer (HR 1.46, 95% CI 1.24 to 1.73}, coronary heart disease (HR 1.13, 95% CI 1.00 to 1.29) and stroke (HR 1.24, 95% CI 1.01 to 1.53) than those who quit using tobacco entirely. Conclusion: The risks of dying from major tobacco-related diseases were higher among former cigarette smokers who switched to spit tobacco after they stopped smoking than among those who quit using tobacco entirely. [ABSTRACT FROM AUTHOR]

Aims: Little is known about the extent to which quit attempts are planned ahead or initiated immediately following a sudden decision to quit. This is important because if most smokers quit abruptly, rather than plan ahead, this could impact heavily upon recommendations to health care professionals on the kind of smoking cessation advice they deliver to patients. This paper aims to address this gap in knowledge by examining detailed smoking histories taken from smoking and ex-smoking patients. Design: Face-to-face in depth semi-structured interviews. Participants: 146 smoking and ex-smoking patients within a family medicine practice were recruited by means of screening 700 consecutive patients (14 years of age and older) and inviting eligible patients to participate. To be eligible, patients had to have smoked a minimum of five cigarettes per day for at least six months in their lives and made at least one serious quit attempt that lasted at least 24 hours. There were no refusals. Ex-smokers (n = 67) were defined as those who had not smoked for six months. The remainder were classified as smokers (n = 79). Measurements: Participants were asked to describe, in their own words, their most recent quit attempt and whether they had planned the quit attempt in advance, what were the triggers, and how long they abstained. A quit attempt was defined as planned if smokers set a quit date at some future time point. An unplanned quit attempt was defined as a sudden decision not to smoke any more cigarettes including those that might be remaining in the current pack. Information was also collected on methods used to quit and reasons for quilting. Results: A majority (51.6%) of quit attempts were reported as being unplanned. The figure was higher for ex-smokers than for smokers (67.1 % v 36.7%, p « 0.001). Most quit attempts were unaided (64%) and made for reasons of health (64%). Conclusions: The finding that so many quit attempts are unprepared suggests that models of smoking cessation should place greater emphasis on the dynamic nature of motivation to quit. This is an area that requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: To estimate the number of deaths that could be prevented in the UK by implementing population strategies to reduce smoking prevalence. Design: A prospective analysis of future mortality using recent national smoking prevalence data and relative risks of mortality in current smokers, ex-smokers, and never-smokers. Population: Smokers in the UK. Interventions: Population measures of proven effectiveness assumed to reduce smoking prevalence by 1 percentage point per year for 10 years, or alternatively by 13% over 19 years (1 percentage point per annum for seven years, 0.5 percentage point per annum for 12 years) as considered to be achievable in a recent report to the UK Chancellor of the Exchequer. Main outcome measure: Estimated deaths from smoking prevented in the 35-75 year age group. Results: Reducing the prevalence of smoking by 1 percentage point each year for 10 years would prevent 69 049 deaths at ages between 35 and 74 years during that period. The model of reduction by 13% over 19 years would prevent 54 308 and 194 493 deaths in 10 and 19 years, respectively. Continued prevalence reductions at the current rate of 0.4 percentage points each year will prevent 23 192 deaths over 10 years. Conclusions: Full implementation of simple population measures to encourage smoking cessation could prevent substantial numbers of deaths in the UK. [ABSTRACT FROM AUTHOR]

Objective: This study examined the impact of smoking, quitting, and time since quit on absences from work. Methods: Data from the nationally representative Tobacco Use Supplements of the 1992/93, 1995/96, and 1998/99 Current Population Surveys were used. The study included full time workers aged between 18-64 years, yielding a sample size of 383 778 workers. A binary indicator of absence due to sickness in the lost week was analysed as a function of smoking status including time since quit for former smokers. Extensive demographic variables were included as controls in all models. Results: In initial comparisons between current and former smokers, smoking increased absences, but quitting did not reduce them. However, when length of time since quit was examined, it was discovered that those who quit within the last year, and especially the last three months, had a much greater probability of absences than did current smokers. As the time since quitting increased, absences returned to a rate somewhere between that of never and current smokers. Interactions between health and smoking status significantly improved the fit of the model. Conclusions: Smokers who quit reduced their absences over time but increase their absences immediately after quilting. Quitting ill may account for some but not all of this short run impact. [ABSTRACT FROM AUTHOR]

Objective: Past studies hove produced ambiguous or inconsistent results when testing whether smokers actually underestimate their own risks of experiencing tobacco related illness. Whereas smokers claim that they ore less at risk than the average smoker on self administered questionnaires, this unrealistic optimism has not been found in telephone or face-to-face interviews. We avoided the measurement problems of past studies and examined responses to a number of new questions to assess different aspects of smokers' perceptions. Methodology: A US national telephone survey (n = 6369; 1245 current smokers) posed a variety of questions designed to examine beliefs about the risks of smoking. For key questions, separate samples of smokers were asked either about their own risk or about the risk of the average smoker. Results: Smokers underestimated their relative risk compared to non-smokers and, contrary to previous interview surveys, believed they have a lower risk of developing lung cancer than the average smoker. Furthermore, their perceived risk of lung cancer and of cancer in general barely increases with the number of cigarettes smoked per day, and their estimates of their risk of cancer are actually slightly lower than their estimates of their risk of lung cancer. Substantial proportions of smokers and former smokers agree with several myths, more than half agreeing that exercise undoes most smoking effects. Conclusion: Smokers underestimate their risk of lung cancer both relative to other smokers and to non- smokers and demonstrate other misunderstandings of smoking risks. Smoking cannot be interpreted as a choice made in the presence of full information about the potential harm. [ABSTRACT FROM AUTHOR]

Background: Sex specific cross sectional reference values for lung function indices usually employ a linear model with terms for age and stature. The effects of also matching for body mass index (BMI = mass/stature(2)) or its components, fat percentage of body mass (fat%) and fat free mass index (FFMI = fat free mass/stature(2)) were studied.Methods: The subjects were 458 asymptomatic male and female non-smokers (383 men) and 22 female ex-smokers. Measurements were made of ventilatory capacity, lung volumes, transfer factor (diffusing capacity, single breath CO method), and body composition (skinfold method). Linear and proportional regression models were used.Results: Terms for fat% and FFMI significantly improved the accuracy of reference values for all the primary lung function indices. The improvements in subjects with atypical physiques (fat% and FFMI at the ends of the distributions for the subjects) were in the range 0.3-2.3 SD compared with conventional regression equations. The new partial regression coefficients on age were independent of age related changes in body fat. The coefficient for total lung capacity (TLC) on age in men was now positive. Most differences between the sexes were eliminated. A term for BMI improved the descriptions of subdivisions of TLC but lacked the other advantages.Conclusion: Allowance for fat% and FFMI increases the accuracy of reference equations for lung function, particularly for subjects with a lot of fat and little muscle or vice versa. Allowance for BMI is less informative. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To: evaluate the impact of smoking status on objective productivity and absenteeism measures; evaluate the impact of smoking status on subjective measures of productivity; and assess the correlation between subjective and objective productivity measures. DESIGN: Prospective cohort study in a workplace environment. SUBJECTS: Approximately 300 employees (100 each of former, current, and never smokers) at a reservation office of a large US airline. MAIN OUTCOME MEASURES: Objective productivity and absenteeism data were supplied by the employer. Subjective assessments of productivity were collected using a self report instrument, the Health and Work Questionnaire (HWQ). RESULTS: Current smokers had significantly greater absenteeism than did never smokers, with former smokers having intermediate values; among former smokers, absenteeism showed a significant decline with years following cessation. Former smokers showed an increase in seven of 10 objective productivity measures as compared to current smokers, with a mean increase of 4.5%. While objective productivity measures for former smokers decreased compared to measures for current smokers during the first year following cessation, values for former smokers were greater than those for current smokers by 1-4 years following cessation. Subjective assessments of "productivity evaluation by others" and "personal life satisfaction" showed significant trends with highest values for never smokers, lowest for current smokers, and intermediate for former smokers. CONCLUSIONS: Workplace productivity is increased and absenteeism is decreased among former smokers as compared to current smokers. Productivity among former smokers increases over time toward values seen among never smokers. Subjective measures of productivity provide indications of novel ways of productivity assessment that are sensitive to smoking status. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate health expectancy-- that is, the average lifetime in good health--among never smokers, ex-smokers, and smokers in Denmark. DESIGN: A method suggested by Peto and colleagues in 1992 for estimating smoking attributable mortality rates was used to construct a life table for never smokers. This life table and relative risks for death for ex-smokers and smokers versus never smokers were used to estimate life tables for ex-smokers and smokers. Life tables and prevalence rates of health status were combined and health expectancy was calculated by Sullivan's method. SETTING: The Danish adult population. MAIN OUTCOME MEASURES: The expected lifetime in self rated good health or without longstanding illness for never smokers and smokers. RESULTS: The expected lifetime of a 20 year old man who will never begin to smoke is 56.7 years, 48.7 (95% confidence interval (CI), 46.8 to 50.7) years of which are expected to be in self rated good health. The corresponding figures for a man who smokes heavily are 49.5 years, 36.5 (95% CI 35.0 to 38.1 ) years of which are in self rated good health. A 20 year old woman who will never begin to smoke can expect to live a further 60.9 years, with 46.4 (95% CI 44.9 to 47.8) years in self rated good health; if she is a lifelong heavy smoker, her expected lifetime is reduced to 53.8 years, 33.8 (95% CI 31.7 to 35.9) years of which are in self rated good health. Health expectancy based on long standing illness is reduced for smokers when compared with never smokers. CONCLUSIONS: Smoking reduces the expected lifetime in good health and increases the expected lifetime in poor health. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: To examine the long term impact of workplace smoking bans on employee smoking cessation and relapse. Over three years we studied a total of 1033 current or former smokers (intervention group) employed in smoke-free hospitals and 816 current or former smokers (comparison group) employed in non-smoke-free workplaces. The design of this natural experiment is a prospective cohort study. We randomly selected both hospitals and employees from 12 strata based on hospital size and state tobacco regulations, and sampled employees in the same communities. Main outcome measures were post-ban quit ratio and relapse rate. RESEARCH DESIGN: Between groups comparisons were conducted using the Cochran-Mantel-Haenszel statistic for general association, stratified Cox proportional hazards models, and the CMH analysis of variance statistic based on ranks. McNemar''s test and the sign test were used to test for changes over time within each group. RESULTS: Differences in the post-ban quit ratio were observed between intervention and comparison groups (p &les; 0.02). For employees whose bans were implemented at least seven years before survey, the post-ban quit ratio was estimated at 0.256, compared with 0.142 for employees in non-smoke-free workplaces (p = 0.02). After controlling for a variety of factors, time to quit smoking was shorter for the hospital employees (p < 0.001), with an overall relative risk of quitting of 2.3. Contrary to expectations, relapse rates were similar between the groups. CONCLUSION: Employees in workplaces with smoking bans have higher rates of smoking cessation than employees where smoking is permitted, but relapse is similar between these two groups of employees. The results of this investigation have international applicability for policy makers, clinicians, employers, and employees. Countries should review smoking policies in workplaces in light of their own smoking patterns and efforts to deal with environmental tobacco smoke. [ABSTRACT FROM AUTHOR]

Objective To assess the extent to which the prevailing model of smoking cessation (that smokers typically prepare their attempts to stop smoking in advance and that doing so increases their chances of success) is correct. Design Cross sectional household survey. Setting England. Participants 918 smokers who reported having made at least one quit attempt and 996 ex-smokers aged 16 and over. Main outcome measures Whether the most recent quit attempt was planned in advance and whether quit attempts made at least six months before resulted in at least six months' abstinence. Results 48.6% of smokers reported that their most recent quit attempt was put into effect immediately the decision to quit was made. Unplanned quit attempts were more likely to succeed for at least six months: among respondents who had made a quit attempt between six months and five years previously the odds of success were 2.6 times higher (95% confidence interval 1.9 to 3.6) in unplanned attempts than in planned attempts; in quit attempts made 6-12 months previously the corresponding figure was 2.5 (1.4 to 4.7). The differences remained after controlling for age, sex, and socioeconomic group. Conclusions A model of the process of change based on "catastrophe theory" is proposed, in which smokers have varying levels of motivational "tension" to stop and then "triggers" in the environment result in a switch in motivational state. If that switch involves immediate renunciation of cigarettes, this can signal a more complete transformation than if it involves a plan to quit at some future point. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of cigarette smoking and right ventricular (RV) systolic and diastolic functions in a population-based cohort of individuals at middle age., Methods: This cross-sectional study included participants who answered the smoking questionnaire and underwent echocardiography at the Coronary Artery Risk Development in Young Adulthood year 25 examination. RV systolic function was assessed by echocardiographic-derived tricuspid annular plane systolic excursion (TAPSE) and by right ventricular peak systolic velocity (RVS'), while RV diastolic function was evaluated by early right ventricular tissue velocity (RVE'). Multivariable linear regression models assessed the relationship of smoking with RV function, adjusting for age, sex, race, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, diabetes mellitus, alcohol consumption, pulmonary function, left ventricular systolic and diastolic function and coronary artery calcium score., Results: A total of 3424 participants were included. The mean age was 50±4 years; 57% were female; and 53% were black. There were 2106 (61%) never smokers, 750 (22%) former smokers and 589 (17%) current smokers. In the multivariable analysis, current smokers had significantly lower TAPSE (β=-0.082, SE=0.031, p=0.008), RVS' (β=-0.343, SE=0.156, p=0.028) and RVE' (β=-0.715, SE=0.195, p<0.001) compared with never smokers. Former smokers had a significantly lower RVE' compared with never smokers (β=-0.414, SE=0.162, p=0.011), whereas no significant difference in RV systolic function was found between former smokers and never smokers., Conclusions: In a large multicenter community-based biracial cohort of middle-aged individuals, smoking was independently related to both worse RV systolic and diastolic functions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Examines the concentration of plasma lipoprotein after smoking cessation. Increase in high-density lipoprotein concentration; Nutritional factors in the plasma lipoprotein concentration among smokers; Measurement of the time-course for changes in lipoprotein concentration.

Life time smoking of ready made cigarettes can be readily quantified as "pack years" smoked, but methods For measuring loose tobacco use are less well established. In this study the frequency of loose tobacco use by 247 hospital in-patients was determined; 64%were current or ex-smokers, 41.3% of whom (25.9% of participants) had smoked loose tobacco. A formula was developed for converting loose tobacco use to pack years smoked; based on the weight of tobacco in ready made cigarettes; 12.59 or hail On ounce of loose tobacco was approximately equivalent to one packet of 20 cigarettes. Using a. questionnaire it was Found that hospital physicians of all grades were able to convert smoking histories of ready made cigarettes, but not loose tobacco, into number of "pack years" smoked. [ABSTRACT FROM AUTHOR]

Presents medicine and the media. Show on radio, In the Psychiatrist's Chair, hosted by Professor Anthony Clare and Dr. Eddie Roebuck; Conversations of Mr. Clare with formal celebrities; Survey conducted on the ranks of ex-smokers; Presentation of Endless Variety Show, by eight to 11 years old of St. Peter's Primary School; History and great events.

The article discusses the claim by former British health secretary John Reid that smoking increased people's enjoyment of life. The article discusses research that refutes the claim that smoking is associated with a heightened enjoyment of life. The study shows that smokers have lower levels of pleasure and quality of life than people who have never smoked, with ex-smokers being somewhere in between. The study focused on 9176 men and women 50 years old or older. The subjects were asked about past and present smoking habits, and their socioeconomic conditions. The subjects were also asked questions to gauge their quality of life.

The article presents a systematic review of smokers and ex-smokers with chronic asthma, who did not respond to high dose oral corticosteroids. Patients who had never smoked had improvement in prealbuterol forced expiratory volume and asthma control scores with prednisone compared with placebo, whereas smokers and ex-smokers did not. Morning peak expiratory flow improved in never-smokers and ex-smokers but not current smokers. Early data on the underlying biological mechanisms of smoking related corticosteroid resistance in asthma suggest a different inflammatory process resembling non-eosinophilic asthma.

Reports that five senior managers of a tobacco manufacturer in the Netherlands have been subpoenaed to give evidence under oath about what they know of the health damages caused by smoking. Case brought by two seriously ill former smokers who claim they were not sufficiently warned of the dangers of smoking; Expectations for the case.

Focuses on the end of the litigation of ex-smokers with lung cancer against British companies, Imperial Tobacco Ltd. and Gallaher Ltd. when a number of smokers withdrew their claims. Decision of the High Court on the litigation; Comments from a High Court judge.