Review Question - QID 102960

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Smoking Cessation Introduction Smoking cessation should be discussed with all smokers at EVERY clinical contact QID: 102960 (M3.PY.16.19)

QID 102960 (Type "102960" in App Search)

A 65-year-old male comes into your office for a check-up. He states that he has been feeling tired and short of breath but does not have any fevers or cough. He has a history of smoking 1 pack of cigarettes per day for the last 40 years. He states that, over the last few years, he has had difficulty walking even one block. He cannot climb a set of stairs and states that he has been hospitalized many times over the past year for pneumonia. He is prescribed inhaled corticosteroids along with ipratropium and albuterol. His chest radiograph is shown in Figure A. Which of the following is most likely to decrease this patient's risk of hospitalizations for disease exacerbation and development of lung cancer?

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Home oxygen therapy

0/1

Long acting beta2-agonist

0/1

Antibiotics

0/1

Oral corticosteroids

0/1

Smoking cessation

100%

1/1

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An elderly patient presenting with a 40 pack-year history of smoking in the setting of increased shortness of breath is likely suffering from chronic obstructive pulmonary disease (COPD). Smoking cessation is most likely to decrease both his risk for future hospitalizations and his risk for developing lung cancer.

COPD is an illness that mainly affects smokers and is diagnosed with spirometry in clinically stable patients with a post-bronchodilator forced expiratory volume in one second (FEV1) / forced vital capacity (FVC) ratio of less than 0.70. All patients with COPD who smoke should be counseled about smoking cessation. Influenza and pneumococcal vaccinations are recommended for all patients with COPD due to impaired bronchociliary clearance and increased mortality in the setting of illness, especially pneumonia.

Lee et al. discuss COPD and its associated guidelines. In those with mild intermittent symptoms, they recommend a short-acting anticholinergic or a short-acting beta2 agonist. In those with persistent symptoms, they recommend adding long-acting anticholinergics or beta2 agonists. In those with exacerbations or even worse cases of COPD, they recommend a combination of an inhaled corticosteroid and a long-acting beta2 agonist along with an anticholinergic (triple therapy). They also note that continuous oxygen therapy improves mortality in patients with severe COPD.

Kinnula et al. discuss the effects of smoking cessation programs over a 10-year period in Finland. They report that over that period, smoking decreased in males (30% to 26%, P<0.01) and females (20% to 17%, P<0.01). They also noticed a significant decrease in hospitalizations relating to COPD (down 39.7%, P<0.01) along with a decrease of 88% in COPD-related healthcare costs.

Figure A shows an AP radiograph of the patient's chest, showing hyperinflation with hyperlucency in the lung fields suggestive of COPD in the setting of his smoking history.

Incorrect Answers:
Answers 1 and 2: Continuous home oxygen therapy and long-acting beta2-agonists have been shown to decrease mortality in patients with severe COPD, but they are not as effective as smoking cessation.
Answer 3 and 4: The patient is not presenting with an exacerbation or symptoms of pneumonia, so he does not require antibiotics. Furthermore, these interventions have not shown to be as effective as smoking cessation for decreasing future hospitalizations and risk of lung cancer.