Addictions and Recovery

I showed the following graph in the previous blog pertaining to smoking cessation strategies:

It is, indeed, very encouraging, and it shows a progressive improvement in cardiovascular health that extends over many years.

Nonetheless, smoking will set into motion a number of conditions that will persist, perhaps throughout the lifetime of the smoker, and certain elements of cardiovascular health will remain compromised, and this is the topic of this blog. I dedicate in memory of someone very dear to me who started to smoke as a teenager, quit in middle age, and still developed emphysema and chronic obstructive pulmonary disease (COPD) in her later years.

According to Bai, et. al., (2017), “COPD is a major cause of chronic morbidity/mortality and is the fourth leading cause of death all over the world. COPD is characterized by a persistent limitation of airflow caused by chronic inflammatory responses to noxious particles or gases. Cigarette smoking is the most commonly encountered and readily identifiable risk factor for COPD, which progresses in ~15% of smokers. COPD is 3-5 times more likely to occur in smokers than in nonsmokers.”

One of the parameters that is used to measure lung function is FEV(1), i.e. Forced Expiratory Volume in 1 second. According to the CDC, forced expiratory volume in one second (FEV ₁ ) is the most widely used measure for monitoring lung function decline. This, and other lung functions are either measured, or calculated with results collected with a spirometer:

Smart one App-based Personal Spirometer for PEF and FEV1 Home Testing, as shown in https://spirometry.com/en/products/smart-one/.

The normal trajectory of FEV1 is that there is a gradual decline with age:

Data for graph are adapted from Hankinson, et. al., 1999.

The assumption is that any acceleration in decline is indicative of significant lung disease, including COPD.

Oelsner et. al. (2020) show that among the 25,352 participants of their multi-center study, former smokers had a FEV1 decline that was between those of sustained never-smokers and current smokers:

In a long-term study spanning 25 years, Lokke et. al. (2006) clearly showed both that there is a clear benefit to discontinuing smoking and that the risk of developing COPD persists even among those individuals who quit smoking prior to or during the study.

I will concede that I am cherry-picking their results in the following graph, but the authors are emphatic about their assertion that “Smoking cessation, especially early in the follow up period, decreased (blogger’s note: they don’t say ‘eliminate’) the risk of developing COPD substantially compared with continuous smoking. During the follow up period there were 2919 deaths, 109 of which were from COPD. 92% of the COPD deaths occurred in subjects who were current smokers at the beginning of the follow up period.”

Clearly, then, it is far better not to start smoking, and Plan B is to stop smoking as soon as possible.

Bai, J-W; Chen, X-x; Liu, S.; Yu, L.; Xu, J-F. (2017). Smoking cessation affects the natural history of COPD. International Journal of COPD 2017:12 3323-3328.

Hankinson, J.L.; Odencrantz, J.R.; Fedan, K.B. (1999). Spirometric Reference Values from a Sample of the General U.S. Population. Am J. Respir. Crit. Car Med 1999; 159:179-187.

Lokke, A.; Lange, P.; Scharling, H.; Fabricius, P.; Vestbo, J. (2006). Developing COPD: a 25 year follow up study of the general population. Thorax 2006; 61: 935-939. doi 10.1136/thx.2006.062802.

Oelsner, E.C.; Balte, P.P.; Bhatt, S.P.; Cassano, P.A.; Couper, D.; Folsom, A.R.; Freedman, H.D.; Jacobs, D.R., Jr.; Kalhan, R.; Mathew, A.R.; Kronmal, R.A.; Loehr, L.R.; London, S.J.; Newman, A.B.; O’Connor, G.T.; Schwartz, J.E.; Smith, L.J.; White, W.B.; Yende, S.Y. (2020). Lung function decline in former smokers and low-intensity current smokers: the NHLBI Pooled Cohorts Study. Lancet Respir Med. 2020 January; 8(1):34-44. doi:10.1016/S2213-2600(19)30276-0.