Irving Kass

Smoking cessation among patients with chronic obstructive pulmonary disease (COPD)

Abstract Nine variables were assessed to determine which were most associated with the ability to quit smoking among 107 pulmonary rehabilitation patients with chronic obstructive pulmonary disease (COPD). Most (67%) patients were ex-smokers at the time of admission. Discriminant analysis revealed that psychosocial factors were significantly related to the ability to stop smoking prior to hospitalization, and pack-years smoking history significantly differentiated smokers from ex-smokers at follow-up 5–54.5 months after hospitalization. None of the other variables were significantly associated with smoking cessation, and even the two significant variables (psychosocial assets and pack-years) were not able to separate smokers from ex-smokers beyond base-rate expectations. While most smokers with COPD did quit smoking, those who failed to do so prior to their hospitalization were likely to continue their habit indefinitely.

Cognitive functioning and survival among patients with chronic obstructive pulmonary disease.

An earlier study by the authors had demonstrated neuropsychological impairment among 66 clinically stable patients suffering from chronic obstructive pulmonary disease (COPD), and had found that the deficits were directly associated with the amount of oxygen available to body tissue. We were able to follow 62 of the patients for three years when retrospective analyses were performed to determine the relationship of the neuropsychological test scores with the patients three-year survival status. Patients who survived had scored significantly (p less than 0.01) higher on the neuropsychological tests than those who had died. Individual analyses of variance indicated that the significant relationship between the neuropsychological tests and survival status was attributable primarily to the Benton Visual Motor Retention Test and the digit symbol subtest of the Wechsler Adult Intelligence Scale. The latter test had, in the earlier study, shown the strongest relationship with partial pressure of oxygen and with a pulmonary function test. These findings suggest that certain neuropsychological tests may reflect both the progress of COPD and three-year survival probability among the patients.

RELATIONSHIP BETWEEN A PULMONARY FUNCTION TEST (FEV1) AND THE ADAPT QUALITY-OF-LIFE SCALE

In a previous study the Additive Daily Activities Profile Test (ADAPT©) correlated .83 with maximum oxygen consumption among pulmonary rehabilitation patients. The present study expanded the pulmonary population base and compared the ADAPT scores of 41 patients at two independent centers with a more readily available parameter, the forced expiratory volume in the first second of forced exhalation (FEV1). The relationships between the two major ADAPT subscales and FEV1 were significant but lower in magnitude than that found with maximum oxygen consumption. The ADAPT continues to be sensitive to physical impairment and in translating the effect of impairment upon daily physical activity.

Smoking intervention: Combination therapy using nicotine chewing gum and the American Lung Association's “Freedom from Smoking” manuals

The smoking cessation efficacy of a two-session group program using the American Lung Associations Freedom from Smoking self-help manuals, nicotine gum, and brief, repeated professional supervision was estimated in an uncontrolled clinical trial. Of the 39 participants, 12 (31%) remained cigarette free for 1 year, and 4 others (10%) had not smoked during the 3 months prior to the 1-year follow-up. Claims of cessation were verified by expired-air carbon monoxide measurement. Nearly all successful abstainers were able to achieve 48-hr cessation during their first week using the gum. This finding suggests that nicotine gum is best used to help the smoker quit abruptly, rather than as an aid in a tapering-off strategy. This studys smoking intervention program appears to provide a relatively low-cost method of improving the success rates among smokers who wish to quit.

Personality traits affecting vocational rehabilitation success in patients with chronic obstructive pulmonary disease.

Item analysis of the Minnesota Multiphasic Personality Inventory responses of 147 patients with chronic obstructive pulmonary disease produced 48 items associated with three levels of post-hospital vocational adjustment, and with death. A subgroup of vocational rehabilitation candidates provided insights to the psychological processes underlying successful outcome. Those who worked more than six months following hospitalization were more gregarious and used more denial than other patients. Those who did not work at all were more anxious and had lower self-confidence. Patients who died within a year had shown a charitable philosophical orientation.

Urinary Alkalinization and Smoking Cessation.

Previous studies have shown that large doses of a urinary alkalinizing agent reduced cigarette consumption spontaneously among smokers. After establishing a safe daily dose of an alkalinizing agent, sodium bicarbonate, its effect upon smoking cessation rates among 72 enrollees in a smoking cessation program was studied. In the first study, we determined that sodium bicarbonate (3900 mg per day) significantly increased urinary pH (from 6.0 to 6.7) and lowered titratable acidity. Ascorbic acid (1500 mg per day) had no effect of pH or acidity. In a second study, a group given sodium bicarbonate surpassed a placebo control group (who were given 1500 mg per day ascorbic acid) in total daily cigarette reduction after 5 weeks and in week-to-week smoking reduction. The groups did not, however, differ in the number who achieved total abstinence.

Physiological-intellectual components of rehabilitation success in patients with chronic obstructive pulmonary disease (COPD)☆

Abstract Intelligence test scores (IQ) and physiological measures were evaluated to determine their relationship in predicting vocational rehabilitation (VR) in patients with chronic obstructive pulmonary diseases (COPD). From a population of COPD patients unrestricted as to age or degree of impairment in a previous study, 52 patients most appropriate for VR in terms of age and severity of disease were selected for retrospective analysis. Intelligence scores were able to predict VR outcome with 83% accuracy. A regression analysis with first-second forced expiratory volume (FEV1.0) and IQ as the predictors increased the accuracy of prediction of VR outcome to 90%. While the FEV1.0 relation to VR outcome has been previously shown, the strong IQ influence as a predictor of VR success in a COPD population was not expected. It was hypothesized that differences in job energy requirements among various IQ levels may be the underlying reason for this finding.

EMOTIONAL, INTELLECTUAL AND PHYSIOLOGICAL PREDICTORS OF VOCATIONAL OUTCOME OF PULMONARY REHABILITATION PATIENTS

Previous researchers have independently shown that pulmonary function measures, intelligence test scores, and a recently developed MMPI-derived scale can predict post-hospital employment among rehabilitation patients with chronic obstructive pulmonary disease. This study compared the effectiveness of the three variables in predicting employment among a group of vocational rehabilitation candidates with chronic obstructive pulmonary disease. Only the MMPI-derived scale (COPD-VR) identified the non-working patients significantly above base rate. While this finding does not necessarily mean that personality, or attitudinal, factors are more important than physiological or intellectual variables in vocational rehabilitation success among such patients, it gives further support to the validity of the COPD-VR scale.

Immediate carbon monoxide estimates and self-reported smoking.

Because carbon monoxide (CO) is an easily understood danger of cigarette smoking, new breath CO analyzers may be useful in cessation programs. Self-reported cigarette consumption and breath CO correlated .70 using a 90-sec. CO-determination method. Smokers averaging 17 daily cigarettes had average breath CO of 24 parts per million (ppm), falling to 7.71 ppm for smokers claiming at least 24-hr. abstinence. Corresponding carboxyhemoglobin (COHb) estimates were 4.34% (slightly above World Health Organization 4% safety limit) and 1.39%. Smoking clinics can use CO-monitoring devices for feedback or surveillance, although feedback would provide the most benefits for participants.

Chest Physiotherapy for Chronic Obstructive Pulmonary Disease

Chest physiotherapy is designed to increase the capacities and activities of the patient with chronic obstructive pulmonary disease. This program of bronchial hygiene, breathing exercises, and physical hardening meets this goal. In addition, patients readily accept the procedures and can continue to use them after discharge with minimal cost and assistance.