Norman G. Hepper

Detection of chronic obstructive lung disease. An evaluation of the medical history and physical examination.

The value of a standard medical history and physical examination in the diagnosis of chronic obstructive lung disease was tested. Nine hundred and ninety-three male patients 40 years old and older were studied at the Mayo Clinic by the use of ventilatory tests and a retrospective review of the medical record for pulmonary symptoms and physical signs. Nearly 20% had abnormal results on at least one test, and about 28% were classified as clinically abnormal according to specified criteria. Ventilatory test results were abnormal in 10% of 714 patients in whom no symptoms, signs, or past history of pulmonary disease was noted. This represents the detection rate for ventilatory abnormality by the use of routine spirometry. Severe degrees of impairment of ventilation may be undetected by the history and physical examination.

Long-Term Follow-Up of Persons Attending a Community-Based Smoking-Cessation Program

The long-term effectiveness of a smoking-cessation program based on education, behavior modification, and group support was evaluated. Because of the availability of long-term follow-up data, the natural history of cessation of smoking in persons who had attended a smoking-cessation program could be studied. At 1 year, the permanent rate of cessation of smoking was 22%, and permanent cessation continued to occur at least through 6 years of follow-up. Factors related to a higher rate of cessation of smoking were a white-collar occupation, having previously stopped smoking for more than 1 month or more than 1 year, being male, and wanting to stop smoking because of health concerns. In the absence of an almost complete return of questionnaires, sole reliance on mailed self-reports would have substantially overestimated the smoking-cessation rates. Although smoking-cessation programs alone involve relatively few smokers, analysis of the methods used in programs such as the one described continues to be important for the development of successful efforts to help people stop smoking.