ABSTRACT
Cigarette smoking is the most important cause of chronic obstructive pulmonary
disease (COPD). In the United States, approximately 80% of individuals with low lung
function who would qualify as COPD (1) and a similar percentage who die from COPD
are current or former smokers (2). Cigarette smoking may also contribute to COPD
among 20% of the nonsmokers with the disease, as passive smoke exposure is also a
risk factor (3). Cigarette smoking can lead to COPD through a number of interacting
mechanisms (4,5). These include direct damage to the lung, initiation of inflammation
in the lung that leads to secondary lung damage and impairment of lung repair
processes that can exacerbate lung damage. In addition, smoking by children who are
still growing can compromise lung growth (6), which is a risk factor for subsequent
development of COPD (7,8). Finally, infants born to mothers who were smoking during
pregnancy are also at risk for the development of COPD (9,10), perhaps due to effects
on lung development. Targeting smoking, therefore, is the most important strategy to
address the etiology of COPD. The best strategy, of course, would be to prevent
smoking initiation. The second best strategy, once smoking has been initiated, is to quit,
the sooner the better. The current chapter will provide an overview of smoking
cessation, particularly as it relates to the patient with COPD. A further strategy, which
may be appropriate for individuals who cannot or will not quit, sometimes termed harm
reduction (11), will be addressed only briefly as evidence supporting the utility of this
approach is limited.
