A Classic Study: The lung Health Study

Every now and again I like to pick one of the classic research studies on smoking cessation in order to highlight some of the key findings. Today I’m going to focus on the part of the Lung Health Study.

The Lung Health Study is certainly one of the best smoking cessation studies ever carried out, partly because of the comprehensive nature of the assessment and follow-up of its 5,887 participants and partly because it was way ahead of its time in delivering a truly “state-of-the-art” intensive smoking cessation intervention which was compared in a randomized manner to the effects of “usual care”. The Lung Health Study (LHS) was a randomized clinical trial of smoking cessation and inhaled bronchodilator therapy in smokers 35 to 60 years of age who did not consider themselves ill but had evidence of mild to moderate airway obstruction. Almost 4,000 of the participants were randomly allocated to receive a very intensive smoking cessation intervention consisting of group treatment (12 group meetings over 10 weeks), combined with aggressive use of nicotine gum. Patients’ partners were also allowed to attend for treatment, patients were encouraged to attend for retreatment if they did not quit, and were provided with ongoing relapse prevention over the 5 years of the study. They were also encouraged to continue using the nicotine gum for as long as it was helpful, and to use it even if still smoking in order to get quit. This excellent intervention resulted in 35% quit rates at the end of the first year and 22% remained sustained quitters at 5 year follow-up (compared to 9% and 5% in the “usual care” group.

This cohort was followed up for 15 years and dozens of excellent research papers have been published describing the health effects and the factors associated with quitting smoking. But one of the key results was that when they did the 15 year follow up they found that significantly more people who had been randomized to receive the smoking cessation intervention were still alive, as compared to those who were randomized to “usual medical care”. At face value this may not sound so surprising but unlike most studies of smoking and mortality this was based on analysis of a randomization to smoking-cessation treatment versus no treatment and shows that those getting smoking cessation treatment had better survival, even though the long term sustained quit rate was only 22%. So if you want proof that intensive smoking cessation treatment saves lives, this is the study that proves it.
The authors of the study estimated that the unit cost for providing the smoking cessation treatment and relapse prevention program in this study was $2,000 per patient. In comparison to almost every other healthcare intervention, this is incredibly good value for a life-saving intervention. Just for comparison, the Tobacco Dependence Clinic at UMDNJ-School of Public Health tries to provide a similarly intensive treatment for over 500 new patients per year on $102,000 of funding (i.e. $200 per patient). Although I feel that a unit cost in the range of $500-$2000 is more realistic when all the costs are included, this shows that quality smoking cessation treatment, similar to that provided in the Lung Health Study, can be provided relatively efficiently outside of a research context.

The Lung Health Study provides an excellent guide to providing quality smoking cessation treatment and the health outcomes that can be obtained.

Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE; Lung
Health Study Research Group. The effects of a smoking cessation intervention on
14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005 Feb

Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, Conway WA
Jr, Enright PL, Kanner RE, O'Hara P, et al. Effects of smoking intervention and
the use of an inhaled anticholinergic bronchodilator on the rate of decline of
FEV1. The Lung Health Study. JAMA. 1994 Nov 16;272(19):1497-505.

Foulds J, Gandhi KK, Steinberg MB, Richardson D, Williams J, Burke M, Rhoads GG. Factors associated with quitting smoking at a tobacco dependence treatment clinic. American Journal of Health Behavior 2006; 30:400-412
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.