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Research Article

Association between smoking behavior patterns and chronic obstructive pulmonary disease: A long-term follow-up study among Finnish adults

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Pages 598-606 | Received 13 Dec 2010, Accepted 04 Apr 2011, Published online: 10 Sep 2012
 

Abstract

Low-rate smoking patterns are common, but their pulmonary effects remain poorly known. The study hypothesis was that any level of daily smoking may cause chronic obstructive pulmonary disease (COPD).

We investigated the association between longitudinal smoking patterns and COPD using logistic regressions and survival models adjusted for multiple covariates. Data from Finnish Twin Cohort surveys were used. Participants (n = 21,609) were grouped into categories describing 1981 smoking and change in smoking during 1975–1981. Light smoking was defined as < 5 cigarettes per day, moderate 5–19 cigarettes, and heavy ≥ 20 cigarettes per day. Finland's Social Insurance Institution provided data on inhaled anticholinergics purchases (1995–2008) and diagnoses entitling to special reimbursements (1981–2008). We defined COPD as regular anticholinergic use or special reimbursement eligibility for COPD, emphysema, or chronic bronchitis.

COPD incidence was 2.5% (n = 528). Elevated disease risks were observed in former, moderate, and heavy smokers, in all who increased smoking, and in those who reduced from moderate to light smoking. Increased risk for anticholinergic use was found in former smokers, in constant light, moderate, and heavy smokers, and in increasers. Former, light, moderate, and heavy smoking in 1981 was associated with future development of disease. Our results demonstrate that all daily smoking patterns may impair pulmonary function.

Acknowledgements

The Finnish Twin Cohort study is funded by the Academy of Finland Centre of Excellence in Complex Disease Genetics. The analyses here were supported by a research grant from the Yrjö Jahnsson Foundation. The Social Insurance Institution of Finland is thanked for providing the outcome data on special reimbursements and medication purchases related to COPD.

All authors participated in the research, contributed to several drafts of the manuscript, and approved the final manuscript. JK designed the study and its methods, supervised data collection, and contributed to the analyses and interpretation of data. MH conducted the literature review, summarized related works, wrote the manuscript, and performed the statistical analyses under the supervision of TK. KH provided substantial help with statistical analyses.

JK attests that the study objectives and procedures are honestly disclosed. He reviewed the study execution data and confirms that procedures were followed to an extent that convinces all authors that the results are valid and generalizable to a population similar to that enrolled in this study.

Declaration of interest: The authors have no conflicts of interest to declare.

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