title: Does the duration of smoking cessation have an impact on hospital admission and health-related quality of life amongst COPD patients?
abstract: BACKGROUND
  Lack of awareness among ex-smokers on the benefits of sustaining smoking cessation may be the main cause of their smoking relapse. This study explored health-related quality of life (HRQoL) and hospital admission amongst chronic obstructive pulmonary disease (COPD) patients according to the duration of smoking cessation.
  
  
  METHODS
  This study recruited COPD patients from a chest clinic who agreed to participate in a medication therapy-adherence program from January to June 2013. They were interviewed during their visits to obtain information regarding their smoking history and HRQoL. They were divided into three groups according to smoking status (sustained quitters, quit ≥5 years; quitters, quit <5 years; and smokers, smoking at least one cigarette/day). The effects of the duration of cessation on HRQoL and hospital admission were analyzed using a multinomial logistic model.
  
  
  RESULTS
  A total of 117 participants with moderate COPD met the inclusion criteria, who were comprised of 41 sustained quitters, 40 quitters, and 36 smokers. Several features were similar across the groups. Most of them were married elderly men (aged >64 years) with low-to-middle level of education, who smoked more than 33 cigarettes per day and had high levels of adherence to the medication regimen. The results showed that sustained quitters were less likely to have respiratory symptoms (cough, phlegm and dyspnea) than smokers (odds ratio 0.02, confidence interval 0-0.12; P<0.001). The hospital admission rate per year was increased in quitters compared to smokers (odds ratio 4.5, confidence interval 1.91-10.59; P<0.005).
  
  
  CONCLUSIONS
  A longer duration of quitting smoking will increase the benefits to COPD patients, even if they experience increased episodic respiratory symptoms in the early period of the cessation. Thus, the findings of this study show the benefits of early smoking cessation.
authors.affiliation: Malacca Pharmaceutical Services Division, Ministry of Health Malaysia, Ayer Keroh, Malaysia ; Department of Respiratory Medicine, Malacca Hospital, Jalan Mufti Haji Khalil, Malaysia.
authors.forename: Hazlinda
authors.initials: H
authors.lastname: Abu Hassan
authors.affiliation: Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
authors.forename: Noorizan
authors.initials: N
authors.lastname: Abd Aziz
authors.affiliation: Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
authors.forename: Yahaya
authors.initials: Y
authors.lastname: Hassan
authors.affiliation: Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
authors.forename: Fahmi
authors.initials: F
authors.lastname: Hassan
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: HRQoL; chronic obstructive pulmonary disease (COPD); hospital admission and hospital stay