***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The Chronic Obstructive Pulmonary Disease Early Intervention Trial , or Lung Health Study , is a multicenter r and omized clinical trial sponsored by the Division of Lung Diseases of the National Heart , Lung , and Blood Institute . The hypothesis being tested is that over a 5-year period , a comprehensive intervention program can reduce both the rate of decline in pulmonary function and the rates of respiratory morbidity and mortality in middle-aged smokers with mild to moderate airflow obstruction . The primary outcome variable of the trial is the annual rate of decline of maximum postbronchodilator FEV1 . Secondary outcomes are the development of respiratory and nonrespiratory morbidity and mortality . After screening 73,694 cigarette smokers , aged 35 to 60 years , 5,887 participants were r and omized into three equal groups : usual care , smoking intervention with daily use of a metered-dose inhaler with ipratropium bromide , and smoking intervention with inhalation of placebo .  Eligible participants had a ratio of FEV1 to forced vital capacity ( FVC ) of 70 percent or less , were free of known life-limiting conditions , expressed willingness to enter the intervention program if so r and omized , and gave written informed consent prior to entry into the trial . Spirometry , methacholine challenge , and question naires were strictly st and ardized within and across centers . The purpose of this report is to describe the characteristics of r and omized participants at the time of entry into the study . For both sexes , three measures of lung function -- average cross-sectional FEV1/FVC ratio , FEV1 , and FEV1 percentage of predicted normal -- showed slight downward trends for each successively older 5-year age cohort . The increase in FEV1 after isoproterenol was 15 percent or more in only 2.4 percent of men and 2.8 percent of women . A positive response to methacholine ( defined as a fall in FEV1 of > 20 percent from baseline at concentrations up to 25 mg/ml ) occurred in 63 percent of men and 87 percent of women . The cross-sectional prevalences of cough , phlegm , wheeze on most days or nights , and shortness of breath were 49 percent , 43 percent , 32 percent , and 43 percent , respectively . Respiratory symptoms were reported by a higher proportion of participants in the younger age groups than in the older age groups . Participants who reported cough , phlegm , and /or wheeze averaged lower FEV1 percent predicted and higher probability of positive response to methacholine than participants who did not . Shortness of breath appeared to be significantly associated with lower lung function and higher reactivity in men but not in women . ( ABSTRACT TRUNCATED AT 400 WORDS A r and omised controlled trial of smoking cessation is reported in 1445 male smokers aged 40 - 59 at high risk of cardiorespiratory disease . The 714 men in the intervention group were recalled for a series of personal interviews with a doctor . After one year , 51 % of the intervention group reported that they were not smoking any cigarettes , and most of the others reported a reduction . Compared with the " normal care " group , the men in the intervention group showed a decline in the prevalence of sputum production and dyspnoea ; ventilatory function did not improve but its rate of decline was significantly slowed . There were no evident effects on blood pressure levels , nor on electrocardiographic findings over three years , nor on sickness absence over one year . Mortality follow-up has continued for an average of 7.9 years ; 98 ( 13.7 % ) of the intervention group have died , compared with 94 ( 12.9 % ) of the " normal care " group . The 95 % confidence limits on mortality range from 2.63 % in favour of intervention to 4.37 % in favour of normal care . The power of the trial has been reduced by smoking cessation in the " normal care " group . It is concluded that smoking cessation in these middle-aged men improved the symptoms and progress of chronic bronchitis ; but the reversibility of the risk of cigarettes to the smoker 's life may have been overestimated in observational studies Abstract Objective To compare the hazards of cigarette smoking in men who formed their habits at different periods , and the extent of the reduction in risk when cigarette smoking is stopped at different ages . Design Prospect i ve study that has continued from 1951 to 2001 . Setting United Kingdom . Participants 34 439 male British doctors . Information about their smoking habits was obtained in 1951 , and periodically thereafter ; cause specific mortality was monitored for 50 years . Main outcome measures Overall mortality by smoking habit , considering separately men born in different periods . Results The excess mortality associated with smoking chiefly involved vascular , neoplastic , and respiratory diseases that can be caused by smoking . Men born in 1900 - 1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers . Cessation at age 60 , 50 , 40 , or 30 years gained , respectively , about 3 , 6 , 9 , or 10 years of life expectancy . The excess mortality associated with cigarette smoking was less for men born in the 19th century and was greatest for men born in the 1920s . The cigarette smoker versus non-smoker probabilities of dying in middle age ( 35 - 69 ) were 42 % ν24 % ( a twofold death rate ratio ) for those born in 1900 - 1909 , but were 43 % ν 15 % ( a threefold death rate ratio ) for those born in the 1920s . At older ages , the cigarette smoker versus non-smoker probabilities of surviving from age 70 to 90 were 10 % ν 12 % at the death rates of the 1950s ( that is , among men born around the 1870s ) but were 7 % ν 33 % ( again a threefold death rate ratio ) at the death rates of the 1990s ( that is , among men born around the 1910s ) . Conclusion A substantial progressive decrease in the mortality rates among non-smokers over the past half century ( due to prevention and improved treatment of disease ) has been wholly outweighed , among cigarette smokers , by a progressive increase in the smoker ν non-smoker death rate ratio due to earlier and more intensive use of cigarettes . Among the men born around 1920 , prolonged cigarette smoking from early adult life tripled age specific mortality rates , but cessation at age 50 halved the hazard , and cessation at age 30 avoided almost all of it The Lung Health Study ( LHS ) , a multicenter r and omized clinical trial of treatment to prevent chronic obstructive pulmonary disease ( COPD ) , recruited , over a 28-month period , 5887 smokers aged 35 - 60 who had evidence of mild airflow obstruction on pulmonary function testing . The LHS participants were identified from a pool of over 73,000 age-eligible smokers who underwent the initial pulmonary function screening tests . Methods of recruitment in the 10 centers are here classified into five general strategies : worksites , public sites , mail/phone , media , and other . This paper deals with the results of each of these general methods and their effectiveness in producing participants eligible for the study . The most effective strategies proved to be  mail/phone and media .  Ongoing monitoring and a flexible approach to recruitment characterized the most successful clinics . Over the recruitment period , LHS clinics shifted their emphasis away from worksite and public site strategies and tended to focus on variations of the mail/phone strategy . Female screenees who passed first-screen eligibility criteria were more likely than males to refuse further participation The authors examine weight gains associated with smoking cessation in the Lung Health Study ( 1986 - 1994 ) over a 5-year follow-up period . A cohort of 5,887 male and female smokers in the United States and Canada , aged 35 - 60 years , were r and omized to either smoking intervention or usual care . Among participants who achieved sustained quitting for 5 years , women gained a mean of 5.2 ( st and ard error , 5.0 ) kg in year 1 and a mean of 3.4 ( st and ard error , 5.5 ) kg in years 1 - 5 . Men gained a mean of 4.9 ( st and ard error , 4.9 ) kg in year 1 and a mean of 2.6 ( st and ard error , 5.8 ) kg in years 1 - 5 . In regression analyses , smoking-change variables were the most potent predictors of weight change . Participants going from smoking to quit-smoking in a given year had mean weight gains of 2.95 kg/year ( 3.61 % ) in men and 3.09 kg/year ( 4.69 % ) in women . Over 5 years , 33 % of sustained quitters gained > or = 10 kg compared with 6 % of continuing smokers . Also among sustained quitters , 7.6 % of men and 19.1 % of women gained > or = 20 % of baseline weight ; 60 % of the gain occurred in year 1 , although significant weight gains continued through year 5 . The average gains and the high proportions of sustained and intermittent quitters who gained excessive weight suggest the need for more effective early interventions that address both smoking cessation and weight control OBJECTIVE To ascertain the differences in smoking characteristics between a group of smokers with COPD and another group of healthy smokers , both of which were identified in a population -based epidemiologic study . DESIGN AND PARTICIPANTS This is an epidemiologic , multicenter , population -based study conducted in seven areas of SPAIN : A total of 4,035 individuals , men and women aged 40 to 69 years , who were selected r and omly from a target population of 236,412 subjects , participated in the study . INTERVENTIONS Eligible subjects answered the European Commission for Steel and Coal question naire . Spirometry was performed followed by a bronchodilator test when bronchial obstruction was present . The Fagerström question naire was used for study of the degree of physical nicotine dependence , and the Prochazka model was followed for analysis of the smoking cessation phase . RESULTS Of 1,023 active smokers , 153 ( 15 % ) met the criteria for COPD . Smokers with COPD were more frequently men ( odds ratio [ OR ] , 2.18 ; 95 % confidence interval [ CI ] , 1.21 to 3.95 ) , were > or = 46 years of age ( OR , 1.97 ; 95 % CI , 1.18 to 3.31 ) , had a lower educational level ( OR , 1.96 ; 95 % CI , 1.23 to 3.14 ) , and had smoked > 30 pack-years ( OR , 3.70 ; 95 % CI , 2.42 to 5.65 ) . Smokers with COPD showed a higher dependence on nicotine than healthy smokers ( mean [ + /- SD ] Fagerström test score , 4.77 + /- 2.45 vs 3.15 + /- 2.38 , respectively ; p < 0.001 ) and higher concentrations of CO in exhaled air ( mean concentration , 19.7 + /- 16.3 vs 15.4 + /- 12.1 ppm , respectively ; p < 0.0001 ) . Thirty-four percent of smokers with COPD and 38.5 % of smokers without COPD had never tried to stop smoking . CONCLUSIONS Smokers with COPD have higher tobacco consumption , higher dependence on nicotine , and higher concentrations of CO in exhaled air , suggesting a different pattern of cigarette smoking . Cases of COPD among smokers predominate in men and in individuals with lower educational levels . A significant proportion of smokers have never tried to stop smoking ; thus , advice on cessation should be reinforced in both groups of smokers There have been few community-based r and omized , controlled intervention trials for cessation in high-risk smokers . In such a trial we evaluated the effects of postal smoking cessation advice in smokers with asbestos exposure and /or reduced forced expiratory volume in one second ( FEV1 ) . All men aged 30 - 45 yrs ( n=22,392 ) living in 34 municipalities in western Norway were invited to a cross-sectional community survey . Information on smoking habits and occupational asbestos exposure were obtained from self-administered question naires and measurements of FEV1 were performed with dry-wedge bellow spirometers . Among 16,393 participants we identified a group of 2,610 smokers with previous occupational asbestos exposure and /or adjusted FEV1 in the lowest quartile . A r and om half ( n=1,300 ) received a mailed personal letter from a respiratory physician with a person-specific health advice to quit smoking and a pamphlet on smoking cessation . The remaining smokers ( n=1,310 ) acted as controls and did not receive any information . Twelve months after the intervention , information on smoking habits was re-examined using a postal question naire . Among the respondents ( n=2,282 ) , smoking cessation was reported altogether by 13.7 % in the intervention group versus 9.9 % in the control group ( p<0.01 ) . The 1 yr sustained quit rate ( no sm 
    Output:
    
REVIEW ER 'S CONCLUSIONS Based on this systematic review , the authors found evidence that a combination of psychosocial interventions and pharmacological interventions is superior to no treatment or to psychosocial interventions alone .