***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 Factors associated with outcome were investigated in the British Thoracic Society 's study of smoking withdrawal in 1550 patients attending hospital with smoking related diseases . A long term abstinence rate of 9.7 % was found . Men did better than women , 12.2 % of them succeeding in stopping smoking compared with 5.3 % of the women . Success rate increased with age , and people with heart disease did better than those with any other diagnosis . The success rate of the best group , men with heart disease , was 21 % . Sex , age , and diagnosis appeared to act independently . If the most important other person in the patient 's life was a non-smoker success was more likely . Weight increased by an average of 5.9 kg over a year in those who stopped smoking Background Exposure to environmental tobacco smoke ( ETS ) , which contains potent respiratory irritants , may lead to chronic airway inflammation and obstruction . Although ETS exposure appears to cause asthma in children and adults , its role in causing COPD has received limited attention in epidemiologic studies . Methods Using data from a population -based sample of 2,113 U.S. adults aged 55 to 75 years , we examined the association between lifetime ETS exposure and the risk of developing COPD .  Participants were recruited from all 48 contiguous U.S. states by r and om digit dialing . Lifetime ETS exposure was ascertained by structured telephone interview . We used a st and ard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis , emphysema , or COPD . Results Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD . The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD , controlling for age , sex , race , personal smoking history , educational attainment , marital status , and occupational exposure to vapors , gas , dusts , or fumes during the longest held job ( OR 1.55 ; 95 % CI 1.09 to 2.21 ) . The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD ( OR 1.36 ; 95 % CI 1.002 to 1.84 ) . The population attributable fraction was 11 % for the highest quartile of home ETS exposure and 7 % for work exposure . Conclusion ETS exposure may be an important cause of COPD . Consequently , public policies aim ed at preventing public smoking may reduce the burden of COPD -related death and disability , both by reducing direct smoking and ETS exposure BACKGROUND Cessation rates in smokers attending special clinics or their General Practitioners can be increased by transdermal nicotine ( TNS ) . This study assesses the efficacy of TNS as an adjunct to advice and support in helping patients attending hospital with smoking-related diseases to stop smoking . METHODS In a double-blind , placebo-controlled , r and omized manner , 234 in patients and out patients with smoking-related respiratory or cardiovascular disease , aged 18 - 75 years , who were willing to try to stop smoking , were advised by their hospital doctor to stop smoking . This was reinforced by repeated advice and encouragement from the Smoking Cessation Counsellor initially and at 2 , 4 , 8 and 12 weeks , supplemented by a 24 h patch in adjusted doses over that period . Those not smoking at 12 weeks were followed up at 26 and 52 weeks . Self-reported complete abstinence from 12 to 52 weeks was vali date d by expired air carbon monoxide measurement at 12 , 26 and 52 weeks . RESULTS Twenty-four ( 21 % ) of 115 TNS patients were verified as non-smokers at 12 , 26 and 52 weeks and cl aim ed continued abstinence , compared with 17 ( 14 % ) of 119 in the placebo ( P ) group ( P = 0 center dot 15 ) -5 % confidence limits for odds ratio of abstinence on TNS compared to P : 0 center dot 83 , 3 center dot 37 . Cessation was related to increasing age ( P = 0 center dot 02 ) and lower Fagerstrom score ( P = 0 center dot 05 ) . Minor skin reactions were more frequent in the TNS group ( 47 % TNS ; 34 % P ) , as was nausea ( 12 % TNS ; 3 % P ) . Severe skin reactions were rare ( 5 % TNS ; 4 % P ) . CONCLUSION The suggestion that TNS produces an increase of 50 % in relative terms ( 7 % absolute increase ) in smoking cessation over placebo in this population of hospital patients is sufficiently strong to warrant a further study large enough to answer whether or not this result was due to chance BACKGROUND The design and results of the initial intervention program of the Lung Health Study are presented for 3,923 male and female participants . One of the major aims of this clinical trial was to achieve smoking cessation early in the study and to provide intensive follow-up procedures for maintaining abstinence . In addition , compliance with use of aerosolized inhalers ( either placebo or active bronchodilator ) would be necessary in order to achieve the trial goal of improved pulmonary function . RESULTS Eighty-eight percent of the special intervention participants attended the 4-month follow-up visit . Forty-six percent reported not smoking from quit day through the visit , and an additional 13 % had stopped smoking at the end of 4 months , although they had not achieved abstinence since quit day . The aerosol  inhaler compliance was self-reported at 81 % at the 4-month visit . Validating the self-reports by weighing canisters reduced the " good " compliance rates to 66 % . CONCLUSIONS The intensive behavioral program was effective in achieving high initial rates of smoking cessation and inhaler compliance . Use of nicotine gum appeared to be an effective adjunct to the multicomponent behavioral program . Smoking status does appear to be related to inhaler compliance among both men and women participants Smoking cessation is the only treatment in patients with chronic obstructive pulmonary disease ( COPD ) effective in slowing down disease progression . Its effect on airway inflammation in COPD is unknown , although cross-sectional studies suggest ongoing inflammation in ex-smokers . In order to eluci date the effect of smoking cessation on airway inflammation , 28 smokers with COPD ( mean age : 55 yrs ; forced expiratory volume in one second : 71 % predicted ) and 25 asymptomatic smokers with normal lung function ( aged 50 yrs ) were included in a 1-yr smoking cessation programme . Effects of smoking cessation on airway inflammation were investigated in bronchial biopsies ( baseline , 12 months ) and sputum sample s ( baseline , 2 , 6 and 12 months ) . In the 12 c and i date s with COPD who successfully ceased smoking , airway inflammation persisted in bronchial biopsies , while the number of sputum neutrophils , lymphocytes , interleukin (IL)-8 and eosinophilic-cationic-protein levels significantly increased at 12 months . In the 16 asymptomatic smokers who successfully quitted , inflammation significantly reduced ( i.e. number of sputum macrophages , percentage of eosinophils and IL-8 levels ) or did not change . The current authors suggest that the observed persistent airway inflammation in patients with chronic obstructive pulmonary disease is related to repair of tissue damage in the airways . It remains to be eluci date d whether this reflects a beneficial or detrimental effect BACKGROUND The Lung Health Study ( LHS ) , a 5-year , r and omized , prospect i ve clinical trial , studied the effects of smoking intervention and therapy with inhaled anticholinergic bronchodilators on FEV(1 ) in participants who were 35 to 60 years of age and had mild COPD . Participants were r and omized into the following three groups : usual care ; smoking cessation plus inhaled ipratropium bromide ; and smoking cessation plus placebo inhaler . This report evaluates the effects of these interventions , demographic characteristics , smoking status , and FEV(1 ) changes on airway responsiveness ( AR ) . METHODS AND RESULTS Of 5,887 participants , 4,201 underwent methacholine challenge testing both at study entry and study completion . All groups increased AR during the 5-year period . The increase in AR was greatest in continuing smokers and was associated with a greater FEV(1 ) decline . An intent-to-treat analysis indicated no significant differences in AR changes among the three groups . CONCLUSIONS Changes in AR over a 5-year period in the LHS were primarily related to changes in the FEV(1 ) . The greater the decline in FEV(1 ) , the greater the increase in AR . Smoking cessation had a small additional benefit in AR beyond its favorable effects on FEV(1 ) changes Background : Little is known about the effects of changes in smoking habits on the subsequent risk of chronic obstructive pulmonary disease ( COPD ) . The aim of this study was to investigate the relationship between smoking cessation and reduction and admission to hospital for COPD in a general population sample . Methods : A total of 19 709 participants from three prospect i ve population studies in Copenhagen were followed with record linkage for date of first hospital admission for COPD until 1998 ( mean follow up 14 years ) . Heavy smokers ( ≥15 cigarettes/day ) who reduced their tobacco consumption by at least 50 % between the two initial examinations without quitting and smokers who stopped smoking during this time were compared with continuous heavy smokers using a Cox proportional hazards model . Results : During the follow up period 1260 subjects ( 741 men and 519 women ) were admitted to hospital for COPD . After multivariate adjustment , quitting smoking was associated with a significant reduction in the risk of hospital admission . The relative hazard ( HR ) was 0.57 ( 95 % confidence interval ( CI ) 0.33 to 0.99 ) . Those who reduced smoking did not show a significantly lower risk of hospitalisation than continuing heavy smokers ( HR 0.93 ( 95 % CI 0.73 to1.18 ) ) . Exclusion of events during the first 5 study years , detailed adjustment for lung function , or restriction of analyses to participants with impaired pulmonary function did not reverse the observed trend . Conclusions : Self-reported smoking cessation is associated with a reduction in the risk of COPD morbidity of approximately 40 % ; the benefit of smoking reduction is question able Smoking causes chronic obstructive pulmonary disease ( COPD ) , but few controlled studies have tested anti-smoking treatments in COPD . With procedures likely to attract unmotivated persons we recruited 49 quite-ill , smoking COPD patients . 
    Output:
    
Further research is needed to determine if a more family-focused intervention , in conjunction with pharmacological and counselling approaches , would lead to improved smoking cessation outcomes