***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: Background Tobacco consumption is a preventable risk factor for chronic disease and complicates the treatment of medical conditions . Therefore , the German health insurance company AOK NORDWEST has developed a collaborative smoking cessation intervention for individuals with cardiovascular disease , chronic obstructive pulmonary disease and heavy smokers , with the aim of reducing tobacco consumption . The objective of the study ENTER is to evaluate the effectiveness of the collaborative smoking cessation intervention and determine its cost-effectiveness . Methods / Design This study is a cluster-r and omized controlled trial conducted with 40 medical practice s that are being selected from different geographic regions in Germany . Participating medical practice s will be r and omly allocated to either the intervention or control group . Within the medical practice s , a total of 800 patients will be recruited for participation in the study and blinded to group assignment . Patients are included in the study if they are 18 years or older , insured by AOK , heavy smokers ( smoke at least 20 cigarettes per day ) and /or suffer from chronic obstructive pulmonary disease or cardiovascular disease . Exclusion criteria are patients who are nonsmokers , who have cognitive impairments or who are illiterate . Physicians from medical practice s in the intervention group will motivate patients to participate in a smoking cessation program offered by the health insurance , refer them to the program and ask about their program participation . Physicians from medical practice s in the control group will provide usual care . Data collection will take place on the date of study inclusion and after 6 and 12 months . The primary outcome is the amount of cigarettes consumed during the past 30 days , 12 months after the initial medical consultation . Secondary outcomes are abstinence from smoking , health-related quality of life and respiratory complaints . Moreover , a process evaluation and health economic analysis will be performed . Discussion The results of this study will help to determine whether the collaborative smoking cessation intervention is an effective and feasible way to promote smoking cessation in the primary care setting and provide evidence regarding its cost-effectiveness . Trial registration German Clinical Trials Register DRKS00006079 . Registered 4 June 2014 OBJECTIVES The prevalence of COPD in Greece is unknown . The aim of this study was to determine the prevalence and trends of COPD among adults in Greece . METHODS This study involved 888 r and omly identified adults ( 475 men and 413 women ) aged > 35 years , and smokers of at least 100 cigarettes , in a population -based , multiregional , cross-sectional descriptive design . The selected individuals reflected the urban/rural population distribution in Greece and , within each study region , the age group and gender of the community setting . The diagnosis of COPD was based on clinical and spirometric data including reversibility test ( DeltaFEV(1 ) < 15 % ) . RESULTS The overall prevalence of COPD in the population aged > 35 years with a smoking history of > 100 cigarettes per lifetime was 8.4 % . The gender-st and ardized COPD prevalence was 11.6 % for men and 4.8 % for women . The COPD prevalence by community setting was as follows : Athens , 6 % ; other urban areas , 10.1 % ; semiurban areas , 8.5 % ; and rural areas , 9.1 % . Smoking intensity and age were significantly associated with higher COPD prevalence in both men and women . CONCLUSIONS COPD is a substantial health problem in Greece , although prevalence rates are lower than expected when the high smoking rates are taken into account . The high proportion of the patients with mild COPD who were unaware of their illness highlights the need to increase public awareness of COPD Stopping smoking is the only known method to slow down the inevitable progression of COPD . Early detection of the disease in smokers at risk of COPD gives a unique opportunity to prevent the disease progression . The aim of the study was to evaluate the effects of smoking intervention in a group of subjects with newly diagnosed airflow limitation ( AL ) . Of 558 current smokers participating in population spirometric screening for COPD combined with smoking cessation advice , 297 were diagnosed to have AL ( FEV1/FVC < 0.7 ) . After one year 193 presented for follow-up visit . Thirty subjects ( 10.1 % ) quit smoking . Remaining 163 smokers were invited to smokers ' clinic . Attendees ( n = 70 ) , 40 males , and 30 females , mean age 56 years , were r and omized at visit 1 to treatment with nicotine patch ( n = 38 ) or bupropion SR ( n = 32 ) . Follow-up was scheduled at 2 weeks , at the end of treatment , 6 months and 12 months . After 12 months a phone call assessed the smoking status . Non smoking was vali date d with carbon monoxide measurements in exhaled air . Patients who did not attend the follow-up visits were considered smokers . The number of participants at follow-up decreased significantly : from 70 subjects at visit one to 57 after 2 weeks , 34 at end of treatment and 14 subjects at months . Almost all ( n = 69 ) were reached at 12 month by the phone . The vali date d quit rate after 12 months was 18.5 % ( 13/70 ) , 8 in group treated with nicotine patch and 5 in the group treated with bupropion SR ( NS ) . When total group of smokers with newly diagnosed COPD was considered 10 % quit smoking as result of minimal intervention with another 4.5 % after pharmacological treatment Introduction COPD is a leading cause of morbidity and mortality . Self-management interventions are considered important in order to limit the progression of the disease . Computer-tailored interventions could be an effective tool to facilitate self-management . Methods This r and omized controlled trial tested the effectiveness of a web-based , computer-tailored COPD self-management intervention on physical activity and smoking behavior .  Participants were recruited from an online panel and through primary care practice s. Those at risk for or diagnosed with COPD , between 40 and 70 years of age , proficient in Dutch , with access to the Internet , and with basic computer skills ( n=1,325 ) , were r and omly assigned to either the intervention group ( n=662 ) or control group ( n=663 ) . The intervention group received the web-based self-management application , while the control group received no intervention . Participants were not blinded to group assignment . After 6 months , the effect of the intervention was assessed for the primary outcomes , smoking cessation and physical activity , by self-reported 7-day point prevalence abstinence and the International Physical Activity Question naire – Short Form . Results Of the 1,325 participants , 1,071 ( 80.8 % ) completed the 6-month follow-up question naire . No significant treatment effect was found on either outcome . The application however , was used by only 36 % of the participants in the experimental group . Conclusion A possible explanation for the nonsignificant effect on the primary outcomes , smoking cessation and physical activity , could be the low exposure to the application as engagement with the program has been shown to be crucial for the effectiveness of computer-tailored interventions . ( Netherl and s Trial Registry number : NTR3421 . UNLABELLED There are few data concerning changes in lung function and respiratory symptoms in smokers with chronic obstructive pulmonary disease ( COPD ) weeks to months after quitting smoking . We examined serial changes in spirometry and Clinical COPD Question naire ( CCQ ) scores ( measuring respiratory symptoms and health-related quality of life ) in COPD participants by smoking status during a smoking cessation trial . In this r and omized , double-blind trial , smokers with mild-to-moderate COPD were treated with varenicline 1 mg b.i.d . or placebo for 12 weeks and followed to Week 52 . Primary endpoints of abstinence were previously reported . Secondary endpoints were mean changes from baseline in post-bronchodilator forced expired volume in 1 s ( FEV(1 ) ) and CCQ scores . Change from baseline in post-bronchodilator FEV(1 ) was significantly improved in continuous abstainers ( 121.8 mL ) vs. continuous smokers ( 37.9 mL ) at Week 12 ( P = 0.0069 ) , but not at Weeks 24 or 52 . Mean change from baseline at Week 12 in CCQ Total Score was significantly better in continuous abstainers ( -1.04 ) vs. continuous smokers ( -0.53 ; P < 0.0001 ) : this improvement was sustained at Weeks 24 and 52 . In a 1-year cessation trial of smokers with COPD , continuous abstinence compared with continuous smoking significantly improved post-bronchodilator FEV(1 ) at Week 12 ( although the difference narrowed subsequently ) and CCQ Total Scores at Week 12 , with sustained improvement thereafter . ( TRIAL REGISTRY http://www . clinical trials.gov ; trial identifier : NCT00285012 ) Background Anxiety and depression are common co-morbidities in patients with chronic obstructive pulmonary disease ( COPD ) . Serious implication s can result from psychological difficulties in COPD including reduced survival , lower quality of life , and reduced physical and social functioning , increased use of health care re sources and are associated with unhealthy behaviours such as smoking . Cognitive behavioural therapy ( CBT ) is a psychological intervention which is recommended for the treatment of many mental health problems including anxiety and depression . Unfortunately access to trained CBT therapists is limited . The aim of this study is to test the hypothesis that CBT delivered by respiratory nurses is effective in the COPD population . In this paper the design of the Newcastle Chronic Obstructive Pulmonary Disease Cognitive Behavioural Therapy Study ( Newcastle COPD CBT Care Study ) is described . Methods / Design This is a prospect i ve open r and omised controlled trial comparing CBT with self-help leaflets . The primary outcome measure is the Hospital Anxiety & Depression Scale ( HADS ) – anxiety subscale . Secondary outcome measures include disease specific quality of life COPD Assessment Tool ( CAT ) , generic quality of life ( EQ5D ) and HADS-depression subscale . Patients will be followed up at three , six and 12 months following r and omisation . Discussion This is the first r and omised controlled trial to evaluate the use of cognitive behavioural therapy undertaken by respiratory nurses . Recruitment has commenced and should be complete by February 2014.Trial registration Current Controlled Trials , IS RCT Rationale : Adults with chronic lower respiratory disease differ in their barriers to smoking cessation but also suffer from tobacco‐related health concerns , which may motivate quit attempts . Few studies have examined differences in tobacco treatment response between smokers with and without chronic lower respiratory disease . Objective : We examined the effectiveness of a  proactive outreach program  for cessation among smokers with and without chronic lower respiratory disease . Methods : Subgroup analysis of the Veterans Victory over Tobacco Study , a pragmatic r and omized controlled trial that demonstrated the effectiveness of proactive outreach and the choice of tobacco treatments compared with usual care . Smokers identified via the electronic medical record were proactively offered phone‐based counseling and care coordination to receive medication from their Veterans Affairs providers or in‐person care . We compared the response among those with and without an International Classification of Diseases , 9th Revision diagnosis of a chronic lower respiratory disease ( chronic obstructive pulmonary disease , chronic bronchitis , emphysema , asthma ) . We used stratification by propensity scores to adjust for imbalanced covariates between groups with and without chronic lower respiratory disease within each treatment arm , using complete case analysis accounting for the stratified sampling by site . Results : The study participants were predominantly older , white , male smokers . Overall , 19.6 % had chronic lower respiratory disease . A total of 3,307 had outcome data with the following assignments to the intervention : proactive care : n = 1,272 without chronic lower respiratory disease , n = 301 with chronic lower respiratory disease ; usual care : n = 1,387 without chronic lower respiratory disease , n = 347 with chronic lower respiratory disease . A total of 1,888 had both complete baseline and outcome data and were included in the primary analysis . In unadjusted analyses ( n = 3,307 ) , among individuals with chronic lower respiratory disease , 13.1 % in the proactive group reported 6‐month prolonged abstinence compared with 8.7 % of those in the usual care group ( odds ratio , 1.57 ; 95 % confidence interval , 0.93‐2.65 ) . Among individuals without chronic lower respiratory disease , 13.1 % quit in the proactive group compared with 11.0 % in the usual care group ( odds ratio , 1.22 ; 95 % confidence interval , 0.95‐1.55 ) . In adjusted analyses ( n = 1,888 ) , the association between treatment arm and quit rate varied by the presence of chronic lower respiratory disease , with a stronger association between allocation to the proactive group and quit rate among those with chronic lower respiratory disease ( odds ratio , 3.45 ; 95 % confidence interval , 1.59‐7.47 ) than those without chronic lower respiratory disease ( odds ratio , 1.34 ; 95 % confidence interval , 0.95‐1.88 ; P for interaction with chronic lower respiratory disease = 0 
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Finally , the results showed effectiveness of various combinations of psychosocial and pharmacological interventions .
We found high- quality evidence in a meta- analysis including four ( 1,540 participants ) of the 16 included studies that a combination of behavioural treatment and pharmacotherapy is effective in helping smokers with COPD to quit smoking .
Furthermore , we conclude that there is no convincing evidence for preferring any particular form of behavioural or pharmacological treatment