Smoking and chronic obstructive pulmonary disease (COPD). Parallel epidemics of the 21 century

Int J Environ Res Public Health. 2009 Jan;6(1):209-24. doi: 10.3390/ijerph6010209. Epub 2009 Jan 9.


One hundred million deaths were caused by tobacco in the 20(th) century, and it is estimated that there will be up to one billion deaths attributed to tobacco use in the 21(st) century. Chronic obstructive pulmonary disease (COPD) is rapidly becoming a global public health crisis with smoking being recognized as its most important causative factor. The most effective available treatment for COPD is smoking cessation. There is mounting evidence that the rate of progression of COPD can be reduced when patients at risk of developing the disease stop smoking, while lifelong smokers have a 50% probability of developing COPD during their lifetime. More significantly, there is also evidence that the risk of developing COPD falls by about half with smoking cessation. Several pharmacological interventions now exist to aid smokers in cessation; these include nicotine replacement therapy, bupropion, and varenicline. All pharmacotherapies for smoking cessation are more efficacious than placebo, with odds ratios of about 2. Pharmacologic therapy should be combined with nonpharmacologic (behavioral) therapy. Unfortunately, despite the documented efficacy of these agents, the absolute number of patients who are abstinent from smoking at 12 months of follow-up is low.

Keywords: COPD; Tobacco; smoking; smoking cessation.

Publication types

  • Review

MeSH terms

  • Benzazepines / therapeutic use
  • Bupropion / therapeutic use
  • Combined Modality Therapy
  • Dopamine Uptake Inhibitors / therapeutic use
  • Humans
  • Nicotine / therapeutic use
  • Nicotinic Agonists / therapeutic use
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / etiology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Quinoxalines / therapeutic use
  • Smoking / adverse effects
  • Smoking / drug therapy*
  • Smoking / epidemiology
  • Smoking Cessation / methods*
  • Varenicline


  • Benzazepines
  • Dopamine Uptake Inhibitors
  • Nicotinic Agonists
  • Quinoxalines
  • Bupropion
  • Nicotine
  • Varenicline