Abstract
CHRONIC obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the United States, exceeded only by heart attacks, cancers, and stroke. It is estimated that in 1996 more than 100 000 people will die of COPD alone, though for many more COPD will be a contributing cause of death. The recently completed Lung Health Study, sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) showed that sustained smoking cessation can be successful with coordinated intervention in up to 22% of subjects at risk of developing COPD.1 During the 5-year follow up period, smoking cessation resulted in a initial slight improvement then a slower rate of FEV1 decline compared with continued smokers. Since the rate of FEV1 decline is a powerful prognostic indicator, these results show not only the potential importance of early intervention, but also the