Second, the association between all anxiety disorders and COPD appears to be largely explained by confounding by former cigarette smoking and nicotine dependence, with the exception of the relationship http://www.selleckchem.com/products/MLN-2238.html between COPD and social phobia. Specifically, the links between any anxiety disorder and COPD and PTSD and COPD appears to be explained by confounding with former cigarette smoking, and the link between COPD and GAD appears to be explained by confounding with nicotine dependence. Third, the association between mood disorders and COPD appears to be largely explained by nicotine dependence. The consistency of these findings with previous results as well as the clinical and public health implications will be discussed below. The first objective of this paper was to examine the role of nicotine dependence in the relationship between cigarette smoking and COPD.

We found that confounding by nicotine dependence partially explained the link between cigarette smoking and COPD. While number of cigarettes is likely to be the mechanism of this link, this finding has important and underexamined public health implications. Specifically, the Healthy People 2010 goal of reducing cigarette smoking to 12% of the population has not been met (Levy, Nikolayev, Mumford, & Compton, 2005). The intractability of nicotine dependence is considered similar to an addiction to alcohol and/or drug use disorders. Yet, treatments for illicit drug use disorders are more widely available and reimbursable by insurance and Medicaid, and many more resources are put toward clinical interventions with these populations.

For instance, New York State Medicaid offers two courses of smoking cessation therapy per year at a maximum, and if one course is not completed, it cannot be replaced (State of New York Department of Health, 2007). A greater emphasis on treating nicotine dependence among cigarette smokers will yield the most productive outcomes in terms of reducing smoking-related COPD. Not surprisingly, we also found that lifetime nicotine dependence is even more strongly associated with COPD than either current or former cigarette smoking. While this may seem obvious, what is important in documenting this finding is that nicotine dependence is a mental disorder, as defined by the DSM-IV. Therefore, these data suggest that a mental disorder (i.e.

, nicotine dependence) appears to account for a substantial Drug_discovery percentage of COPD, a leading cause of premature mortality among adults. This highlights the potential cost and life-saving benefit of devoting more resources toward improving access to smoking cessation programs that address nicotine dependence, either through behavioral or pharmacologic therapies. These programs are more costly��but show much greater effectiveness than those without such components��in successful quit rates (Crain & Bhat, 2010).