DÄ internationalArchive4/2010Smoking—A Study That Leaves Many Questions Unanswered
LNSLNS Some 10000 study participants were recruited by specialist physicians in private practice in the German state of Saarland for the data analysis of the ESTHER (Epidemiological Study on the Chances of Prevention, Early Recognition, and Optimized Treatment of Chronic Diseases in the Older Population) study’s baseline examination (4).

As the clinical director of the hospital for internal medicine V (pneumology, allergology, respiratory and environmental medicine) at the University Hospitals of Saarland, I was very surprised by the evaluations of this baseline examination.

The analyses did not take into consideration smoking related pulmonary pathologies, such as chronic obstructive pulmonary disease (COPD) or cancers—especially lung carcinoma—although the internationally acknowledged epidemiological cancer registry in Saarland participated in the study.

Lung carcinoma is the fourth most common cause of death in Germany (Federal Statistical Office, ICD-10, C34) and the most common cause of death due to cancer in men. Worldwide, COPD is the fourth most common cause of death; it reached 6th position in Germany in 2007 (Federal Statistical Office, ICD-10, J44). It is to be expected that mortality due to COPD will move into 3rd position of the worldwide statistic by 2030; it should therefore be the focus of particular interest in the context of the ESTHER study.

In 1950, the British researcher Sir Richard Doll described for the first time the association between smoking and lung cancer (1). He later expressed regret that he had not included comorbidities (such as COPD) in his deliberations immediately at the outset of his clinical observations (2). It seems that the ESTHER study is subject to an identical error—namely, that diseases that are extremely important as smoking related comorbidities were not included. The result is a limited perspective, and the question arises of how such an epidemiological study was done with such a narrow approach. Surely, additional questions to the study participants, to elicit additional diseases and comorbidities, and their evaluation would not have been excessively time consuming or elaborate. A valuable opportunity was thus missed to collect data on these comorbidities—much as in a series of other studies in smokers (3).
DOI: 10.3238/arztebl.2010.0059b

Prof. Dr. med. Gerhard W. Sybrecht
Universitätsklinikum des Saarlandes
Innere Medizin V
Pneumologie, Allergologie, Beatmungs- und Umweltmedizin
66421 Homburg/Saar, Germany
gerhard.sybrecht@uks.eu
1.
Doll R, Hill AB: Smoking and carcinoma of the lung: a preliminary report. BMJ 1950; 2: 739–48 MEDLINE
2.
Doll R: Smoking and lung cancer. Am J Respir Crit Care Med 2000; 162: 4–6 MEDLINE
3.
Godtfredsen NS, et al.: COPD-related morbidity and mortality after smoking cessation: status of the evidence. ERJ 2008; 32: 844–53 MEDLINE
4.
Breitling L, Rothenbacher D, Stegmaier C, Raum E, Brenner H: Older smokers’ motivation and attempts to quit smoking: Epidemiological insight into the question of lifestyle versus addiction [Aufhörversuche und -wille bei älteren Rauchern – Epidemiologische Beiträge zur Diskussion um „Lifestyle“ versus „Sucht“]. Dtsch Arztebl Int 2009; 106(27): 451–5 VOLLTEXT
1. Doll R, Hill AB: Smoking and carcinoma of the lung: a preliminary report. BMJ 1950; 2: 739–48 MEDLINE
2. Doll R: Smoking and lung cancer. Am J Respir Crit Care Med 2000; 162: 4–6 MEDLINE
3. Godtfredsen NS, et al.: COPD-related morbidity and mortality after smoking cessation: status of the evidence. ERJ 2008; 32: 844–53 MEDLINE
4. Breitling L, Rothenbacher D, Stegmaier C, Raum E, Brenner H: Older smokers’ motivation and attempts to quit smoking: Epidemiological insight into the question of lifestyle versus addiction [Aufhörversuche und -wille bei älteren Rauchern – Epidemiologische Beiträge zur Diskussion um „Lifestyle“ versus „Sucht“]. Dtsch Arztebl Int 2009; 106(27): 451–5 VOLLTEXT