a SciTechnol journal Research Article Pascale et al., J Addict Behav Ther Rehabil 2013, 2:3 http://dx.doi.org/10.4172/2324-9005.1000111 Journal of Addictive Behaviors, Therapy & Rehabilitation All articles published in Journal of Addictive Behaviors, Therapy & Rehabilitation are the property of SciTechnol, and is protected by copyright laws. Copyright © 2013, SciTechnol, All Rights Reserved. International Publisher of Science, Technology and Medicine Cigarette Smoking, Dependence and Chronic Obstructive Pulmonary Disease: A Renewed Approach of an Old Relationship Salameh Pascale 1 *, Khayat Georges 2 , Salame Joseph 3 and Waked Mirna 4 *Corresponding author: Pascale Salameh, PharmD, MPH, PhD, Professor of Epidemiology, Jdeidet El Meten, Chalet Suisse street, Ramza Azzam bldg, 5th floor, Beirut, Lebanon, Tel: 009613385542; Fax: 009611696600; E-mail: psalameh@ul.edu.lb, pascalesalameh1@hotmail.com Received: July 04, 2013 Accepted: August 23, 2013 Published: August 26, 2013 Abstract Introduction: Cigarette dependence is common in cigarette smokers, but the evaluation of its relationship with Chronic Obstructive Pulmonary Disease (COPD) has been rarely performed, particularly for the dimensions of this dependence. The objective of this study is to assess such an association. Methods: We used data on current smokers from two samples: a cross-sectional national study and a case-control study. Results: We found a significant association between cigarette dependence and COPD in current smokers (OR between 2 and 4); the results were confirmed in samples of both studies, by multivariate analysis and dose-effect relationship. The results were in favor of an effect that is independent of cumulative smoking dose and of nicotine physiological dependence; moreover, there was a significant increase in the prevalence of COPD per LCD quintile and FTND dependence categories (p<0.001 for trends). Conclusion: Cigarette dependence is associated with COPD in current smokers, independently of the smoking dose and of nicotine dependence level. Keywords FTND; LCD; Tobacco; Chronic obstruction; Lebanon Introduction Tobacco consumption is one of the leading causes of deadly diseases in the world, and total tobacco-attributable deaths are projected to rise to 8.3 million in 2030, at which point they will represent almost 10% of all deaths globally, mainly in developing countries [1]. Some researchers draw a distinction between nicotine dependence and tobacco dependence [2], so that nicotine dependence is sometimes considered as one dimension of the more complex tobacco dependence [3]. In regular smokers, the Fagerström Test for Nicotine Dependence (FTND) is used as a screening tool for physiological nicotine dependence [4,5]; it is extensively used in various countries [6]. e Lebanon Cigarette Dependence (LCD) scale is another tool intended to evaluate the whole cigarette dependence concept, including nicotine dependence, reinforcement and craving intensity [7]. Smokers with nicotine dependence tend to have increased cigarette consumption, and this addiction may worsen the impact of smoking exposure by altering the frequency or depth of smoke inhalation, besides consuming a greater number of cigarettes; this was shown in patients with Chronic Obstructive Pulmonary Disease (COPD) [8]. e other way round, smokers with COPD exhibit higher levels of cigarette dependence, smoke more cigarettes a day, and have higher cotinine concentrations than smokers without COPD. However, they do not display higher motivation to quit than smokers without COPD [9]. As a result, it is reasonable to hypothesize that increased dependence to nicotine would facilitate the development and progression of COPD, a disease that is considered highly tobacco related and preventable [1,10]. Nevertheless, available studies have linked overall cigarette dependence to COPD, while very few of them looked at dimensions of tobacco dependence in this relationship. e objective of this analysis was to evaluate the association between overall cigarette dependence and its dimensions (nicotine dependence, psychological craving and reinforcement), smoking dose and COPD in current smokers. Material and Methods Population and sampling Sample 1 (epidemiological setting): A cross-sectional study was carried out between October 2009 and September 2010, using a multistage cluster sample all over Lebanon. Lebanese residents aged 40 years and above were enrolled in the study, with no exclusion criteria. From the list of circumscriptions, we randomly selected one hundred circumscriptions i.e. local communities. We then randomly chose individuals to be interviewed from a provided list of dwelling households through a local authority representative; all eligible individuals within a household were interviewed using a standardized questionnaire. Additional methodological details are available in a separate publication [11]. Sample 2 (clinical setting): A case-control study was performed between July 2009 and June 2010, comparing a group of patients with COPD from two tertiary care hospitals in Beirut with a control group. e COPD group was composed of incident outpatient cases of COPD. Cases were included if they were ≥ 40 years of age, free of other respiratory diseases, diagnosed as COPD by a chest physician, and had a post-bronchodilator FEV1/FVC <0.7 [12]. Outpatients consulting for various extra-pulmonary problems were included as controls if they were ≥ 40 years of age, free of any respiratory disease or symptom. Additional methodological details are available in a separate publication [13]. For both studies, the Lebanese University ethical review board waived the need for approval because they were observational studies that respected both confidentiality and autonomy of involved participants.