Abstract

Background 

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, with smoking representing the primary modifiable risk factor for disease progression [1]. Despite clear clinical benefits associated with cessation, a substantial proportion of patients continue smoking following diagnosis, suggesting that smoking persistence in COPD is influenced by complex behavioural, socioeconomic and healthcare-related factors [2]. This study aimed to investigate both smoking behaviour and the barriers and facilitators to smoking cessation, with interpretation informed by specialist consultation and patient and public involvement (PPI) discussions.

Methods

A retrospective analysis of anonymised primary care data from the DataLoch Trusted Research Environment involving 57,079 COPD patients, was conducted to examine smoking prevalence across demographic, socioeconomic and clinical subgroups. Experiential perspectives were gathered through consultation with a smoking cessation specialist and PPI group feedback from people living with COPD. These perspectives were used to support interpretation and contextualisation of the quantitative findings.

Results

39% of patients were current smokers. A strong socioeconomic gradient was observed, with smoking prevalence decreasing from 50% in the most deprived quintile to 24% in the least. Smoking prevalence remained persistently high across disease severity groups, suggesting that increasing disease burden alone did not reliably translate into smoking cessation. Current smokers  demonstrated significantly higher hospitalisation rates compared to non-smokers (p<0.001). PPI discussions and specialist perspectives highlighted addiction, psychological distress, social environment, stigma and inconsistent engagement with cessation services as key contributors to continued smoking behaviour. Comparison of quantitative findings with specialist and lived experience perspectives demonstrated strong alignment between deprivation-associated smoking patterns, patient-reported behavioural and healthcare barriers.

Conclusion

Smoking appears to be strongly shaped by socioeconomic disadvantage, behavioural dependence and healthcare system factors. These findings highlight the need for flexible, psychologically informed and inequality-sensitive smoking cessation strategies, tailored towards high-risk COPD populations.

References 

1.Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for prevention, diagnosis and management of COPD: 2025 report. Fontana (WI): GOLD; 2025. Available from: GOLD 2025 Report

2.Wang Z, Qiu Y, Ji X, Dong L. Effects of smoking cessation on individuals with COPD. Front Public Health. 2024;12:1433269. doi:10.3389/fpubh.2024.1433269.