Characteristics of COPD smokers and effectiveness and safety of smoking cessation medications.

INTRODUCTION: Smoking is the main cause of chronic obstructive pulmonary disease (COPD), and smoking cessation is the only treatment shown to be effective in arresting the progression of COPD. Different epidemiological and population-based studies have shown smokers with COPD to have specific smoking characteristics that differentiate them from the rest of smokers and which complicate smoking cessation. The main objective of this study is to analyze the effectiveness and safety of drug treatments for smoking cessation in smokers with severe or very severe COPD. METHODS: Smokers with severe or very severe COPD (Global Initiative for Chronic Obstructive Lung Disease stages III and IV) received treatment for smoking cessation. The treatment program consisted of a combination of behavioral therapy and drug treatment. Patients were followed up at 1, 2, 4, 6, 8, 10, 12, 18, and 24 weeks after the quit date. RESULTS: Four hundred seventy-two patients were seen, 65% were male, and their mean age was 58.3 (9.8). They smoked an average of 29.7 (13.4) cigarettes/day, and their mean Fagerström test for nicotine dependence score was 7.4 (2.1). Continuous abstinence rate from 9 to 24 weeks (CAR 9-24) was 48.5%. According to type of treatment used, CAR 9-24 for nicotine replacement therapy (NRT), bupropion, and varenicline were 38.2%, 55.6%, and 58.3%, respectively. Varenicline was more effective than nicotine patches: 61% versus 44.1% (odds ratio: 1.98; 95% CI: 1.25-3.12; p = .003). NRT was the treatment producing the fewest adverse effects. The onset of psychiatric symptoms due to medication was rare and evenly distributed across groups. CONCLUSIONS: This study shows that smokers with severe or very severe COPD are predominantly males with a high degree of physical dependence upon nicotine. CAR 9-24 was 48.5%. Varenicline and bupropion yielded higher abstinence rates than NRT. Varenicline was more effective than nicotine patches: all types of treatments were safe.

[Care results in a specialist stop-smoking unit]. / Resultados asistenciales de una unidad especializada en tabaquismo.

BACKGROUND AND OBJECTIVE: To present the short, medium and long-term results of a stop-smoking clinic after 5 years of experience. The clinic was designed following the SEPAR Recommendations. PATIENTS AND METHODS: Two types of clinic protocols have been applied: individual and group. Both included the offer of a combination of psychological intervention and pharmacological treatment. The programme included 10 visits over 12 months. The pharmacological treatment consisted of: nicotine replacement therapy (NRT) or bupropion or varenicline or a combination. The psychological intervention consisted of: self-monitoring, copying skills, cognitive-behavioural therapy and social intra-treatment support. The treatment was always offered for free. RESULTS: A total of 3920 patients were seen in the clinic. These patients made 21,418 clinic visits. The analysis was performed on the 1850 smokers who attended the clinic consecutively. Their mean age was 47.83 (+/-11.03) and the mean fagerström test for nicotine dependence (FTND)-score was 6.56 (+/-2.41). 55.9% patients received NRT, 22.8% bupropion, 18.9% varenicline and 2.4% did not receive any pharmacological treatment. Continuous abstinence rates at 6 and 12 months follow up were 58.5% and 54.9%, respectively. These abstinence rates at 36 and 57 months follow up were 42% and 35%, respectively. The cost in medication for each patient was 118 euros and the cost in medication for a successful abstainer at 6, 12, 36, and 57 months of follow up were 202, 215, 281 and 338 euros, respectively. CONCLUSIONS: A stop-smoking clinic that is designed according to SEPAR Recommendations is effective and has a good cost/effective ratio.

Resultados de un programa de tratamiento con vareniclina a largo plazo / No disponible

Objetivo: Analizar los resultados de eficacia y seguridad de uso de un tratamiento prolongado con vareniclina en un grupo de sujetos que acudieron a una unidad de Tabaquismo. Pacientes y métodos: Se trataron 132 fumadores, de ellos 63 (48%) eran hombres, con una edad media de 49,5 ± 6,1 años. La puntuación media en el test de Fagerström fue 7,1 ± 1,2. El programa de tratamiento consistió en una combinación de tratamiento farmacológico y tratamiento conductual. El tratamiento conductual se desarrolló en 11 sesiones individuales: una visita inicial y diez de seguimiento. El tratamiento farmacológico consistió en vareniclina a dosis de 1 mg cada 12 horas durante 24 semanas. Resultados: Las tasas de abstinencia continua, validadas mediante cooximetria, entre la 9-12 semanas, 9-24 semanas y 9-52 semanas, fueron: 72%, 66% y 48% respectivamente. Nauseas y trastornos del sueño fueron los efectos adversos más frecuentes. No se detectó un incremento en el número y tipo de efectos adversos. Conclusiones: El uso prolongado de vareniclina y tratamiento cognitivo-conductual en un grupo de fumadores con alto grado de dependencia que acuden a una unidad de tabaquismo se mostró eficaz y seguro para ayudarlos a dejar de fumar (AU)

Objective: To analyse effi cacy and safety of using a long term treatment with varenicline in a group of smokers who attended a smoking cessation service. Patients and methods: 132 smokers were treated. 63 (48%) were males. Mean age 49,5 ± 6,1 years. Mean FTND score 7,1 ± 1,2. The programme consisted of combination of pharmacological treatment and cognitive-behavioural treatment (CBT). The CBT was developed in 11 individuals sessions: 1 basal visit and 10 follow up visits. The pharmacological treatment consisted in using varenicline 1 mg bid for 24 weeks.. Results: CO validated continuous abstinence rates between 9-12 weeks, 9-24 weeks and 9.52 weeks were: 72%, 66% and 48% respectively. Anormal dreams and nausea were the more common adverse events. No increase in the number and intensive of adverse events were detected. Conclusions: The use of long term varenicline plus CBT in a group of dependent smokers who attended a smoking cessation service was effective and safe (AU)

Resultados de un programa de tratamiento combinado con bupropion mas chicles de nicotina / No disponible

Objetivo: Analizar los resultados de eficacia y seguridad de la combinación de chicles de nicotina y bupropion en un grupo de sujetos que acudieron a una unidad de Tabaquismo. Pacientes y métodos: Se trataron 197 fumadores, de ellos 79 (40%) eran hombres, con una edad media de 47,2 ± 9,5 años. La puntuación media en el test de Fagerström fue 6,8 ± 2,3. El programa de tratamiento consistió en una combinación de tratamiento farmacológico y tratamiento conductual. El tratamiento conductual se desarrolló en 11 sesiones individuales: una visita inicial y diez de seguimiento. El tratamiento farmacológico consistió en bupropion y chicles de nicotina. Resultados: Las tasas de abstinencia continua, validadas mediante cooximetria, entre la 9-12 semanas, 9-24 semanas y 9-52 semanas, fueron: 63% (95% IC 51%- 69%), 58% (95% IC 47%-62%) y 51% (95% IC 41%- 54%), respectivamente. Insomnio y cefaleas fueron los efectos adversos mas frecuentes. No se detectó un incremento en el número y tipo de efectos adversos. Conclusiones: La combinación de TSN y bupropion en un grupo de fumadores que acuden a una unidad de tabaquismo se mostró eficaz y segura para ayudarlos a dejar de fumar (AU)

Objective: To analyse efficacy and safety of combination therapy ( Nicotine gum plus v bupropion) in a group of smokers who attend a smoking cessation service. Patients and methods: 197 smokers were treated. 79 (40%) were males. Mean age 47,2 ± 9,5 years. Mean FTND score 6,8 ± 2,3. The programme consisted of combination of pharmacological treatment and cognitive- behavioural treatment (CBT). The CBT was developed in 11 individuals sessions: 1 basal visit and 10 follow up visits. The pharmacological treatment consisted in a combination of nicotine gum plus bupropion. Results: CO validated continuous abstinence rates between 9-12 weeks, 9-24 weeks and 9.52 weeks were: 63% (95% IC 51%-69%), 58% (95% IC 47%-62%) and 51% (95% IC 41%-54%), respectively. Insomnia, and headache were the more common adverse events. No increase in the number and intensive of adverse events were detected. Conclusions: Combination of nicotine gum and bupropion in a group of dependent smokers who attended a smoking cessation service was effective and safe (AU)

Resultados asistenciales de una unidad especializada en tabaquismo / Care Results in a Specialist Stop-Smoking Unit

IntroducciónEl objetivo del presente artículo es presentar los resultados asistenciales y de gasto farmacéutico de una unidad especializada en tabaquismo (UET).Pacientes y métodosSe aplicaron 2 protocolos asistenciales: individual y grupal. En ambos casos se oferta una combinación de tratamiento farmacológico y psicológico en 10 consultas, a lo largo de 12 meses de seguimiento. Como tratamiento farmacológico se emplea: tratamiento sustitutivo con nicotina, bupropión o vareniclina, o una combinación de ellos. El tratamiento psicológico contempla: realización de autorregistros, identificación de situaciones de alto riesgo, técnicas de afrontamiento, técnicas cognitivo-conductuales y apoyo intratratamiento. En todos los casos el tratamiento fue gratuito.ResultadosSe han realizado 21.418 consultas sanitarias a un total de 3.920 fumadores (un 49% varones). Se analiza una muestra constituida por 1.850 fumadores que acudieron consecutivamente a la UET entre enero de 2004 y marzo de 2007. Su edad media (± desviación estándar) era de 47,83±11,03 años, y la puntuación media del test de Fagerström, 6,56±2,41. El 55,9% recibió tratamiento sustitutivo con nicotina, el 22,8% bupropión, el 18,9% vareniclina y un 2,4% no recibió tratamiento farmacológico. La abstinencia continua a los 6 y 12 meses de seguimiento fue del 58,5 y el 54,9%, respectivamente. Estas cifras fueron del 42 y el 35% a los 36 y 57 meses de seguimiento.El coste en fármacos por paciente atendido fue de 118 €, y el coste por fumador atendido que consiguió mantenerse abstinente a los 6; 12; 36, y 57 meses fue de 202; 215; 281, y 338 €, respectivamente.ConclusionesUna UET obtiene buenos resultados asistenciales y económicos a corto, medio y largo plazo(AU)

Background and objectiveTo present the short, medium and long-term results of a stop-smoking clinic after 5 years of experience. The clinic was designed following the SEPAR Recommendations.Patients and methodsTwo types of clinic protocols have been applied: individual and group. Both included the offer of a combination of psychological intervention and pharmacological treatment. The programme included 10 visits over 12 months. The pharmacological treatment consisted of: nicotine replacement therapy (NRT) or bupropion or varenicline or a combination. The psychological intervention consisted of: self-monitoring, copying skills, cognitive-behavioural therapy and social intra-treatment support. The treatment was always offered for free.ResultsA total of 3920 patients were seen in the clinic. These patients made 21,418 clinic visits. The analysis was performed on the 1850 smokers who attended the clinic consecutively. Their mean age was 47.83 (±11.03) and the mean fagerström test for nicotine dependence (FTND)-score was 6.56 (±2.41). 55.9% patients received NRT, 22.8% bupropion, 18.9% varenicline and 2.4% did not receive any pharmacological treatment. Continuous abstinence rates at 6 and 12 months follow up were 58.5% and 54.9%, respectively. These abstinence rates at 36 and 57 months follow up were 42% and 35%, respectively. The cost in medication for each patient was 118 euros and the cost in medication for a successful abstainer at 6, 12, 36, and 57 months of follow up were 202, 215, 281 and 338 euros, respectively.ConclusionsA stop-smoking clinic that is designed according to SEPAR Recommendations is effective and has a good cost/effective ratio(AU)