Fagerström Test and Heaviness Smoking Index. Are they Interchangeable as a Dependence Test for Nicotine?

Objective: The purpose of this study was to evaluate the degree of agreement between the Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) in daily smokers admitted to smoking cessation clinics from National Healthcare System in Spain and Argentine Republic. Material and methods: An observational, longitudinal, multicenter study (prospective cohort) conducted in smoking clinics in daily clinical practice. The patients were consecutively included as they attended the consultations. The statistical analysis was descriptive, and correlation and concordance tests as well as analysis and regression models were used. Results: In total, 308 subjects were included [161 women (52.3%)], with a mean age of 51.4 (10.8) years. We found an absence of agreement and the existence of a proportional difference between both tests [Regression coefficient for global series: 0.55 (0.52-0.59) p < .001]. This difference increased as the value of the FTCD score increased; that is, the higher the value of the FTCD score was, the greater the difference in relation to the value of the HSI score. Likewise, Cohen's kappa concordance coefficient, according to various combinations of categorization of both tests, showed that the agreement between these variables was only good. Approximately 20% of the subjects were not classified with the same degree of dependence by the two tests. Thus, a classification mismatch existed. Conclusions: We found an absence of agreement between both tests. These data imply that we should not substitute one test for the other when we analyze nicotine dependence in a population of smokers.

Varenicline in smokers with severe or very severe COPD after 24 weeks of treatment. A descriptive analysis: VALUE study.

A large number of COPD patients are smokers. The particular characteristics of this group as well as their need to quit usually require psychological counselling and pharmacological treatment to achieve abstinence and, often, intensively. Little information is available about this issue.  The main objective of the study was to evaluate the effectiveness of varenicline after 24 weeks of treatment, with continuous abstinence between weeks 9 and 24.  This study was a post-authorization, open label, observational study of prospective follow-up. Patients included were smokers with severe or very severe COPD criteria who were treated with varenicline for 24 weeks, i.e. with a 12-week extension over the usual treatment.  The outcomes in the population of subjects completing 24 weeks of follow-up were at week 24: continuous abstinence 36.8%, 7 days point prevalence abstinence 65.7%, and continuous smoking 31.5%.The outcomes in the intention-to-treat population included at baseline were: continuous abstinence 17.7% of patients, 7 days point prevalence abstinence 31.6%, continuous smoking 15.1% and not valid/unknown 51.8%.  The mean CAT score at week 24 was 15 and reduction from the baseline was 3.77 (paired T test, p<0.01). The most common adverse events reported were nausea, vivid dreams, stomach ache, insomnia, headache and vomiting.  Patients included in VALUE were active smokers despite all of them had a severe COPD which suggests a very high degree of dependence. Although the study do not allow to infer the results to the global population of smokers with severe COPD, the outcomes have shown that, at 24 weeks follow up 36.8% of the patients were successful in quitting but from 79 patients enrolled initially only 17.7% quit.

Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023.

INTRODUCTION: There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. MATERIAL AND METHODS: 12 PICO questions are formulated from a GLOBAL PICO question: "Efficacy and safety of pharmacological treatment of tobacco dependence". A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. RESULTS: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. CONCLUSIONS: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence.

Certified Smoking Cessation Units in Spain: High Potential for Detection of Undiagnosed Chronic Obstructive Pulmonary Disease and Profile of Newly Diagnosed Cases.

PURPOSE: Smokers attending smoking cessation units (SCUs) may offer a unique opportunity for early recognition of undiagnosed chronic obstructive pulmonary disease (COPD). We aimed at assessing the impact of SCUs on the early diagnosis of COPD and describing the clinical and smoking profile of newly-diagnosed COPD cases at SCUs certified by the Spanish Society of Respiratory Diseases and Thoracic Surgery (SEPAR). PATIENTS AND METHODS: A multicenter cross-sectional observational cohort study (DIPREPOQ study) was performed in eight SEPAR-certified SCUs in Spain. Adult current smokers with no previously diagnosed respiratory disease and having one o more respiratory symptoms were included. Lung functional tests were performed and previously undiagnosed COPD cases were identified and characterized based on national guidelines. RESULTS: Out of 401 individuals newly attending the SCUs, 252 participants were included and 73 (28.9%) met the definition of previously undiagnosed COPD. A characterization of patients with COPD being newly recognized in SCUs showed: age (mean±SD) 61±9 years; men 59%; active work status 53.1%; functional class I/II dyspnea 82.8%, GOLD state mild/moderate/severe 57%/31%/12%; non-exacerbators 90%, CAT 14±4; emphysema in X-rays 40%. Most common co-morbidities were cardiovascular and psychiatric (anxiety and depression) ones. Usual smoking history included a lengthy smoking history (41±9 years) and a current consumption of 24±9 cigarettes/day. CONCLUSIONS AND IMPLICATIONS: Consistently certified SCUs can have a substantial contribution to early diagnosis of COPD. A typical profile of newly detected cases is reported, with most patients being men at their early sixties, with mild symptoms and with high and lengthy smoking history. Our study reports a high usefulness of lung functional tests to detect undiagnosed COPD in appropriately selected participants attending SCUs at a large national scale, using a standardized methodology. This is likely to be facilitated by the certification of SCUs using well-defined requirements by national scientific societies.

Is the motivation to quit smoking a predictor of abstinence maintenance?

INTRODUCTION: The aim of this study was to explore the utility of measuring motivation to quit smoking as a predictor of abstinence maintenance among smokers who wanted to quit and who were included in a multicenter study conducted in daily clinical practice. METHODS: This observational, longitudinal (prospective cohort), multicenter study was conducted in smoking clinics in Spain and the Argentine Republic in daily clinical practice. Motivation was assessed using three quantitative motivation tests and a Visual Analogue Scale. Statistical analysis included descriptive, association measures and logistic regression models. RESULTS: Of a total of 404 subjects, 273 were ultimately included for analysis (147 women; 53.8%), mean age 51±11 years). In one year, 53.5% (36.13% by intention to treat) of subjects (146) were successful in quitting smoking [men: 45.2% (66) and women: 54.8% (80)], with no differences between sexes. None of the scales utilized was associated, in an unquestionable or direct way, with long-term abstinence, although three of them, in a very complex model, with additional variables and added interactions, were associated with the 'result' variable, when other variables intervened in certain circumstances. CONCLUSIONS: None of the analyzed motivational scales alone demonstrated an association with success or failure in quitting smoking; thus, their use in isolation is of no value. Some of the scales analyzed might be related to the maintenance of abstinence but in complex models where other variables intervene, which makes interpretation considerably difficult. Therefore, the predictive capacity of the tests analyzed, based on the models, was low.

Consensus Document on Medical Faculty Education on the Treatment of Smoking. / Documento de consenso sobre la docencia del tabaquismo en las facultades de Medicina.

We report the results of a consensus reached by an expert group of representatives from different medical societies in Latin America on the objectives, competencies (knowledge, and skills), content, and duration of smoking cessation education in Latin American medical schools. The document discusses the following aspects: epidemiology, nicotine dependence, factors for initiation and maintenance of tobacco use, smoking-related disorders, diagnosis, minimal intervention, non-pharmacological and pharmacological interventions for smoking cessation, and prevention of smoking.

Is There an Association Between the Degree of Nicotine Dependence and the Motivation to Stop Smoking? / ¿Existe asociación entre el grado de dependencia por la nicotina y la motivación para dejar de fumar?

OBJECTIVE: To evaluate the association between degrees of nicotine dependence measured by the Fagerström test (FTCD) and different tests of motivation to stop smoking. MATERIAL AND METHODS: Observational study, multicenter conducted in smoking clinics in daily clinical practice. Demographics, smoking status, FTCD scores, and motivation test results were collected: Richmond test (TR), Henri Mondor Paris motivation test (HMP), Khimji-Watts test (KW), and the visual analog scale of motivation to stop smoking. The statistical analysis was descriptive, and correlation and analysis tests and regression models were used. RESULTS: A total of 314 subjects were included [162 women (51.59%)]. Males smoked an average of 3.3 cigarettes/day more than women (95% CI: 0.9-5.6 cigarettes/day, p=0.006) and their cumulative consumption was 7.8 pack-years higher than in women (95% CI: 2.1 to 13.5 pack-years). We found no association between FTCD and the motivation tests to stop smoking used in this study. CONCLUSIONS: We found no association between the degree of dependence and the motivation to quit smoking measured by the aforementioned instruments.

Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023

Introduction: There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. Material and methods: 12 PICO questions are formulated from a GLOBAL PICO question: “Efficacy and safety of pharmacological treatment of tobacco dependence”. A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. Results: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. Conclusions: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence. (AU)

Relación entre la autoeficacia para dejar de fumar, la voluntad propia y quién envía a los pacientes / Relationship between self-efficacy to quit smoking, own will and who referred patients

Objetivo: Comprobar si el grado de autoeficacia (AE) para dejar de fumar es diferente según quién remita al fumador a la consulta de tabaquismo y evaluar si el grado de AE medida según procedencia tiene impacto en el resultado (éxito o fracaso). Método: Estudio observacional, longitudinal (cohorte prospectiva), multicéntrico, en consultas para dejar de fumar de España y Argentina. Para valorar la motivación, fueron utilizados test cuantitativos (Richmond, Henry Mondor de Paris y Khimji Watts) y una escala semicuantitativa. La AE se midió con una pregunta de dos cuestionarios distintos (pregunta 4 del cuestionario de Richmond y pregunta 3 del cuestionario de Khimji-Watts). El análisis estadístico incluyó modelos descriptivos, de asociación y de regresión. Resultados: Muestra de 182 sujetos (90 [49,5%] mujeres, edad media 51,4 años [DE: 11; IC 26-77]). Con la pregunta 3 de AE del test Khimji-Watts se encontró asociación con la procedencia en los varones: acudir por voluntad propia incrementa la AE frente a los que acuden enviados desde atención primaria o desde otras especialidades. Ninguna de las variables de AE presentó asociación con el resultado en dejar de fumar, pero las mujeres que acudieron por voluntad propia o enviadas desde atención primaria tienen más probabilidades de dejar de fumar. Los varones procedentes de otras especialidades y con edades medias tienen más probabilidades de fracaso. Conclusiones: Los varones que acuden a dejar de fumar por voluntad propia presentan puntuaciones más altas de AE que aquellos que acuden enviados por atención primaria y otras especialidades. No hemos encontrado una mayor abstinencia final según la puntuación de AE y la procedencia.(AU)

Objective: To check whether the degree of self-efficacy to quit smoking is different depending on who refers the smoker to the smoking cessation clinics, considering as origin: primary care, from another medical specialist or by the patient’s own volition, and to assess whether the degree of self-efficacy measured by who refers the patient has an impact on the ­outcome (success or failure). Methods: Observational, longitudinal (prospective cohort), multicentre study in smoking cessation clinics in Spain and Argentina (daily clinical practice). Quantitative tests (Richmond, Henry Mondor de Paris and Khimji Watts) and one semiquantitative test were used to assess motivation. Self-efficacy was measured with one question from two different questionnaires (question 4 of the Richmond questionnaire and question 3 of the Khimji-Watts questionnaire). Statistical analysis included descriptive, association, and regression models. Results: 182 subjects [90 (49.5%) women, mean age 51.4 years (11; 25-77)]. With question three of the auto-efficacy of the Khimji-Watts test an association was found with the origin in men: attending of their own free will increases self-efficacy compared to those who attend sent from primary care or from other specialties. None of the self-efficacy variables was associated with the outcome of quitting smoking, but women who attended of their own free will or referred from primary care are more likely to quit smoking. Men from other specialties and with middle ages are more likely to fail. Conclusions: Men referred for QS by his OV have higher SE scores (KWT3 question) than those referred by PC and OS. We did not find a higher final abstinence according to SE score and source.(AU)

Guidelines for the Treatment of Smoking in Hospitalized Patients. / Normativa sobre tratamiento del tabaquismo en pacientes hospitalizados.

Between 15 and 27% of patients admitted to Spanish hospitals are smokers. Hospitalization is an ideal time for a smoker to decide to quit. We performed a MEDLINE search of controlled, randomized or observational studies associated with helping hospitalized patients quit smoking, published between January 1, 2002 and September 30, 2015. On the basis of the results of those studies, we have issued some recommendations for the treatment of smoking in hospitalized patients. The recommendations were drawn up according to the GRADE system. Offering the smoker psychological counselling and prolonging follow-up for at least 4 weeks after discharge is the most effective recommendation for helping hospitalized patients to quit.

Prevalence, Knowledge and Attitudes Towards Smoking Among SEPAR Members. / Prevalencia, conocimiento y actitudes acerca del consumo de tabaco en los miembros de SEPAR.

The aims of this study were to estimate the prevalence of smoking among SEPAR members, and their approach to smoking cessation in their patients. An online survey was completed by 640 members (496 pulmonologists, 45 nurses, 34 thoracic surgeons, 37 physiotherapists, and 28 other specialists). Of the members interviewed, 5% confessed that they were smokers: 3.5% pulmonologists; 8.9% nurses; 8.8% thoracic surgeons, and 13.5% physiotherapists. A total of 96% of members assign a lot or quite a lot of importance to setting an example; 98% of members always or often ask their patients about their smoking habit. The most effective anti-smoking intervention, according to 77% of members, is a combination of drugs and psychological support. These results are an indicator of the awareness and commitment of SEPAR members to smoking and its cessation.

Cinco medidas urgentes para ganar el control del tabaquismo en España / Five urgent steps to gain control of the smoking habit in Spain

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¿Existe asociación entre el grado de dependencia por la nicotina y la motivación para dejar de fumar? / Is There an Association Between the Degree of Nicotine Dependence and the Motivation to Stop Smoking?

Objetivo: Evaluar la existencia de asociación entre el grado de dependencia por la nicotina medido por el test de Fagerström (FTCD) y diferentes test de motivación para dejar de fumar. Material y métodos: Estudio observacional y multicéntrico realizado en consultas de tabaquismo en la práctica clínica diaria. Se recogieron variables demográficas, de estatus de fumador y las puntuaciones del FTCD y los test de motivación: test de Richmond (TR), test motivacional Henri Mondor de París (HMP), test Khimji-Watts (KW) y la escala analógica visual de motivación para dejar de fumar. El análisis estadístico fue descriptivo y se utilizaron test de correlación y análisis y modelos de regresión. Resultados: Fueron incluidos 314 sujetos (162 mujeres [51,59%]). Los varones fumaron en promedio 3,3cig/día más que las mujeres (IC95%: 0,9-5,6cig/día, p = 0,006) y tuvieron un consumo acumulado superior a las mujeres en 7,8 años-paquete (IC95%: 2,1 a 13,5 años-paquete). No se encontró asociación entre el FTCD y los test de motivación para dejar de fumar empleados en este estudio. Conclusiones: No hemos encontrado asociación entre el grado de dependencia y la motivación para dejar de fumar medidos por los instrumentos mencionados

Objective: To evaluate the association between degrees of nicotine dependence measured by the Fagerström test (FTCD) and different tests of motivation to stop smoking. Material and methods: Observational study, multicenter conducted in smoking clinics in daily clinical practice. Demographics, smoking status, FTCD scores, and motivation test results were collected: Richmond test (TR), Henri Mondor Paris motivation test (HMP), Khimji-Watts test (KW), and the visual analog scale of motivation to stop smoking. The statistical analysis was descriptive, and correlation and analysis tests and regression models were used. Results: A total of 314 subjects were included [162 women (51.59%)]. Males smoked an average of 3.3 cigarettes/day more than women (95% CI: 0.9-5.6 cigarettes/day, p = 0.006) and their cumulative consumption was 7.8 pack-years higher than in women (95% CI: 2.1 to 13.5 pack-years). We found no association between FTCD and the motivation tests to stop smoking used in this study. Conclusions: We found no association between the degree of dependence and the motivation to quit smoking measured by the aforementioned instruments