ABSTRACT
Our main objective was to demonstrate that, in smoker patients hospitalised for Chronic Obstructive Pulmonary Disease (COPD) exacerbation, early initiation of varenicline during 12 weeks, combined with an intensive counselling, is associated with a higher continuous abstainers rate (CAR) at one year as compared to intensive counselling alone. In this multicenter, prospective, double-blind, randomised study, 81 smoking COPD patients hospitalised for an acute exacerbation for at least 24 h were allocated to receive either varenicline (n = 42) or placebo (n = 39) for 12 weeks, in association with an intensive counselling in the 2 groups, and followed up for 40 weeks. The primary outcome was CAR at week 52. Secondary outcomes included CAR at week 12 and 26, partial abstinence rate (PAR) at week 12, 26 and 52, nicotinic substitute consumption and adverse events. At week 52, CAR was not different in placebo and varenicline groups (25.6%). At week 12, CAR was significantly higher in the varenicline group (50%) as compared to placebo group (27%) (p = 0.041). Nicotine consumption was significantly higher at week 52 in the placebo group (55.3%) as compared to the varenicline group (24.4%) (p = 0.005). There was no significant difference in PAR at week 12, 26 and 52; the frequency of adverse events was similar between the two groups. Among active smoker COPD patients with exacerbation, 12-week varenicline associated with intensive counselling for smoking cessation increased the rate of continuous abstainers as compared to placebo. However, benefit was not maintained after varenicline discontinuation.Clinical Trials Registration: URL: http://www.controlled-trials.com. Unique identifier: NCT01694732.
Subject(s)
Counseling/methods , Pulmonary Disease, Chronic Obstructive/therapy , Smoking Cessation Agents/therapeutic use , Smoking Cessation/methods , Tobacco Use Disorder/therapy , Varenicline/therapeutic use , Aged , Disease Progression , Early Medical Intervention , Female , Hospitalization , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/complications , Tobacco Use Disorder/complications , Treatment OutcomeABSTRACT
INTRODUCTION: While smoking continues to kill 73,000 people each year in France, new legislation allows pharmacists to ensure public health actions. How do pharmacists contribute to smoking cessation? METHODS: This study described smoking cessation professional practices, the tests used and dispensing of nicotine replacement therapy based on an online questionnaire administered to a random sample of 220 pharmacists, selected from the "Ordre des pharmaciens" website. The questionnaire concerned the type of pharmacy, place of smoking cessation support, knowledge and application of tests, training, referral to the physician and dispensing of nicotine replacement therapy. RESULTS: Among the 133 respondent pharmacies, minimal intervention and the Fagerström test were two tools most commonly used and 82.7% of pharmacists advised nicotine replacement therapy. Practices complied with guidelines, although certain dispensing difficulties were identified, as well as somewhat approximate or even incorrect knowledge concerning the dispensing of nicotine replacement therapy for certain patients (coronary heart disease, pregnant and breastfeeding women, teenagers). DISCUSSION: Certain improvements can be proposed such as the use of a confidential place for private conversations, better patient follow-up, better training and improvement of good practices by young pharmacists.