[Smoking cessation after 12 months follow-up at a smoking cessation unit]. / Abstinencia de tabaquismo tras 12 meses de seguimiento en una unidad de tabaquismo integral.

BACKGROUND AND OBJECTIVE: To assess the cessation and relapse rates of smoking, and analyze the associated variables in a 12-month follow-up study at a smoking cessation unit. SUBJECTS AND METHOD: Patients from the Area de Salud 19 of the Conselleria de Sanitat of the Generalitat Valenciana, coming to a smoking cessation unit. VARIABLES: sociodemographic, smoking habits, smoking social context, psychiatric or medical problems, use of other substances, and treatment. Treatment was administered either individually or in group, and with or without pharmacological support. Type of pharmacological treatment: nicotine replacement therapy and/or bupropion. Evaluation of smoking cessation and relapse: at the end of the treatment, and at follow-up months 1, 3, 6, 9, and 12. Criteria to accept cessation were: it had to be uninterrupted, referred as such by the patient and corroborated by relatives or other witnesses, and supported by a co-oxymetry level < or = 6 ppm. STATISTICAL ANALYSES: description of quantitative and qualitative variables, evaluation of the relationship between relapse rate and follow-up time when it happens by means of Kaplan-Meier curves, Cox regression, construction of curves of prediction of cessation for subjects with different patterns in the independent variables, and estimations of risk of relapse between any 2 subjects, according to those patterns. RESULTS: 255 subjects (46.7% males); 41.8 (10.8) years of mean age (standard deviation); 25 years of mean duration of the smoking habit; a mean of 2 to 3 previous attempts of cessation smoking, mean duration of the longest period of cessation 6 to 7 months; smoking habit 26.5 (12.1) mean of cigarrettes per day, the average nicotine dependency was moderate, and the average co-oxymetry levels high. Of all the subjects included, 53.3% received single therapy (60% together with pharmacological treatment) and 46.7% had group therapy (18.4% also with pharmacological treatment). Pharmacological treatment was 14.9% nicotine replacement therapy, 17.3% bupropion, and 7.1% both. At the end of the treatment, 42.7% of the subjects kept smoking and, at the end of the follow-up period only 11.4% remained abstinent. Median cessation extent was one month. VARIABLES associated to the extent of the cessation: type of therapy (individual or in a group), pharmacological support, and previous daily amount of cigarrette consume. CONCLUSIONS: There were high relapse rates, that depended on the previous amount of consume and on the treatment applied. Both group therapy and pharmacological treatment are significantly useful in order to obtain the best results in long-term cessation rates.

Abstinencia de tabaquismo tras 12 meses de seguimiento en una unidad de tabaquismo integral / Smoking cessation after 12 months follow-up at a smoking cessation unit

Fundamento y objetivo: El propósito del estudio es presentar los resultados obtenidos en la tasa de abstinencia y de recaída del hábito tabáquico y analizar las variables asociadas tras un seguimiento de 12 meses en una unidad de tabaquismo integral. Sujetos y método: Se incluyó a pacientes pertenecientes al Área de Salud 19 de la Conselleria de Sanitat de la Generalitat Valenciana remitidos a una unidad de tabaquismo integral. Se analizaron variables sociodemográficas, del hábito tabáquico y del contexto social tabáquico, problemas médicos o psiquiátricos, consumo de otras sustancias y tipo de tratamiento recibido. Se administró terapia individual o grupal, con o sin apoyo farmacológico. La intervención farmacológica consistió en tratamiento sustitutivo con nicotina y/o bupropión. Se evaluó el estado de abstinencia o las recaídas al final del tratamiento y en los meses 1, 3, 6, 9 y 12 de seguimiento. La abstinencia considerada fue la continua, obtenida por autodeclaración, corroborada por acompañantes o familiares y confirmada por un valor en la cooximetría de 6 ppm o inferior. Resultados: Se incluyó a 255 sujetos (un 46,7% varones), con una edad media (desviación estándar) de 41,8 (10,8) años y 25 años de media de consumo. El número medio de intentos previos de abandono fue de 2 o 3, con una duración media del intento más largo de 6 a 7 meses. El número medio de cigarrillos consumidos era de 26,5 (12,1) al día, la dependencia nicotínica media era moderada y los valores medios de cooximetría, altos. El 53,3% recibió terapia individual (un 60% con tratamiento farmacológico) y el 46,7% psicoterapia de grupo (un 18,4% con tratamiento farmacológico). El tratamiento farmacológico administrado fue en un 14,9% de los casos tratamiento sustitutivo con nicotina, en un 17,3% bupropión y en el 7,1% ambos. Al final del tratamiento el 42,7% de los sujetos seguía fumando y al final del seguimiento sólo el 11,4% permanecía abstinente. La mediana de abstinencia fue de un mes. Las variables asociadas con el tiempo de abstinencia fueron el tipo de terapia (individual o de grupo), recibir tratamiento médico y el número de cigarrillos consumidos. Tuvieron mayor probabilidad de éxito aquellos que recibieron terapia de grupo con medicación y presentaban menor consumo de cigarrillos. Conclusiones: En este estudio realizado en pacientes remitidos a una unidad de tabaquismo integral se han observado tasas altas de recaída, que se modifican en función del consumo y del tipo de tratamiento aplicado. Los efectos de la psicoterapia de grupo y de la medicación son considerablemente beneficiosos a la hora de conseguir mejores resultados en las tasas de abstinencia a largo plazo

Background and objective: To assess the cessation and relapse rates of smoking, and analyze the associated variables in a 12-month follow-up study at a smoking cessation unit. Subjects and method: Patients from the Área de Salud 19 of the Conselleria de Sanitat of the Generalitat Valenciana, coming to a smoking cessation unit. Variables: sociodemographic, smoking habits, smoking social context, psychiatric or medical problems, use of other substances, and treatment. Treatment was administered either individually or in group, and with or without pharmacological support. Type of pharmacological treatment: nicotine replacement therapy and/or bupropion. Evaluation of smoking cessation and relapse: at the end of the treatment, and at follow-up months 1, 3, 6, 9, and 12. Criteria to accept cessation were: it had to be uninterrupted, referred as such by the patient and corroborated by relatives or other witnesses, and supported by a co-oxymetry level ¾ 6 ppm. Statistical analyses: description of quantitative and qualitative variables, evaluation of the relationship between relapse rate and follow-up time when it happens by means of Kaplan-Meier curves, Cox regression, construction of curves of prediction of cessation for subjects with different patterns in the independent variables, and estimations of risk of relapse between any 2 subjects, according to those patterns. Results: 255 subjects (46.7% males); 41.8 (10.8) years of mean age (standard deviation); 25 years of mean duration of the smoking habit; a mean of 2 to 3 previous attempts of cessation smoking, mean duration of the longest period of cessation 6 to 7 months; smoking habit 26.5 (12.1) mean of cigarrettes per day, the average nicotine dependency was moderate, and the average co-oxymetry levels high. Of all the subjects included, 53.3% received single therapy (60% together with pharmacological treatment) and 46.7% had group therapy (18.4% also with pharmacological treatment). Pharmacological treatment was 14.9% nicotine replacemnte therapy, 17.3% bupropion, and 7.1% both. At the end of the treatment, 42.7% of the subjects kept smoking and, at the end of the follow-up period only 11.4% remained abstinent. Median cessation extent was one month. Variables associated to the extent of the cessation: type of therapy (individual or in a group), pharmacological support, and previous daily amount of cigarrete consume. Conclusions: There were high relapse rates, that depended on the previous amount of consume and on the treatment applied. Both group therapy and pharmacological treatment are significantly useful in order to obtain the best results in long-term cessation rates