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PULMONARY
DISORDERS Devra K. Dang,
Section Advisor
Repeat and higher-intensity smoking cessation interventions
best
Key points: Results from two clinical trials
published in the April 7 Annals of Internal Medicine suggest
that repeated, intensive interventions consisting of pharmacotherapy,
counseling, and continued dialogue with health providers are the most
successful in helping patients quit smoking.
Finer points: Ellerbeck et al. conducted a
multicenter trial in 750 primary care patients who smoked at least 10
cigarettes per day. At baseline, all patients received a health
education mailing that included a welcome letter, information about
pharmacotherapy of smoking cessation, and patient education materials.
Patients were randomly assigned to pharmacotherapy (nicotine patch 21
mg/day for 6 weeks or bupropion SR 150 mg twice daily for 7 weeks),
pharmacotherapy supplemented with up to two calls from trained
counselors, or pharmacotherapy supplemented with up to six counseling
calls; smoking abstinence rates at 2 years were 23, 24, and 28%,
respectively. Use of each intervention, which was offered every 6 months
for 2 years, was similar among the groups. Abstinence rates increased
throughout the study for each group. Point-prevalence abstinence did not
differ by 2 years; however, an analysis of abstinence over the 2 years
of treatment indicated that higher-intensity interventions that include
pharmacotherapy and more counseling were associated with increased
abstinence. All participants were offered free pharmacotherapy, and
self-reporting was used to document point-prevalence smoking
abstinence.
Steinberg et al. conducted a randomized trial of 127 smokers with
medical illness such as cardiovascular disease or chronic obstructive
pulmonary disease (COPD). Patients were randomly assigned to a nicotine
patch for 10 weeks with a standard taper or a combination of a nicotine
patch, a nicotine oral inhaler, and bupropion SR (triple therapy) for an
as-needed duration; at 26 weeks, abstinence rates were 19 and 35%,
respectively. Patients receiving triple therapy were advised to use full
doses of medications until 14 consecutive days of no withdrawal
symptoms, cravings, or near lapses occurred. After achieving this
milestone, patients were advised to gradually taper doses of each
medication until all had been discontinued. Standard monotherapy versus
extended triple therapy was associated with less insomnia (9 vs. 25%,
respectively) and less anxiety (3 vs. 22%, respectively); however, only
6% of patients in each group withdrew from study because of an adverse
effect.
What you need to know: Smoking cessation should be
managed like a chronic disease to achieve successful outcomes. Many who
smoke are willing to make repeated medically assisted attempts at
quitting smoking, which may lead to progressively greater smoking
abstinence. Health providers should talk to their patients continually
about quitting.
Medically ill smokers are less likely to quit and are at greater risk
for complications from continued smoking than smokers without COPD or
cardiovascular disease. Intensive treatment with a triple combination of
medications was found to help medically ill patients quit smoking and
remain abstinent.
What your patients need to know: Explain to patients
that smoking cessation is not easy and will likely require repeated and
intensive interventions. Tell patients that even if they have tried to
quit smoking in the past and failed, they should continue to try until
they are successful.
Sources
Related resources on www.pharmacist.com
Joe Sheffer (jsheffer@aphanet.org)
Posted May 7, 2009
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