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Qin R, Liu Z, Cheng AQ, Zhou XM, Su Z, Cui ZY, Li JX, Wei XW, Zhao L, Chung KF, Xiao D, Wang C. Efficacy of varenicline or bupropion and its association with nicotine metabolite ratio among smokers with COPD. Respirology 2024; 29:479-488. [PMID: 38494828 DOI: 10.1111/resp.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Nicotine metabolic ratio (NMR) has been associated with nicotine metabolism and smoking characteristics. However, there are few studies on the potential association between NMR and smoking cessation efficacy in smokers with chronic obstructive pulmonary disease (COPD) in China or elsewhere. METHODS This study was a stratified block randomized controlled trial for smoking cessation in Chinese smokers with COPD. NMR was used as a stratification factor; slow metabolizers were defined as those with NMR <0.31, and normal metabolizers as those with NMR ≥0.31. Participants were randomly assigned to the varenicline or bupropion group. Follow-up visits were conducted at 1, 2, 4, 6, 9, 12 and 24 weeks. RESULTS Two hundred twenty-four participants were recruited and analysed from February 2019 to June 2022. In normal metabolizers, the 9-12 weeks continuous abstinence rate of varenicline (43.1%) was higher than in bupropion (23.5%) (OR = 2.47, 95% CI 1.05-5.78, p = 0.038). There was no significant difference in abstinence rates between treatment groups in slow metabolizers (54.1% vs. 45.9%, OR = 1.39, 95% CI 0.68-2.83, p = 0.366). For slow metabolizers, the total score of side effects in the varenicline group was significantly higher than the bupropion group (p = 0.048), while there was no significant difference in side effects between groups for normal metabolizers (p = 0.360). CONCLUSION Varenicline showed better efficacy than bupropion in normal metabolizers, and bupropion showed equivalent efficacy in slow metabolizers with less side effects. According to our study, NMR provides a better justification for both scientific research and tailoring optimal pharmacotherapy for smoking cessation among smokers in COPD.
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Affiliation(s)
- Rui Qin
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - An-Qi Cheng
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Xin-Mei Zhou
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Zheng Su
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Zi-Yang Cui
- Department of Geriatric Medicine, Beijing Shijitan Hospital, Beijing, China
| | - Jin-Xuan Li
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Capital Medical University, Beijing, China
| | - Xiao-Wen Wei
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Capital Medical University, Beijing, China
| | - Liang Zhao
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dan Xiao
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Tobacco Control and Prevention of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
| | - Chen Wang
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
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Cheng A, Liu Z, Zhou X, Su Z, Xiao D, Wang C, China National Tobacco Cessation Cohort Study (CNTCCS) Study Group T. Real-World Treatment Adherence to Smoking Cessation Medications and Association with Treatment Outcome - 27 Centers, China, 2017-2022. China CDC Wkly 2024; 6:522-529. [PMID: 38855569 PMCID: PMC11154102 DOI: 10.46234/ccdcw2024.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/16/2024] [Indexed: 06/11/2024] Open
Abstract
What is already known about this topic? Medication non-adherence significantly impedes smoking cessation efforts. While effective smoking cessation medications are accessible in China, real-world adherence and its correlation with treatment outcomes remain largely unexplored. What is added by this report? From December 2017 to January 2022, 1,120 participants were recruited from 27 centers in all seven geographical regions of China. Results revealed that only 38.2% of smokers adhered to the prescribed 12-week smoking cessation treatment and those with a higher education level were more likely to be adherent. In addition, smokers with good adherence were more likely to successfully quit smoking. What are the implications for public health practice? The data obtained could enhance our understanding of smoking cessation practices in China. Improving adherence is a crucial strategy to enhance the effectiveness of smoking cessation treatments and management provided to smokers.
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Affiliation(s)
- Anqi Cheng
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention; National Center for Respiratory Medicine; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention; National Center for Respiratory Medicine; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinmei Zhou
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention; National Center for Respiratory Medicine; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Su
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention; National Center for Respiratory Medicine; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Xiao
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention; National Center for Respiratory Medicine; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention; China National Center for Respiratory Medicine; China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lin HX, Liu Z, Hajek P, Zhang WT, Wu Y, Zhu BC, Liu HH, Xiang Q, Zhang Y, Li SB, Pesola F, Wang YY. Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:291-299. [PMID: 38285562 PMCID: PMC10825782 DOI: 10.1001/jamainternmed.2023.7846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 01/31/2024]
Abstract
Importance Electronic cigarettes (ECs) are often used by smokers as an aid to stopping smoking, but evidence is limited regarding their efficacy compared with nicotine replacement therapy (NRT), and no evidence is available on how their efficacy compares with that of varenicline. Objective To evaluate whether ECs are superior to NRT and noninferior to varenicline in helping smokers quit. Design, Setting, and Participants This was a randomized clinical trial conducted at 7 sites in China and including participants who were smoking at least 10 cigarettes per day and motivated to quit, not using stop-smoking medications or EC, and willing to use any of the study products. Participants were first recruited in May 2021, and data analysis was conducted in December 2022. Interventions A cartridge-based EC (30 mg/mL nicotine salt for 2 weeks and 50 mg/mL after that), varenicline (0.5 mg, once a day for 3 days; 0.5 mg, twice a day for 4 days; and 1 mg, twice a day, after that), and 2 mg (for smokers of ≤20 cigarettes per day) or 4 mg (>20 cigarettes per day) nicotine chewing gum, all provided for 12 weeks and accompanied by minimal behavioral support (an invitation to join a self-help internet forum). Main Outcomes and Measures The primary outcome was sustained abstinence from smoking at 6 months as validated by an expired-air carbon monoxide reading (<8 parts per million). Participants lost to follow-up were included as nonabstainers. Results Of 1068 participants, 357 (33.5%) were female, and the mean (SD) age was 33.9 (3.1) years. A total of 409 (38.3%), 409 (38.3%), and 250 (23.4%) participants were randomized to the EC, varenicline, and NRT arms, respectively. The 6-month biochemically validated abstinence rates were 15.7% (n = 64), 14.2% (n = 58), and 8.8% (n = 22) in the EC, varenicline, and NRT study arms, respectively. The quit rate in the EC arm was noninferior to the varenicline arm (absolute risk reduction, 1.47%; 95% CI, -1.41% to 4.34%) and higher than in the NRT arm (odds ratio, 1.92; 95% CI, 1.15-3.21). Treatment adherence was similar in all study arms during the initial 3 months, but 257 participants (62.8%) in the EC arm were still using ECs at 6 months, with no further use in the 2 other study arms. The most common adverse reactions were throat irritation (32 [7.8%]) and mouth irritation (28 [6.9%]) in the EC arm, nausea (36 [8.8%]) in the varenicline arm, and throat irritation (20 [8.0%]) and mouth irritation (22 [8.8%]) in the NRT arm. No serious adverse events were recorded. Conclusions and Relevance The results of this randomized clinical trial found that when all treatments were provided with minimal behavior support, the efficacy of EC was noninferior to varenicline and superior to nicotine chewing gum. Trial Registration Chinese Clinical Trial Registry: ChiCTR2100048156.
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Affiliation(s)
- Hao-Xiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Wan-Tong Zhang
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuan Wu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Chen Zhu
- Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Hua Liu
- Department of Traditional Chinese Medicine, Beijing Geriatric Hospital, Beijing, China
| | - Qiu Xiang
- Respiratory Intensive Care Unit, Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Office of China Journal of Traditional Chinese Medicine and Pharmacy, Beijing, China
| | - Shu-Bin Li
- Beijing PL Technology Co, Ltd, Beijing, China
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Ying-Ying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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Zhang Q, Zhang H, Xu Q. Association of Chronic Obstructive Pulmonary Disease with Risk of Psychiatric Disorders: A Two-Sample Mendelian Randomization Study. Int J Chron Obstruct Pulmon Dis 2024; 19:343-351. [PMID: 38317665 PMCID: PMC10840522 DOI: 10.2147/copd.s442725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder often accompanied by comorbidities. Although the past few years have witnessed significant scientific progress, the potential relationship between COPD and mental illness remains a subject of debate. Materials and Methods We retrieved COPD data from the genome-wide association studies (GWAS) directory and data on mental illnesses, including Alzheimer's disease, schizophrenia, panic disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, multiple disabilities, obsessive-compulsive disorder, post-traumatic stress disorder, and schizophrenia, from the Psychiatric Genomics Consortium. A two-sample Mendelian randomization (MR) approach was applied to explore the association between COPD and mental illnesses, with subgroup analyses based on smoking history. Results Our two-sample MR analysis revealed no causal link between overall COPD and the development of common psychiatric disorders. Subgroup analyses based on smoking history showed no causal association between never-smokers with COPD and the occurrence of psychiatric disorders. However, ever-smokers with COPD were associated with a significantly increased risk of ADHD (OR: 2.303, 95% CI: 1.558-3.403, P = 0.001) and a modestly reduced risk of Alzheimer's disease (OR: 0.994, 95% CI: 0.988-0.999, P = 0.034). Conclusion COPD patients with a history of smoking face a higher risk of developing ADHD but may experience a slight reduction in the risk of Alzheimer's disease. Conversely, there was no observed causal association between COPD and psychiatric disorders among patients who never smoked.
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Affiliation(s)
- Qinxia Zhang
- Department of Respiratory Medicine, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang, 311400, People’s Republic of China
| | - Haifu Zhang
- Department of Medicine, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang, 311400, People’s Republic of China
| | - Qinxing Xu
- Department of Respiratory Medicine, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang, 311400, People’s Republic of China
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Tian Z, Jiang Y, Zhang N, Zhang Z, Wang L. Analysis of the Current State of COPD Nursing Based on a Bibliometric Approach from the Web of Science. Int J Chron Obstruct Pulmon Dis 2024; 19:255-268. [PMID: 38283691 PMCID: PMC10813247 DOI: 10.2147/copd.s440715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024] Open
Abstract
Background and Aim COPD nursing plays a crucial role in alleviating disease symptoms, prolonging patient survival, and is therefore of paramount importance. However, authoritative research findings, research hotspots, and development trends in the field of COPD are still unclear. This study aimed to examine authoritative research findings, research hotspots, and trends in the field of COPD nursing. Descriptive statistics and bibliometric and visual analyses of the literature were conducted. Methods Bibliometric data were obtained from the Web of Science database. Citespace was used to explore publication trends, countries, institutions, journals, authors, keywords, and co-citation characteristics of the included literature in order to summarize the key research in the field of COPD nursing. Results In total, 693 articles on COPD nursing were published. 1998-2014 showed a rapid growth period in this research field, which stabilized in 2015-2022. The research content could mostly be summarized into five categories: acute exacerbation, quality of life, risk, evidence-based nursing, and pulmonary rehabilitation. The research hotspots in 1998-2014 included randomized controlled trials, education, elderly patients, nursing home residents, nursing homes, rehabilitation, and prevalence. Research in 2015-2022 focused on impact, palliative care, needs, and predictors. In recent years, research mainly concentrated on symptom management models, cost-effectiveness, and cumulative meta-analysis. Conclusion Bibliometric analysis of COPD nursing articles indicates that the focus of COPD nursing research is shifting from tertiary prevention to primary and secondary prevention. Helping patients achieve self-management of symptoms, reducing the financial burden of COPD on healthcare, and summarizing research evidence by meta-analyses will likely remain the focus of future research.
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Affiliation(s)
- Zheng Tian
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
| | - Yachen Jiang
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
| | - Nan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
| | - Zhijun Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Lan Wang
- School of Nursing, Tianjin Medical University, Tianjin, 300070, People’s Republic of China
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Xu Y, Zhao H, Yu C, Wang Y, Xu H, Weng Z, Chen C, Mao H. An investigation of the risk factors of chronic obstructive pulmonary disease in natural population-based cohorts in China - a nested case-control study. Front Public Health 2023; 11:1303097. [PMID: 38145085 PMCID: PMC10739482 DOI: 10.3389/fpubh.2023.1303097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has become one of the most significant chronic diseases in China. According to conventional wisdom, smoking is the pathogenic factor. However, current research indicates that the pathophysiology of COPD may be associated with prior respiratory system events (e.g., childhood hospitalization for pneumonia, chronic bronchitis) and environmental exposure (e.g., dust from workplace, indoor combustion particles). Dyspnea, persistent wheezing, and other respiratory symptoms further point to the need for pulmonary function tests in this population. Reducing the burden of chronic diseases in China requires a thorough understanding of the various factors that influence the occurrence of COPD. Methods Using a cohort from the natural population, this study used nested case-control analysis. We carried out a number of researches, including questionnaire surveys and pulmonary function testing, in the Northwest and Southeast cohorts of China between 2014 and 2021. After removing any variations in the baseline data between patients and control subjects using propensity score matching analysis, the risk factors were examined using univariate or multivariate regression. Result It was discovered that prior history of chronic bronchitis, long-term wheezing symptoms, and environmental exposure-including smoking and biofuel combustion-were risk factors for COPD. Dyspnea, symptoms of mobility limitation, organic matter, and a history of hospitalization for pneumonia at an early age were not significant in the clinical model but their incidence in COPD group is higher than that in healthy population. Discussion COPD screening effectiveness can be increased by looking for individuals with chronic respiratory symptoms. Smokers should give up as soon as they can, and families that have been exposed to biofuels for a long time should convert to clean energy or upgrade their ventilation. Individuals who have previously been diagnosed with emphysema and chronic bronchitis ought to be extra mindful of the prevention or advancement of COPD.
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Affiliation(s)
- Yixin Xu
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongjun Zhao
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Chunchun Yu
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuqian Wang
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Xu
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Zhe Weng
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengshui Chen
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Haizhou Mao
- Department of Mathematics, Zhejiang Industry and Trade Vocational College, Wenzhou, Zhejiang, China
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Liu Z, Qin R, Hu XJ, Liu LJ, Xu SQ, Shi GC, Zhou H, Bai J, Zhang CM, Qi Y, Zhou W, Lan SH, Tong J, Su TS, Wang Q, Yang XY, Sun DJ, Zhu LM, Chen XY, Chen H, Xie YP, Xiao ZH, Chen YB, Zhao B, Wu QG, Chen WL, Li DY, Liu H, Cheng AQ, Cui ZY, Zhao L, Li JX, Wei XW, Zhou XM, Su Z, Chung KF, Chen ZM, Xiao D, Wang C. Real-world tobacco cessation practice in China: findings from the prospective, nationwide multicenter China National Tobacco Cessation Cohort Study (CNTCCS). THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100826. [PMID: 37927997 PMCID: PMC10624982 DOI: 10.1016/j.lanwpc.2023.100826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 11/07/2023]
Abstract
Background Tobacco cessation is proven to be the most effective and cost-effective strategy for smokers to reduce their risk of smoking-related disease and premature death. Providing effective, efficient, safe, and patient-centred tobacco cessation treatment to reach those who need them is a significant challenge. To date, only a few nationwide studies in China have assessed the overall clinical care practice and treatment outcome of tobacco cessation. Methods This a prospective, nationwide, multicenter, cohort study covering all Eastern China, Northwest China, Central China, North China, Southwest China, Northeast China, and South China. Participants who were current smokers aged 18-85 years attending clinic for smoking cessation were included. All the participants were treated with 3-month cessation treatment and followed up for 3 months. Data were collected prospectively using online system. The primary outcome was 7-day point abstinence rate at 24 weeks, validated biochemically by an expired carbon monoxide level of less than 10 ppm. The participants lost to follow-up or not providing validation were included as non-abstainers. Findings A representative sample of 3557 participants were recruited and 2943 participants were included into this analysis. These participants had mean age of 53.05 years, and 94.8% were males, with 75.8% showing symptoms of tobacco dependence. A total of 965 (32.8%) participants were treated with Bupropion + behavioural counselling, followed by 935 (31.8%) with behavioural counselling, 778 (26.4%) with Varenicline + behavioural counselling, 135 (4.6%) with alternative treatments + behavioural counselling, and 130 (4.4%) with nicotine replacement therapy (NRT) + behavioural counselling. After 3-month treatment and 3-month follow-up, 21.74% of the participants quit smoking at 24 weeks. In the multivariable-adjusted analyses, quitting smoking was significantly associated with female, higher socioeconomic status, poor health condition, different treatment received, and less smoking intensity. The tobacco cessation treatment varied widely across different areas of China. In particular, the areas with higher usage of cessation medication were associated with better cessation treatment outcome. Interpretation The CNTCCS is the first large-scale nationwide cohort study of smoking cessation in China. Rich data collected from this prospective cohort study provided the opportunity to evaluate the clinical practice of tobacco cessation treatment in China. Funding Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), Heilongjiang Provincial Science and Technology Key Program (2022ZXJ03C02), and National Key R&D Program of China (grant no. 2017YFC1309400).
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Affiliation(s)
- Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Qin
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Xue-Jun Hu
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Li-Jun Liu
- Department of Respiratory and Critical Care Medicine, Baiyin First People's Hospital of Gansu Province, Baiyin, Gansu Province, China
| | - Su-Qin Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Guo-Chao Shi
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jing Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China
| | - Chun-Mei Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yong Qi
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Wei Zhou
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China
| | - Shu-Hua Lan
- Department of Pulmonary and Critical Care Medicine, Nanping People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Nanping, Fujian Province, China
| | - Jin Tong
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tong-Sheng Su
- 3rd Department of Acupuncture and Moxibustion, Shaanxi Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi Province, China
| | - Qiang Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xin-Yan Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - De-Jun Sun
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia Autonomous Region, China
| | - Li-Ming Zhu
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Xiao-Yang Chen
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Peng Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhi-Hua Xiao
- Department of Respiratory and Critical Care Medicine, The Third People's Hospital of Datong City, Datong, Shanxi Province, China
| | - Yan-Bin Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Bo Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qiu-Ge Wu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wen-Li Chen
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Dong-Yan Li
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hongbo Liu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - An-Qi Cheng
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zi-Yang Cui
- Department of Geriatric Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Liang Zhao
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Xuan Li
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xiao-Wen Wei
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xin-Mei Zhou
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Su
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Trust, London, UK
| | - Zheng-Ming Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dan Xiao
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- China National Center for Respiratory Medicine, Beijing, China
- China National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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Rábade-Castedo C, de Granda-Orive JI, Riesco-Miranda JA, De Higes-Martínez E, Ramos-Pinedo Á, Cabrera-César E, Signes-Costa Miñana J, García Rueda M, Pastor-Esplá E, Jiménez-Ruiz CA. Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023. Arch Bronconeumol 2023; 59:651-661. [PMID: 37567792 DOI: 10.1016/j.arbres.2023.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
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.
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Affiliation(s)
- Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - José Ignacio de Granda-Orive
- Servicio de Neumología, Hospital Universitario 12 de octubre Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Juan Antonio Riesco-Miranda
- Servicio de Neumología, Hospital Universitario de Cáceres, Cáceres, Spain; Centro de Investigación en Red de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Spain
| | - Eva De Higes-Martínez
- Unidad de Neumología, Hospital Universitario Fundación Alcorcón, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Ángela Ramos-Pinedo
- Unidad de Neumología, Hospital Universitario Fundación Alcorcón, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Eva Cabrera-César
- Servicio de Neumología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Jaime Signes-Costa Miñana
- Servicio de Neumología, Hospital Clínico Universitario de Valencia, Spain; Instituto de Investigación Sanitaria de Valencia (INCLIVA), Valencia, Spain
| | | | - Esther Pastor-Esplá
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Carlos A Jiménez-Ruiz
- Unidad Especializada en Tabaquismo de la Comunidad de Madrid, Hospital Clínico San Carlos, Madrid, Spain
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9
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Khan KS, Jawaid S, Memon UA, Perera T, Khan U, Farwa UE, Jindal U, Afzal MS, Razzaq W, Abdin ZU, Khawaja UA. Management of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations in Hospitalized Patients From Admission to Discharge: A Comprehensive Review of Therapeutic Interventions. Cureus 2023; 15:e43694. [PMID: 37724212 PMCID: PMC10505355 DOI: 10.7759/cureus.43694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common and debilitating condition that often necessitates hospitalization for exacerbations. Since COPD exacerbations can cause significant morbidity and mortality, managing them is crucial for patient care. Effective management of COPD exacerbations is essential to prevent complications, as COPD exacerbations are associated with increased healthcare costs and decreased quality of life. This review aims to comprehensively discuss the management of COPD exacerbations, covering various pharmacologic and non-pharmacologic strategies. These include inhaled bronchodilators, systemic steroids, antibiotics, invasive and non-invasive ventilation, oxygen therapy, smoking cessation, immunization with pneumococcal vaccine, inhalers at discharge, pulmonary rehabilitation, long-term oxygen therapy (LTOT), ambulatory oxygen therapy, short-burst oxygen therapy, extracorporeal membrane oxygenation (ECMO), lung volume reduction surgery (LVRS), endobronchial procedures, and lung transplant. It is drawn upon various sources, including clinical studies, systemic reviews, and observational studies, to provide a comprehensive overview of current practices and identify areas for future research and innovation in managing COPD exacerbations. Addressing these areas of interest can improve patient outcomes and quality of life.
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Affiliation(s)
- Khizar S Khan
- Basic Sciences, Foundation University Medical College, Islamabad, PAK
| | - Sanyah Jawaid
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Unaib Ahmed Memon
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Tharindu Perera
- General Medicine, Grodno State Medical University, Grodno, BLR
| | - Usman Khan
- General Practice, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Umm E Farwa
- Emergency Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Urmi Jindal
- Internal Medicine, KJ Somaiya Medical College, Mumbai, IND
| | | | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Zain U Abdin
- Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Uzzam Ahmed Khawaja
- Pulmonary and Critical Care Medicine, Jinnah Medical and Dental College, Karachi, PAK
- Clinical and Translational Research, Dr Ferrer BioPharma, South Miami, USA
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10
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Abstract
Background Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). This is an update of a Cochrane Review first published in 2007. Objectives To assess the effectiveness of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. Search methods We searched the Cochrane Tobacco Addiction Group's Specialised Register in April 2022 for trials, using relevant terms in the title or abstract, or as keywords. The register is compiled from searches of CENTRAL, MEDLINE, Embase, and PsycINFO. Selection criteria We included randomised controlled trials that compared the treatment drug with placebo, another smoking cessation drug, e‐cigarettes, or no medication. We excluded trials that did not report a minimum follow‐up period of six months from baseline. Data collection and analysis We followed standard Cochrane methods. Our main outcome was abstinence from smoking at longest follow‐up using the most rigorous definition of abstinence, preferring biochemically validated rates where reported. We pooled risk ratios (RRs), using the Mantel‐Haenszel fixed‐effect model. We also reported the number of people reporting serious adverse events (SAEs). Main results We included 75 trials of 45,049 people; 45 were new for this update. We rated 22 at low risk of bias, 18 at high risk, and 35 at unclear risk. We found moderate‐certainty evidence (limited by heterogeneity) that cytisine helps more people to quit smoking than placebo (RR 1.30, 95% confidence interval (CI) 1.15 to 1.47; I2 = 83%; 4 studies, 4623 participants), and no evidence of a difference in the number reporting SAEs (RR 1.04, 95% CI 0.78 to 1.37; I2 = 0%; 3 studies, 3781 participants; low‐certainty evidence). SAE evidence was limited by imprecision. We found no data on neuropsychiatric or cardiac SAEs. We found high‐certainty evidence that varenicline helps more people to quit than placebo (RR 2.32, 95% CI 2.15 to 2.51; I2 = 60%, 41 studies, 17,395 participants), and moderate‐certainty evidence that people taking varenicline are more likely to report SAEs than those not taking it (RR 1.23, 95% CI 1.01 to 1.48; I2 = 0%; 26 studies, 14,356 participants). While point estimates suggested increased risk of cardiac SAEs (RR 1.20, 95% CI 0.79 to 1.84; I2 = 0%; 18 studies, 7151 participants; low‐certainty evidence), and decreased risk of neuropsychiatric SAEs (RR 0.89, 95% CI 0.61 to 1.29; I2 = 0%; 22 studies, 7846 participants; low‐certainty evidence), in both cases evidence was limited by imprecision, and confidence intervals were compatible with both benefit and harm. Pooled results from studies that randomised people to receive cytisine or varenicline found no clear evidence of difference in quit rates (RR 1.00, 95% CI 0.79 to 1.26; I2 = 65%; 2 studies, 2131 participants; low‐certainty evidence) and reported SAEs (RR 0.67, 95% CI 0.44 to 1.03; I2 = 45%; 2 studies, 2017 participants; low‐certainty evidence). However, the evidence was limited by imprecision, and confidence intervals incorporated the potential for benefit from either cytisine or varenicline. We found no data on neuropsychiatric or cardiac SAEs. We found high‐certainty evidence that varenicline helps more people to quit than bupropion (RR 1.36, 95% CI 1.25 to 1.49; I2 = 0%; 9 studies, 7560 participants), and no clear evidence of difference in rates of SAEs (RR 0.89, 95% CI 0.61 to 1.31; I2 = 0%; 5 studies, 5317 participants), neuropsychiatric SAEs (RR 1.05, 95% CI 0.16 to 7.04; I2 = 10%; 2 studies, 866 participants), or cardiac SAEs (RR 3.17, 95% CI 0.33 to 30.18; I2 = 0%; 2 studies, 866 participants). Evidence of harms was of low certainty, limited by imprecision. We found high‐certainty evidence that varenicline helps more people to quit than a single form of nicotine replacement therapy (NRT) (RR 1.25, 95% CI 1.14 to 1.37; I2 = 28%; 11 studies, 7572 participants), and low‐certainty evidence, limited by imprecision, of fewer reported SAEs (RR 0.70, 95% CI 0.50 to 0.99; I2 = 24%; 6 studies, 6535 participants). We found no data on neuropsychiatric or cardiac SAEs. We found no clear evidence of a difference in quit rates between varenicline and dual‐form NRT (RR 1.02, 95% CI 0.87 to 1.20; I2 = 0%; 5 studies, 2344 participants; low‐certainty evidence, downgraded because of imprecision). While pooled point estimates suggested increased risk of SAEs (RR 2.15, 95% CI 0.49 to 9.46; I2 = 0%; 4 studies, 1852 participants) and neuropsychiatric SAEs (RR 4.69, 95% CI 0.23 to 96.50; I2 not estimable as events only in 1 study; 2 studies, 764 participants), and reduced risk of cardiac SAEs (RR 0.32, 95% CI 0.01 to 7.88; I2 not estimable as events only in 1 study; 2 studies, 819 participants), in all three cases evidence was of low certainty and confidence intervals were very wide, encompassing both substantial harm and benefit. Authors' conclusions Cytisine and varenicline both help more people to quit smoking than placebo or no medication. Varenicline is more effective at helping people to quit smoking than bupropion, or a single form of NRT, and may be as or more effective than dual‐form NRT. People taking varenicline are probably more likely to experience SAEs than those not taking it, and while there may be increased risk of cardiac SAEs and decreased risk of neuropsychiatric SAEs, evidence was compatible with both benefit and harm. Cytisine may lead to fewer people reporting SAEs than varenicline. Based on studies that directly compared cytisine and varenicline, there may be no difference or a benefit from either medication for quitting smoking. Future trials should test the effectiveness and safety of cytisine compared with varenicline and other pharmacotherapies, and should also test variations in dose and duration. There is limited benefit to be gained from more trials testing the effect of standard‐dose varenicline compared with placebo for smoking cessation. Further trials on varenicline should test variations in dose and duration, and compare varenicline with e‐cigarettes for smoking cessation. Can medications like varenicline and cytisine (nicotine receptor partial agonists) help people to stop smoking and do they cause unwanted effects? Key messages · Varenicline can help people to stop smoking for at least 6 months. Evidence shows it works better than bupropion and using only one type of nicotine replacement therapy (e.g. only patches). Quit rates might be similar to using more than one type of nicotine replacement therapy at the same time (e.g. patches and gum together). · Cytisine can help people to stop smoking for at least 6 months. It may work as well as varenicline, but future evidence may show that while it helps, it is not quite as helpful as varenicline. · Future studies should test the effectiveness and safety of cytisine compared with varenicline and other stop‐smoking medications, and should also investigate giving cytisine or varenicline at different doses and for different lengths of time. What are 'nicotine receptor partial agonists'? Smoking tobacco is extremely bad for people’s health. For people who smoke, quitting is the best thing they can do to improve their health. Many people find it difficult to quit smoking. Nicotine receptor partial agonists (NRPAs) are a type of medication used to help people to stop smoking. They help to reduce the withdrawal symptoms people experience when they stop smoking, like cravings and unpleasant mood changes. They also reduce the pleasure people usually experience when they smoke. The most widely‐available treatment in this drug type is varenicline. Cytisine is another, similar medication. They may cause unwanted effects such as feeling sick (nausea) and other stomach problems, difficulties sleeping, abnormal dreams, and headache. They may also lead to potentially serious unwanted effects, such as suicidal thoughts, heart problems and raised blood pressure. What did we want to find out? We wanted to find out if using NRPAs can help people to quit smoking, and if they cause unwanted effects. We wanted to know: · how many people stopped smoking for at least 6 months; and · how many people had unwanted effects. What did we do? We searched for studies that investigated NRPAs used to help people quit smoking. People in the studies had to be chosen at random to receive an NRPA, or another NRPA, placebo (medication like the NRPA but with no active ingredients) or no treatment. They had to be adult tobacco smokers who wanted to stop smoking. What did we find? We found 75 studies that compared NRPAs with: · placebo or no medicine; · nicotine replacement therapy, such as patches or gum; · bupropion (another medicine to help people stop smoking); · another NRPA; · e‐cigarettes. The USA hosted the most studies (28 studies). Other studies took place in a range of countries across the world, some in several countries. Main results People are more likely to stop smoking for at least six months using varenicline than using placebo (41 studies, 17,395 people), bupropion (9 studies, 7560 people), or just one type of nicotine replacement therapy, like patches alone (11 studies, 7572 people). They may be just as likely to quit as people using two or more kinds of nicotine replacement therapy, like patches and gum together (5 studies, 2344 people). Cytisine probably helps more people to stop smoking than placebo (4 studies, 4623 people) and may be just as effective as varenicline (2 studies, 2131 people). For every 100 people using varenicline to stop smoking, 21 to 25 might successfully stop, compared with only 18 of 100 people using bupropion, 18 of 100 people using a single form of nicotine‐replacement therapy, and 20 of 100 using two or more kinds of nicotine‐replacement therapy. For every 100 people using cytisine to stop smoking, 18 to 23 might successfully stop. The most common unwanted effect of varenicline is nausea, but this is mostly at mild or moderate levels and usually clears over time. People taking varenicline likely have an increased chance of a more serious unwanted effect that could result in going to hospital, however these are still rare (2.7% to 4% of people on varenicline, compared with 2.7% of people without) and may include many that are unrelated to varenicline. People taking cytisine may also have a slightly increased chance of serious unwanted effects compared with people not taking it, but this may be less likely compared with varenicline. What are the limitations of the evidence? The evidence for some of our results is very reliable. We’re very confident that varenicline helps people to quit smoking better than many alternatives. We’re less sure of some other results because fewer or smaller studies provided evidence. Several results suggest one treatment is better or less harmful than another, but the opposite could still be true. How up to date is the evidence? The evidence is up to date to 29 April 2022.
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Hajizadeh A, Howes S, Theodoulou A, Klemperer E, Hartmann-Boyce J, Livingstone-Banks J, Lindson N. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2023; 5:CD000031. [PMID: 37230961 PMCID: PMC10207863 DOI: 10.1002/14651858.cd000031.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The pharmacological profiles and mechanisms of antidepressants are varied. However, there are common reasons why they might help people to stop smoking tobacco: nicotine withdrawal can produce short-term low mood that antidepressants may relieve; and some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. OBJECTIVES To assess the evidence for the efficacy, harms, and tolerability of medications with antidepressant properties in assisting long-term tobacco smoking cessation in people who smoke cigarettes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, most recently on 29 April 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people who smoked, comparing antidepressant medications with placebo or no pharmacological treatment, an alternative pharmacotherapy, or the same medication used differently. We excluded trials with fewer than six months of follow-up from efficacy analyses. We included trials with any follow-up length for our analyses of harms. DATA COLLECTION AND ANALYSIS We extracted data and assessed risk of bias using standard Cochrane methods. Our primary outcome measure was smoking cessation after at least six months' follow-up. We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Our secondary outcomes were harms and tolerance outcomes, including adverse events (AEs), serious adverse events (SAEs), psychiatric AEs, seizures, overdoses, suicide attempts, death by suicide, all-cause mortality, and trial dropouts due to treatment. We carried out meta-analyses where appropriate. MAIN RESULTS We included a total of 124 studies (48,832 participants) in this review, with 10 new studies added to this update version. Most studies recruited adults from the community or from smoking cessation clinics; four studies focused on adolescents (with participants between 12 and 21 years old). We judged 34 studies to be at high risk of bias; however, restricting analyses only to studies at low or unclear risk of bias did not change clinical interpretation of the results. There was high-certainty evidence that bupropion increased smoking cessation rates when compared to placebo or no pharmacological treatment (RR 1.60, 95% CI 1.49 to 1.72; I2 = 16%; 50 studies, 18,577 participants). There was moderate-certainty evidence that a combination of bupropion and varenicline may have resulted in superior quit rates to varenicline alone (RR 1.21, 95% CI 0.95 to 1.55; I2 = 15%; 3 studies, 1057 participants). However, there was insufficient evidence to establish whether a combination of bupropion and nicotine replacement therapy (NRT) resulted in superior quit rates to NRT alone (RR 1.17, 95% CI 0.95 to 1.44; I2 = 43%; 15 studies, 4117 participants; low-certainty evidence). There was moderate-certainty evidence that participants taking bupropion were more likely to report SAEs than those taking placebo or no pharmacological treatment. However, results were imprecise and the CI also encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 23 studies, 10,958 participants). Results were also imprecise when comparing SAEs between people randomised to a combination of bupropion and NRT versus NRT alone (RR 1.52, 95% CI 0.26 to 8.89; I2 = 0%; 4 studies, 657 participants) and randomised to bupropion plus varenicline versus varenicline alone (RR 1.23, 95% CI 0.63 to 2.42; I2 = 0%; 5 studies, 1268 participants). In both cases, we judged evidence to be of low certainty. There was high-certainty evidence that bupropion resulted in more trial dropouts due to AEs than placebo or no pharmacological treatment (RR 1.44, 95% CI 1.27 to 1.65; I2 = 2%; 25 studies, 12,346 participants). However, there was insufficient evidence that bupropion combined with NRT versus NRT alone (RR 1.67, 95% CI 0.95 to 2.92; I2 = 0%; 3 studies, 737 participants) or bupropion combined with varenicline versus varenicline alone (RR 0.80, 95% CI 0.45 to 1.45; I2 = 0%; 4 studies, 1230 participants) had an impact on the number of dropouts due to treatment. In both cases, imprecision was substantial (we judged the evidence to be of low certainty for both comparisons). Bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.73, 95% CI 0.67 to 0.80; I2 = 0%; 9 studies, 7564 participants), and to combination NRT (RR 0.74, 95% CI 0.55 to 0.98; I2 = 0%; 2 studies; 720 participants). However, there was no clear evidence of a difference in efficacy between bupropion and single-form NRT (RR 1.03, 95% CI 0.93 to 1.13; I2 = 0%; 10 studies, 7613 participants). We also found evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), and some evidence that bupropion resulted in superior quit rates to nortriptyline (RR 1.30, 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants), although this result was subject to imprecision. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. AUTHORS' CONCLUSIONS There is high-certainty evidence that bupropion can aid long-term smoking cessation. However, bupropion may increase SAEs (moderate-certainty evidence when compared to placebo/no pharmacological treatment). There is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with people receiving placebo or no pharmacological treatment. Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo, although bupropion may be more effective. Evidence also suggests that bupropion may be as successful as single-form NRT in helping people to quit smoking, but less effective than combination NRT and varenicline. In most cases, a paucity of data made it difficult to draw conclusions regarding harms and tolerability. Further studies investigating the efficacy of bupropion versus placebo are unlikely to change our interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over other licensed smoking cessation treatments; namely, NRT and varenicline. However, it is important that future studies of antidepressants for smoking cessation measure and report on harms and tolerability.
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Affiliation(s)
- Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seth Howes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elias Klemperer
- Departments of Psychological Sciences & Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2023; 5:CD006103. [PMID: 37142273 PMCID: PMC10169257 DOI: 10.1002/14651858.cd006103.pub8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). This is an update of a Cochrane Review first published in 2007. OBJECTIVES To assess the effectiveness of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register in April 2022 for trials, using relevant terms in the title or abstract, or as keywords. The register is compiled from searches of CENTRAL, MEDLINE, Embase, and PsycINFO. SELECTION CRITERIA: We included randomised controlled trials that compared the treatment drug with placebo, another smoking cessation drug, e-cigarettes, or no medication. We excluded trials that did not report a minimum follow-up period of six months from baseline. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Our main outcome was abstinence from smoking at longest follow-up using the most rigorous definition of abstinence, preferring biochemically validated rates where reported. We pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model. We also reported the number of people reporting serious adverse events (SAEs). MAIN RESULTS We included 75 trials of 45,049 people; 45 were new for this update. We rated 22 at low risk of bias, 18 at high risk, and 35 at unclear risk. We found moderate-certainty evidence (limited by heterogeneity) that cytisine helps more people to quit smoking than placebo (RR 1.30, 95% confidence interval (CI) 1.15 to 1.47; I2 = 83%; 4 studies, 4623 participants), and no evidence of a difference in the number reporting SAEs (RR 1.04, 95% CI 0.78 to 1.37; I2 = 0%; 3 studies, 3781 participants; low-certainty evidence). SAE evidence was limited by imprecision. We found no data on neuropsychiatric or cardiac SAEs. We found high-certainty evidence that varenicline helps more people to quit than placebo (RR 2.32, 95% CI 2.15 to 2.51; I2 = 60%, 41 studies, 17,395 participants), and moderate-certainty evidence that people taking varenicline are more likely to report SAEs than those not taking it (RR 1.23, 95% CI 1.01 to 1.48; I2 = 0%; 26 studies, 14,356 participants). While point estimates suggested increased risk of cardiac SAEs (RR 1.20, 95% CI 0.79 to 1.84; I2 = 0%; 18 studies, 7151 participants; low-certainty evidence), and decreased risk of neuropsychiatric SAEs (RR 0.89, 95% CI 0.61 to 1.29; I2 = 0%; 22 studies, 7846 participants; low-certainty evidence), in both cases evidence was limited by imprecision, and confidence intervals were compatible with both benefit and harm. Pooled results from studies that randomised people to receive cytisine or varenicline showed that more people in the varenicline arm quit smoking (RR 0.83, 95% CI 0.66 to 1.05; I2 = 0%; 2 studies, 2131 participants; moderate-certainty evidence) and reported SAEs (RR 0.67, 95% CI 0.44 to 1.03; I2 = 45%; 2 studies, 2017 participants; low-certainty evidence). However, the evidence was limited by imprecision, and confidence intervals incorporated the potential for benefit from either cytisine or varenicline. We found no data on neuropsychiatric or cardiac SAEs. We found high-certainty evidence that varenicline helps more people to quit than bupropion (RR 1.36, 95% CI 1.25 to 1.49; I2 = 0%; 9 studies, 7560 participants), and no clear evidence of difference in rates of SAEs (RR 0.89, 95% CI 0.61 to 1.31; I2 = 0%; 5 studies, 5317 participants), neuropsychiatric SAEs (RR 1.05, 95% CI 0.16 to 7.04; I2 = 10%; 2 studies, 866 participants), or cardiac SAEs (RR 3.17, 95% CI 0.33 to 30.18; I2 = 0%; 2 studies, 866 participants). Evidence of harms was of low certainty, limited by imprecision. We found high-certainty evidence that varenicline helps more people to quit than a single form of nicotine replacement therapy (NRT) (RR 1.25, 95% CI 1.14 to 1.37; I2 = 28%; 11 studies, 7572 participants), and low-certainty evidence, limited by imprecision, of fewer reported SAEs (RR 0.70, 95% CI 0.50 to 0.99; I2 = 24%; 6 studies, 6535 participants). We found no data on neuropsychiatric or cardiac SAEs. We found no clear evidence of a difference in quit rates between varenicline and dual-form NRT (RR 1.02, 95% CI 0.87 to 1.20; I2 = 0%; 5 studies, 2344 participants; low-certainty evidence, downgraded because of imprecision). While pooled point estimates suggested increased risk of SAEs (RR 2.15, 95% CI 0.49 to 9.46; I2 = 0%; 4 studies, 1852 participants) and neuropsychiatric SAEs (RR 4.69, 95% CI 0.23 to 96.50; I2 not estimable as events only in 1 study; 2 studies, 764 participants), and reduced risk of cardiac SAEs (RR 0.32, 95% CI 0.01 to 7.88; I2 not estimable as events only in 1 study; 2 studies, 819 participants), in all three cases evidence was of low certainty and confidence intervals were very wide, encompassing both substantial harm and benefit. AUTHORS' CONCLUSIONS Cytisine and varenicline both help more people to quit smoking than placebo or no medication. Varenicline is more effective at helping people to quit smoking than bupropion, or a single form of NRT, and may be as or more effective than dual-form NRT. People taking varenicline are probably more likely to experience SAEs than those not taking it, and while there may be increased risk of cardiac SAEs and decreased risk of neuropsychiatric SAEs, evidence was compatible with both benefit and harm. Cytisine may lead to fewer people reporting SAEs than varenicline. Based on studies that directly compared cytisine and varenicline, there may be a benefit from varenicline for quitting smoking, however further evidence could strengthen this finding or demonstrate a benefit from cytisine. Future trials should test the effectiveness and safety of cytisine compared with varenicline and other pharmacotherapies, and should also test variations in dose and duration. There is limited benefit to be gained from more trials testing the effect of standard-dose varenicline compared with placebo for smoking cessation. Further trials on varenicline should test variations in dose and duration, and compare varenicline with e-cigarettes for smoking cessation.
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Affiliation(s)
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lilian Hartman
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Wei X, Guo K, Shang X, Wang S, Yang C, Li J, Li Y, Yang K, Zhang X, Li X. Effects of different interventions on smoking cessation in chronic obstructive pulmonary disease patients: A systematic review and network meta-analysis. Int J Nurs Stud 2022; 136:104362. [DOI: 10.1016/j.ijnurstu.2022.104362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 07/21/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
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14
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Feng L, Lv X, Wang Y, Chu S, Dai Z, Jing H, Tong Z, Liao X, Liang L. Developments in smoking cessation interventions for patients with chronic obstructive pulmonary disease in the past 5 years: a scoping review. Expert Rev Respir Med 2022; 16:749-764. [PMID: 35916493 DOI: 10.1080/17476348.2022.2108797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Smoking cessation is the most effective strategy for slowing the progression of chronic obstructive pulmonary disease (COPD). However, COPD patients find it difficult to quit smoking with standard cessation interventions. AREAS COVERED A scoping review of smoking cessation for COPD patients was conducted by searching the MEDLINE, Embase, and Cochrane Library databases for all studies published between 1 January 2016 and 22 September 2021. Four themes were set up and 47 studies were included eventually. The majority of the included studies (61.7%, 29/47) investigated efficacy and effectiveness, including new strategies for extended treatment and mobile health (mHealth) delivery approach. Studies examining accessibility and utilization (31.9%, 15/47), safety (10.6%, 5/47), and health economics (6.4%, 3/47) were also reviewed. The quality of the included randomized controlled trials was also evaluated. EXPERT OPINION Pharmacotherapy combined with behavioral interventions delivered via mHealth may be a promising strategy to help COPD smokers quit. However, the overall quality of the current studies is poor, making it challenging for clinicians to make informed decisions. Future high-quality studies are needed to provide conclusive evidence on the optimal pharmacotherapies and the most cost-effective comprehensive smoking cessation interventions, particularly those integrated into disease management for smokers with COPD.
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Affiliation(s)
- Lin Feng
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoshuang Lv
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yingquan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuilian Chu
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zeqi Dai
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100010, China
| | - Hang Jing
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing Liao
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100010, China
| | - Lirong Liang
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Zhang YY, Tang WT, Zhang H, Wang J, Bai XX, Liao YH, Robinson N, Liu JP. Barriers and Facilitators for Smoking Cessation in Chinese Smokers with Chronic Obstructive Pulmonary Disease: A Qualitative Study. Int J Chron Obstruct Pulmon Dis 2022; 17:1107-1120. [PMID: 35573655 PMCID: PMC9091319 DOI: 10.2147/copd.s356935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/28/2022] [Indexed: 12/29/2022] Open
Abstract
Background Smoking cessation is recommended as a key intervention for chronic obstructive pulmonary disease (COPD) smokers. However, in China, few COPD smokers quit successfully. The aim of this study was to explore in depth the barriers and facilitators for smoking cessation among smokers with COPD in China. Methods A purposive sample of 32 hospitalized smokers with COPD were included, 17 ex-smokers and 15 current smokers, participated in the semi-structured interviews. Interviews were analyzed thematically and using a deductive approach guided by Capability, Opportunity, Motivation-Behavior (COM-B) framework. Results Three inter-related themes were generated: smokers’ motivation was a prerequisite for quitting, maintaining capability to quit smoking, and opportunities that facilitated smokers to quit. Motivation to quit for most participants was activated by COPD-related symptoms, although they had a limited knowledge of COPD. Physical benefits from quitting and strong willpower were facilitators for maintaining quitting, while exposure to smoking environment and strong addiction to nicotine were frequent reasons for relapse. Most ex-smokers quit smoking by their own willpower rather than professionally delivered smoking cessation interventions. Smokers’ attitudes toward these interventions depended on their effectiveness and convenience. Very few participants had experienced pharmacotherapy or behavioral support from physicians. However, interviewees preferred auricular acupressure to pharmacotherapy. Conclusion Motivation to quit among smokers with COPD was usually initiated by COPD-related symptoms. Physical benefits observed by quitting and strong willpower facilitated smoking cessation, while exposure to smoking environment and strong addiction to nicotine led to relapse. COPD smokers in China preferred auricular acupressure to pharmacotherapy.
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Affiliation(s)
- Ying-Ying Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Wen-Tao Tang
- Pingyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China
| | - Hong Zhang
- Fangshan Hospital of Traditional Chinese Medicine Affiliated to Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Jing Wang
- Fangshan Hospital of Traditional Chinese Medicine Affiliated to Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Xiao-Xu Bai
- Fangshan Hospital of Traditional Chinese Medicine Affiliated to Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yan-Hui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, People’s Republic of China
| | - Nicola Robinson
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
- Correspondence: Jian-Ping Liu, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, People’s Republic of China, Email ;
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Mao Y, Fu T, Wang L, Wang C. The efficacy and safety of antibiotics and glucocorticoids in the treatment of elderly patients with chronic obstructive emphysema: systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:287. [PMID: 35433939 PMCID: PMC9011238 DOI: 10.21037/atm-22-239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/04/2022] [Indexed: 12/02/2022]
Abstract
Background To systematically evaluate the efficacy and safety of inhaled corticosteroids (ICS) combined with antibiotics in the treatment of elderly chronic obstructive pulmonary disease (COPD) patients, and to provide some reference for the optimization of clinical treatment regimen for elderly COPD patients. Methods Combination of perfect search and keywords from the Chinese and foreign language databases, and the Cochrane Collaboration Center provided Review Manger 5.2 software [Cochrane Information Management System (IMS)] for statistical analysis, and the risk ratio (RR) of dichotic variables was adopted. RR and 95% confidence interval (95% CI) were used as efficacy and side effects analysis statistics in metaanalysis. Results After independent screening by two researchers, 18 studies were included into the meta-analysis. After data analysis and statistics, the results of meta-analysis showed that the observation group (glucocorticoid combined with antibiotic treatment) and the control group (glucocorticoid therapy) first second forced expiratory volume (FEV1%) expected value (OR =1.21; 95% CI: 0.11–2.32; P=0.03), and 6-min walking distances (6-MWDs) (OR =12.92; 95% CI: 4.61–21.22; P=0.002), the COPD Assessment Test (CAT) score (OR =3.08; 95% CI: 2.58−3.57; P<0.00001) the improvement was statistically significant; incidence of adverse reactions (OR =1.24; 95% CI: 0.58–2.67; P=0.58), the incidence of acute exacerbation (OR =0.65; 95% CI: 0.39–1.08; P=0.10), FEV1 (OR =0.07; 95% CI: 0.01–0.15; P=0.09). There was no statistical difference. Discussion The combination of glucocorticoids and antibiotics in elderly patients with stable COPD can significantly improve their lung function and exercise ability with minimal adverse reactions.
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Affiliation(s)
- Yanqing Mao
- Department of General Practice, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of General Practice, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Ting Fu
- Department of General Practice, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Ling Wang
- Department of General Practice, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunjie Wang
- Department of General Practice, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
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Lewis A, Conway J, Middleton J, Startup CK, Wyatt J. Playing the harmonica with chronic obstructive pulmonary disease. A qualitative study. Chron Respir Dis 2022; 19:14799731221083315. [PMID: 35412384 PMCID: PMC9008858 DOI: 10.1177/14799731221083315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To investigate the experience of playing the harmonica
for individuals with COPD. Methods: A qualitative, phenomenological study using semi-structured
interviews and reflexive thematic analysis. Results: Eight people living with COPD (six females, two males) were
recruited, who had attended at least six weeks of harmonica group sessions,
either face-to-face prior to the COVID-19 pandemic or remotely. Five themes were
generated. Themes included ‘hard in the beginning’, ‘holding the condition’,
‘breathing control’, ‘gives you a high’ and ‘needing the Zoom class’. Discussion: Playing the harmonica with COPD is difficult at first,
particularly drawing a breath through the harmonica. With practice, experience
in a fun activity and quality teaching, individuals were able to become more
attuned and embodied with their breathing, and playing the harmonica offered a
breathing control strategy. Songs, rather than breathing, became the focus, and
participants were able to escape living with respiratory disease when playing.
Participants reported the harmonica helped mucous expectoration. The group was a
priority in the weekly lives of participants, even though the ‘buzz’ of being
part of a group was lost when participating online. Further mechanistic studies
and randomised controlled trials are needed to investigate the biopsychosocial
benefits of playing the harmonica with COPD.
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Affiliation(s)
- Adam Lewis
- Department of Health Sciences, 3890Brunel University London, Kingston Lane, UK
| | - Joy Conway
- Department of Health Sciences, 3890Brunel University London, Kingston Lane, UK
| | - Jack Middleton
- Department of Health Sciences, 3890Brunel University London, Kingston Lane, UK
| | - Chris K Startup
- Faculty of Health, Education and Society, Waterside Campus, University Drive, 6087University of Northampton, UK
| | - James Wyatt
- Faculty of Health, Education and Society, Waterside Campus, University Drive, 6087University of Northampton, UK
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