Smoking cessation and COPD

Abstract

The mainstay in smoking cessation is counselling in combination with varenicline, nicotine replacement therapy (NRT) or bupropion SR. Varenicline and combination of two NRTs is equally effective, while varenicline alone is more effective than either NRT or bupropion SR. NRT is extremely safe but cardiovascular and psychiatric adverse events with varenicline have been reported. These treatments have also been shown to be effective in patients with chronic obstructive pulmonary disease (COPD). A model study is the Lung Health Study from the USA. Findings from this study of 5,587 patients with mild COPD showed that repeated smoking cessation for a period of 5 yrs resulted in a quit rate of 37%. After 14.5 yrs the quitters had a higher lung function and a higher survival rate. A study with a new nicotine formulation, a mouth spray, showed high relative efficacy. As 5-10% of quitters use long-term NRT, we report the results of a study where varenicline compared with placebo increased the quit rate in long-term users of NRT. Smoking cessation is the most effective intervention in stopping the progression of COPD, as well as increasing survival and reducing morbidity. This is why smoking cessation should be the top priority in the treatment of COPD.

Conflict of interest statement

Statement of Interest

P. Tønnesen has received fees for speaking about smoking cessation from Johnson & Johnson and McNeil, he has received fees for participating in advisory boards from Pfizer and GSK, and he has participated in smoking cessation studies sponsored by Pfizer and McNeil.

Figures

Figure 1.

Proportion of subjects with carbon monoxide verified 7-day point prevalence of abstinence. Includes all subjects (nicotine mouth spray (NMS): n=318; placebo: n=161). *: p

Figure 2.

Quit rate (7-day point prevalence) for long-term nicotine replacement therapy users in the varenicline and placebo groups from weeks 2 to 52, verified by expired carbon monoxide (except week 36 which was a telephone visit). Modified from [23].

Figure 3.

Smoking cessation rate as point prevalence quit rate from year 1 to 5 in the Lung Health Study with 5,587 chronic obstructive pulmonary disease patients. Smokers were treated with smoking cessation every 4 months in 5 yrs. SCI: smoking cessation intervention; UCA: usual care arm. Modified from [36].