A Smoking Cessation Program Helped Nicotine-Dependent Patients With COPD Quit

Most nicotine-dependent patients with chronic obstructive pulmonary disease (COPD) who attended a smoking cessation program were able to quit, according to an abstract presented at the 2019 American Thoracic Society International Conference, held May 17-22 in Dallas, Texas.

“Although smoking cessation is the cornerstone of COPD management, COPD patients are more resistant to smoking cessation treatment than healthy smokers. Real-world data on outcomes of smoking cessation treatment in COPD patients are scarce,” researchers said.

Researchers identified potential participants from a prospective registry of cigarette smokers. A total of 147 nicotine-dependent patients with COPD participated in a 3-month smoking cessation program at a single-center clinic in Japan between October 2007 and March 2018. Participants had a mean age of 67.1 ± 9.7 years, and 77% were male. They had a mean Brinkman Index of 1015.3 ± 549.1, and a mean forced expiratory volume in 1 second (FEV₁) predicted percentage of 59.3 ± 20.7. The Tobacco Dependence Screener test was used to diagnose nicotine dependence and a score of 5 or more points classified participants as nicotine dependent.

The smoking cessation program combined pharmacological treatment and cognitive behavioral therapy. A total of 82 participants were initially prescribed nicotine patches while 65 were prescribed varenicline. Of the participants, 100, or 68%, completed the program.

The study’s primary outcome was smoking cessation, which was defined by quitting completely between 8-week and 12-week visits and verified by an exhaled carbon monoxide level of less than or equal to 10 ppm. Researchers assessed pulmonary function as well as health-related quality of life, using the Saints George’s Respiratory Questionnaire (SGRQ), at baseline and conclusion of the program.

Data were analyzed to assess outcomes and explore factors associated with successful smoking cessation in patients with COPD. Of the participants who completed the program, researchers found that 69 achieved smoking cessation. When baseline characteristics of quitters and continuous smokers were compared, significant differences were found between them in frequencies of underlying diseases. Mental disorders occurred in 11.6% of quitters and 38.7% of continuous smokers, and diabetes occurred in 4.4% of quitters and 22.6% of continuous smokers. Researchers also found quitters had exhaled carbon monoxide levels of 12.2 ± 7.8 ppm while continuous smokers had levels of 16.4 ± 8.5 ppm.

Regarding pulmonary function tests, quitters were found to have significant increases in FEV₁, maximum midexpiratory flow, and peak expiratory flow. There were no significant changes in pulmonary function tests among continuous smokers. Regarding health-related quality of life, SGRQ total scores were found to significantly improve in both in quitters and continuous smokers. Researchers found no significant difference in changes in SGRQ total scores between both quitters and continuous smokers.

“In our smoking cessation program 69.0% of COPD patients who completed the program succeeded in smoking cessation. Exhaled CO level, mental disorders, and diabetes were significantly associated with either success or failure of smoking cessation,” researchers concluded.

Reference

Tomioka H, Hashimoto R, Wada T. Smoking cessation in COPD patients with nicotine dependence in a single-center clinic in Japan. Presented at 2019 American Thoracic Society International Conference; May 17-22, 2019, Dallas, TX. Abstract A3296. atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A3296. Accessed June 3, 2019.