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Evidence summaries

Smoking Cessation for People with Chronic Obstructive Pulmonary Disease

Nicotine replacement therapy and varenicline are effective for smoking cessation compared with placebo in people with chronic obstructive pulmonary disease (COPD). Combination of behavioural treatment and pharmacotherapy is effective. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 16 studies with a total of 13 123 subjects with chronic obstructive pulmonary disease (COPD). Nicotine sublingual tablet and varenicline (both high quality evidence), bupropion (moderate quality evidence), and nortriptyline (low quality evidence) increased the quit rate over placebo (table T1). There was high-quality evidence for the effectiveness of pharmacotherapy plus high-intensity behavioural treatment compared with placebo plus high-intensity behavioural treatment (RR 2.53, 95% CI 1.83 to 3.50). Furthermore, high-intensity behavioural treatment increased abstinence rates when compared with usual care (RR 25.38, 95% CI 8.03 to 80.22, moderate quality evidence) or low-intensity behavioural treatment (RR 2.18, 95% CI 1.05 to 4.49). Finally, the results showed effectiveness of various combinations of psychosocial and pharmacological interventions.

Pharmacological treatment compared to placebo in smokers with COPD

Outcome: Prolonged abstinence at longest follow-upRelative effect(95% CI)Assumed risk - PlaceboCorresponding risk - Pharmacological treatment (95% CI)No of Participants(studies)
Alldrug treatment: Follow-up 6 to 12 months (mo)RR 2.53 (95% CI 1.83, 3.50)66 / 1000168 / 1000(136 to 207)1429(4)
Nicotine replacement therapy: Follow-up: 12 moRR 2.60 (95% CI 1.29, 5.24)54 / 1000141 / 1000(70 to 283)370(1)
Varenicline:Follow-up:12 moRR 3.34 (95% CI 1.88, 5.92)55 / 1000184 / 1000(104 to 326)504(1)
Bupropion: Follow-up: 6 moRR 2.03 (95% CI 1.26, 3.28)87 / 1000177 / 1000(110 to 285)503(2)
Nortriptyline: Follow-up: 6 moRR 2.54 (95% CI 0.87, 7.44)83 / 1000212 / 1000(72 to 620)100(1)

Clinical comments

Note

Date of latest search: 22 March 2016

References

  • van Eerd EA, van der Meer RM, van Schayck OC et al. Smoking cessation for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016;(8):CD010744. [PubMed]

Primary/Secondary Keywords