Effects of varenicline therapy in combination with advanced behavioral support on smoking cessation and quality of life in inpatients with acute exacerbation of COPD, bronchial asthma, or community-acquired pneumonia: A prospective, open-label, preference-based, 52-week, follow-up trial

Abstract

Quitting smoking is the most important element in the therapeutic management of chronic respiratory diseases. Combining pharmacotherapy with behavioral support increases smoking cessation success rates. In addition, hospitalized smokers have increased motivation to quit. We investigated the efficacy on smoking cessation, of varenicline in combination with behavioral support, in smokers hospitalized due to (a) acute exacerbation of chronic obstructive pulmonary disease (COPD), or (b) bronchial asthma attack, or (c) community-acquired pneumonia (CAP). The method used is prospective, open-label, preference-based, parallel group, 52-week trial. Patients chose the smoking cessation intervention they preferred: a standard regimen of varenicline combined with post-discharge advanced behavioral support (group A) or one private consultation session during hospitalization (group B). Follow-up phone calls were scheduled in weeks 1, 2, and 4 and months 3, 6, and 9. The final hospital visit was performed in week 52. Primary outcome was success rate defined as the percentage (%) of smoking abstinence at week 52 and secondary outcomes were (a) changes in quality of life (QoL) indicated by the scores on the Short Form 36 (SF36) questionnaire and (b) predictors of smoking abstinence investigated with multiple binary logistic regression. One hundred one patients were enrolled, 44 (43.6%) in group A and 57 (56.4%) in group B. Respective abstinence rates were 54.5% and 15.8% at week 12 and 52.3% and 14.0% at week 52. Scores on SF36 were statistically significantly increased in both groups. Predictors of smoking abstinence were varenicline (odds ratio (OR) 7.29; 95% confidence interval (CI) 2.15, 24.77; p = 0.001), age (OR 1.07; 95%CI 1.00, 1.15; p = 0.042), Fagerstrom score (OR 0.37; 95%CI 0.20, 0.68; p = 0.001), SF36 domains “vitality” (OR 1.12; 95%CI 1.04, 1.21; p = 0.003), and “social functioning” (OR 0.95; 95%CI 0.90, 1.00; p = 0.041). Varenicline in combination with behavioral support resulted in high abstinence rates inpatients hospitalized for exacerbation of COPD, asthma attack, or CAP, and improved QoL.

Supporting smoking cessation and preventing relapse following a stay in a smoke‐free setting: a meta‐analysis and investigation of effective behaviour change techniques

“…Twenty‐three studies [10,37–58] were RCTs (intervention n = 6593, control n = 5801). Three studies [59–61] were trials, but adopted a non‐randomized design (intervention n = 845, control n = 394). In one study, patients decided which group they wanted to participate in [61], but the remaining studies did not provide further information regarding how participants were allocated to each group [59,60].…”

Medication-assisted quit rates in participants with smoking-related diseases in EAGLES: Post hoc analyses of a double-blind, randomized, placebo-controlled clinical trial

“…However, between-treatment differences at 24 weeks were not significant due to a high relapse rate. In a recent open-label study 23 , 101 smokers who were hospitalized due to COPD, asthma, or pneumonia, self-selected to receive either varenicline plus intensive behavioral support versus no medicine and one consultation. Quit rates after 12 weeks were 55% versus 16% and after 1 year 52% versus 14% for the respective treatment regimens.…”

Evaluation of Treatment Results in Patients with a History of Acute or Chronic Lung Disease Admitted to the Smoking Cessation Clinic

“…Politis ve ark. (15) çalışmasında KOAH, Astım ve toplum kaynaklı pnömoni hastalarında 3 aylık izlem süresi sonunda sigara bırakma oranları açısından yapılan değerlendirmede, farmakolojik tedavi ve davranışsal desteğin beraber verildiği grupta oran %54,5 saptanırken, yalnızca danışma oturumunun uygulandığı grupta oran %15,8 olarak saptanmıştır. Çalışmamızda kronik akciğer hastalığı öyküsü olan grupta sigara bırakma oranı %58,0 olarak gözlemlenmiş olup, literatürdeki çalışmalar ile benzer düzeylerde olduğu görülmektedir.…”