A smoking cessation programme for use in general practice

The effectiveness of a smoking intervention programme based in general practice was evaluated at six months by a randomized controlled trial. In the programme, general practitioners achieved a 33% success rate compared with 3% in a control group. Reported abstinence was checked by blood tests for cotinine, carboxyhaemoglobin and thiocyanate. The majority of patients considered that their chances of success were greater if a doctor administered the programme, and that having the results of lung function and blood tests explained in relation to the risks of cardiovascular and respiratory diseases constituted a strong incentive to stop smoking. Two cases illustrating a successful and a failed outcome of the programme are described. If one quarter of general practitioners in Australia adopted this programme in their practice, approximately 150,000 new abstainers could be expected each year.     

Sustained-release bupropion for smoking cessation in African Americans: a randomized controlled trial

Context  African Americans disproportionately experience greater smoking attributable morbidity and mortality. Few clinical trials for smoking cessation in African Americans have been conducted, despite a different profile of both smoking and quitting patterns. Objective  To compare a sustained-release form of bupropion hydrochloride (bupropion SR) with placebo for smoking cessation among African Americans. Design, Setting, and Participants  Randomized, double-blind, placebo-controlled trial conducted from February 11, 1999, to December 8, 2000, of 600 African American adults treated at a community-based health care center. Volunteers, who smoked 10 or more cigarettes per day were recruited by targeted media and health care professionals. Intervention  Participants were randomly assigned to receive 150 mg of bupropion SR (n = 300) or placebo (n = 300) twice daily for 7 weeks. Brief motivational counseling was provided in-person at baseline, quit day, weeks 1 and 3, end of treatment (week 6), and by telephone at day 3 and weeks 5 and 7. Main Outcome Measures  Biochemically confirmed 7-day point prevalence abstinence at weeks 6 and 26 following quit day. Results  Using intention-to-treat procedures, confirmed abstinence rates at the end of 7 weeks of treatment were 36.0% in the bupropion SR group and 19.0% in the placebo group (17.0 percentage point difference; 95% confidence interval, 9.7-24.4; P<.001). At 26 weeks the quit rates were 21.0% in the treatment and 13.7% in the placebo groups (7.3 percentage point difference; 95% confidence interval, 1.0-13.7; P = .02). Those taking bupropion SR experienced a greater mean reduction in depression symptoms at week 6 (2.96 [9.45] vs 1.13 [8.84]) than those taking placebo, and after controlling for continuous abstinence, those taking bupropion SR also gained less weight than those taking placebo. Conclusions  Bupropion SR was effective for smoking cessation among African Americans and may be useful in reducing the health disparities associated with smoking.      

"Sick of Smoking": evaluation of a targeted minimal smoking cessation intervention in general practice

Several smoking intervention studies have been conducted overseas which use a minimal amount of general practitioners' time and are conducted within the constraints of a normal consultation. However, there are no published reports of minimal interventions in Australian general practice. This study reports on 1238 South Australian smokers who were assigned to a non-intervention control group or a group which received firm general practitioner advice to quit smoking plus literature. At one-year follow-up, 7.5% of smokers in the minimal advice group who had quit for six or more months remained non-smokers compared with 3.2% in the control group. If similar analytical procedures had been used in this study as were used in the benchmark study in England in 1979, the quit rate for this study would have been 11.3% in the intervention group, and 4.8% in the control group--a net gain of 6.5%. These results are discussed with regard to widespread implementation in Australian general practice.     

我国医生吸烟率、戒烟率及控烟行为的系统研究

目的  采用Meta分析和系统综述方法,评价我国医生吸烟率、成功戒烟率及控烟行为现状。方法  利用PubMed、ProQuest、Springerlink、VIP、WanFang Data和CNKI等数据库检索关于中国医生吸烟情况及控烟行为文献。采用Stata 11.0软件进行数据分析。结果  ①总体吸烟率0.223[95% CI：0.217,0.230],男性0.389[95% CI：0.382,0.397],女性0.007[95% CI：0.006,0.009]。总吸烟率随研究时间略有增长,东部地区医生总吸烟率高于中西部地区。②戒烟率0.088[95% CI：0.083,0.092]。戒烟率随研究年份稍有提高,年龄>35岁组戒烟率高于其他年龄组,东部地区医生戒烟率低于中西部地区。③人均日吸烟量为（8.28～16）支,平均（11.85±2.06）支,随研究时间递减,东部地区医生人均吸烟量高于中西部地区。④医生总体控烟态度积极,但控烟知识方面存在偏差,缺乏控烟技巧和能力培训。结论  我国医生吸烟率高、戒烟率低、人均日吸烟量大、控烟“知信行”表现不太乐观。应加强对医生烟草知识、控烟干预的培训,提高中国医生控烟技巧和能力,推动全社会控烟工作的发展。

     

Therapy for cessation of smoking

Tobacco dependence is a chronic relapsing medical illness. Unfortunately more than 1.1 billion people worldwide smoke tobacco. Tobacco consumption rate is very high in India. Providing three minutes counseling by physicians doubles the cessation rate as compared to no intervention. Nicotine replacement products (gums, transdermal patch, nasal spray, inhaler and lozenge), bupropion and varenicline used with counseling by physicians double the cessation rates at one year. There are drugs like buspirone, naltrexone, mecamylamine and silver acetate; some of which either alone or in combination with any of the above drugs may be routinely used in near future for smoking cessation in at least some specific groups of population. The most difficult problem for patients in smoking cessation is withdrawal symptoms. Counseling with continuous support from physician, family members, friends and overall from the society will help in achieving a higher rate of smoking cessation, with the final aim of making ours a tobacco smoke-free world for future generations.     

伐尼克兰戒烟效果的临床观察

目的探讨戒烟药物伐尼克兰的服用时间长短与戒烟效果的关系。方法观察自愿戒烟的吸烟者25例,均采用伐尼克兰治疗,服药后第2、第4、第6、第8、第12w进行电话随访,对吸烟者的服药时间及戒烟情况进行记录和分析。结果在25例吸烟者中,9～12W戒烟成功者12例,占48％（12／25）,戒烟未成功者13例,占52％（13／25）。戒烟成功者的服药时间平均为7．23w,明显长于戒烟未成功者的4．83W（P=0．011）,服药时间较长者（8—12w）戒烟成功率高=F服药时间较短者（〈8w）（P=0．027）。结论伐尼克兰戒烟有确切的效果,戒烟效果与服药时间长短有关。     

Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial

Context  The 42 nicotinic acetylcholine receptors (nAChRs) are linked to the reinforcing effects of nicotine and maintaining smoking behavior. Varenicline, a novel 42 nAChR partial agonist, may be beneficial for smoking cessation. Objective  To assess efficacy and safety of varenicline for smoking cessation compared with sustained-release bupropion (bupropion SR) and placebo. Design, Setting, and Participants  Randomized, double-blind, parallel-group, placebo- and active-treatment–controlled, phase 3 clinical trial conducted at 19 US centers from June 19, 2003, to April 22, 2005. Participants were 1025 generally healthy smokers (10 cigarettes/d) with fewer than 3 months of smoking abstinence in the past year, 18 to 75 years old, recruited via advertising. Intervention  Participants were randomly assigned in a 1:1:1 ratio to receive brief counseling and varenicline titrated to 1 mg twice per day (n = 352), bupropion SR titrated to 150 mg twice per day (n = 329), or placebo (n = 344) orally for 12 weeks, with 40 weeks of nondrug follow-up. Main Outcome Measures  Primary outcome was the exhaled carbon monoxide–confirmed 4-week rate of continuous abstinence from smoking for weeks 9 through 12. A secondary outcome was the continuous abstinence rate for weeks 9 through 24 and weeks 9 through 52. Results  For weeks 9 through 12, the 4-week continuous abstinence rates were 44.0% for varenicline vs 17.7% for placebo (odds ratio [OR], 3.85; 95% confidence interval [CI], 2.70-5.50; P<.001) and vs 29.5% for bupropion SR (OR, 1.93; 95% CI, 1.40-2.68; P<.001). Bupropion SR was also significantly more efficacious than placebo (OR, 2.00; 95% CI, 1.38-2.89; P<.001). For weeks 9 through 52, the continuous abstinence rates were 21.9% for varenicline vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; P<.001) and vs 16.1% for bupropion SR (OR, 1.46; 95% CI, 0.99-2.17; P = .057). Varenicline reduced craving and withdrawal and, for those who smoked while receiving study drug, smoking satisfaction. No sex differences in efficacy for varenicline were observed. Varenicline was safe and generally well tolerated, with study drug discontinuation rates similar to those for placebo. The most common adverse events for participants receiving active-drug treatment were nausea (98 participants receiving varenicline [28.1%]) and insomnia (72 receiving bupropion SR [21.9%]). Conclusion  Varenicline was significantly more efficacious than placebo for smoking cessation at all time points and significantly more efficacious than bupropion SR at the end of 12 weeks of drug treatment and at 24 weeks. Trial Registration  clinicaltrials.gov Identifier: NCT00141206      

Smoking, smoking cessation, and major depression

A relationship between cigarette smoking and major depressive disorder was suggested in previous work involving nonrandomly selected samples. We conducted a test of this association, employing population-based data (n = 3213) collected between 1980 and 1983 in the St Louis Epidemiologic Catchment Area Survey of the National Institute of Mental Health. A history of regular smoking was observed more frequently among individuals who had experienced major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis. Smokers with major depression were also less successful at their attempts to quit than were either of the comparison groups. Gender differences in rates of smoking and of smoking cessation observed in the larger population were not evident among the depressed group. Furthermore, the association between cigarette smoking and major depression was not ubiquitous across all psychiatric diagnoses. Other data are cited indicating that when individuals with a history of depression stop smoking, depressive symptoms and, in some cases, serious major depression may ensue.     

Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial

Context  Varenicline, a partial agonist at the 42 nicotinic acetylcholine receptor, has the potential to aid smoking cessation by relieving nicotine withdrawal symptoms and reducing the rewarding properties of nicotine. Objective  To determine the efficacy and safety of varenicline for smoking cessation compared with placebo or sustained-release bupropion (bupropion SR). Design, Setting, and Participants  A randomized, double-blind, placebo-controlled trial conducted between June 2003 and March 2005 at 14 research centers with a 12-week treatment period and follow-up of smoking status to week 52. Of 1413 adult smokers who volunteered for the study, 1027 were enrolled; 65% of randomized participants completed the study. Intervention  Varenicline titrated to 1 mg twice daily (n = 344) or bupropion SR titrated to 150 mg twice daily (n = 342) or placebo (n = 341) for 12 weeks, plus weekly brief smoking cessation counseling. Main Outcome Measures  Continuous abstinence from smoking during the last 4 weeks of treatment (weeks 9-12; primary end point) and through the follow-up period (weeks 9-24 and 9-52). Results  During the last 4 weeks of treatment (weeks 9-12), 43.9% of participants in the varenicline group were continuously abstinent from smoking compared with 17.6% in the placebo group (odds ratio [OR], 3.85; 95% confidence interval [CI], 2.69-5.50; P<.001) and 29.8% in the bupropion SR group (OR, 1.90; 95% CI, 1.38-2.62; P<.001). For weeks 9 through 24, 29.7% of participants in the varenicline group were continuously abstinent compared with 13.2% in the placebo group (OR, 2.83; 95% CI, 1.91-4.19; P<.001) and 20.2% in the bupropion group (OR, 1.69; 95% CI, 1.19-2.42; P = .003). For weeks 9 through 52, 23% of participants in the varenicline group were continuously abstinent compared with 10.3% in the placebo group (OR, 2.66; 95% CI, 1.72-4.11; P<.001) and 14.6% in the bupropion SR group (OR, 1.77; 95% CI, 1.19-2.63; P = .004). Treatment was discontinued due to adverse events by 10.5% of participants in the varenicline group, 12.6% in the bupropion SR group, and 7.3% in the placebo group. The most common adverse event with varenicline was nausea, which occurred in 101 participants (29.4%). Conclusions  Varenicline is an efficacious, safe, and well-tolerated smoking cessation pharmacotherapy. Varenicline's short-term and long-term efficacy exceeded that of both placebo and bupropion SR. Trial Registration  clinicaltrials.gov Identifier: NCT00143364      

加味桂枝汤配合针灸治疗风寒湿型肩周炎40例

目的评估伐尼克兰在慢性阻塞性肺疾病(COPD)吸烟患者中的持续戒烟率和安全性。方法 COPD吸烟患者126例,随机分为普通戒烟组(自行凭意志力戒烟)、伐尼克兰组和安慰剂组各42例。伐尼克兰组给予口服12周伐尼克兰,安慰剂组给予安慰剂12周,随访至24周,观察戒烟者的戒烟率、肺功能变化、不良反应、戒断症状及复吸率。结果伐尼克兰组在6周、12周和24周持续戒烟率分别为42.86%、47.62%和28.57%,和其他两组比较差异有统计学意义(P<0.05),圣乔治评分在6周、12周和24周明显优于其他两组,但三组间肺功能无明显差异(P>0.05)。伐尼克兰常见副作用主要是一过性的失眠、恶心等,程度较轻。结论吸烟COPD患者使用伐尼克兰戒烟具有安全、有效的特点,可能提高戒烟患者的戒烟率,可推广应用。     

Prescribing patterns for childhood asthma treatment in general practice

The treatment preferences of 109 general practitioners (GPs) for childhood asthma were determined. Availability and adherence to clinical practice guidelines (CPG) for the treatment of childhood asthma was also assessed. Ninety eight (90%), 60 (55%) and 33 (30%) GPs considered nocturnal symptoms > 2 times/week, exercise induced wheeze and cough respectively as indications for preventer therapy. An oral preparation was preferred for relief medication [72 (66%) for 2-5 years, 60 (55%) for > 5 years]. An inhaled preparation was however preferred for preventer medication [60 (55%) for 2-5 years, 85 (78%) for > 5 years]. The oral form was more likely prescribed for asthmatic children 2-5 years (p < 0.001). Corticosteroids and ketotifen were the commonest inhaled and oral preventer treatment prescribed respectively. Only 36(33%) GPs have a CPG copy for reference. Children with asthma symptoms that require preventer therapy may not always be identified in general practice. The oral route remains important for asthma medication especially in young children. The accessibility to the CPG among GPs is disappointing.     

The pharmacotherapy of smoking cessation

1. The great majority of smokers are chronically dependent on tobacco. This dependence arises from the rituals and sensory associations of smoking that are reinforced, within seconds, by a rapid burst of nicotine from the cigarette. 2. All forms of nicotine replacement therapy (NRT) -- gum, patches and inhaler -- and bupropion are safe and effective for increasing smoking cessation rates in the short and long terms. 3. Other than those who are minimally dependent, all patients willing to quit should be offered one of these therapies unless contraindications exist. The effectiveness of drug treatments is multiplied when associated with effective counselling or behavioural treatments. 4. While NRT is not recommended during pregnancy or in patients with cardiac disease, if the alternative is smoking NRT is almost certainly safe. 5. Combination NRT (more than one therapy) may be indicated in patients who have failed monotherapy in association with withdrawal symptoms. 6. There are some specific contraindications to the use of bupropion. Its subsidised availability should not influence prescribers to ignore these.