Cost-effectiveness of smoking cessation and the implications for COPD

The cost burden of COPD is substantial for patients and families, payers, and society as a whole. Smoking has been known for decades to be the leading cause of the disease. Numerous studies have been completed to address the cost-effectiveness of programs created to aid smokers in their efforts to quit. Because several assumptions must be made in order to conduct such a study, and because differences in study design are numerous, comparison of data is difficult. However, studies have consistently shown that regardless of the perspective from which the study was completed, or the methods used to help smokers abstain, the interventions are cost-effective. Although no study has been conducted specifically to assess the cost-effectiveness of smoking cessation interventions as they relate directly to patients with COPD, based on current data it can be concluded that smoking cessation programs are cost-effective for this population.     

经皮冠状动脉介入治疗急性冠脉综合征患者戒烟后残余心血管疾病的风险评估

目的 探讨行经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者戒烟后残余心血管疾病的风险。方法 本研究基于中国冠心病患者大型登记注册研究(OPT-CAD),纳入2012年1月至2014年2月入选OPT-CAD研究的ACS且行PCI的患者,依据吸烟状态(从未吸烟、正在吸烟及已戒烟1年以上)分为未吸烟、吸烟及戒烟3组,比较3组临床资料及介入手术特征、5年临床随访主要心脑血管不良事件(MACCE)的发生情况。所有的数据分析均基于R语言4.1.2版本,通过Trimatch包进行3组倾向性评分匹配。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ²检验。采用Kaplan-Meier方法绘制累计事件发生曲线并通过log-rank检验进行组间比较。结果 进行倾向性评分匹配后3组患者基线特征基本一致。倾向性评分匹配前,3组1、5年MACCE发生率比较,差异均无统计学意义。倾向性评分匹配后,3组患者1年MACCE发生率差异无统计学意义;吸烟组、戒烟组及未吸烟组患者1年靶血管血运重建率比较,差异有统计学意义[28(3.7%)和24(3.2%)和12(1.6%)...     

Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study(*)

Objectives

The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection.

Methods

Patients who reported smoking status and no previous CVD prior to enrolment in the Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) study were included in this study. Smoking status is collected at each visit as current smoker (yes/no) and ever smoker (yes/no). Time since stopping smoking was calculated for persons who had reported current smoking during follow‐up and no current smoking subsequently. Endpoints were: myocardial infarction (MI); coronary heart disease (CHD: MI plus invasive coronary artery procedure or death from other CHD); CVD (CHD plus carotid artery endarterectomy or stroke); and all‐cause mortality. Event rates were calculated for never, previous and current smokers, and smokers who stopped during follow‐up. Incidence rate ratios (IRRs) were determined using Poisson regression adjusted for age, sex, cohort, calendar year, family history of CVD, diabetes, lipids, blood pressure and antiretroviral treatment.

Results

A total of 27 136 patients had smoking status reported, with totals of 432, 600, 746 and 1902 MI, CHD, CVD and mortality events, respectively. The adjusted IRR of CVD in patients who stopped smoking during follow‐up decreased from 2.32 within the first year of stopping to 1.49 after >3 years compared with those who never smoked. Similar trends were observed for the MI and CHD endpoints. Reductions in risk were less pronounced for all‐cause mortality.

Conclusion

The risk of CVD events in HIV‐positive patients decreased with increasing time since stopping smoking. Smoking cessation efforts should be a priority in the management of HIV‐positive patients.     

Factors associated with long-term smoking relapse in those who succeeded in smoking cessation using regional smoking cessation programs

It is known that approximately 10% of successful quitters relapse annually. This study aimed to investigate the factors related to long-term smoking relapse in individuals who succeeded in maintaining smoking cessation for 6 months after attending a regional smoking cessation program.This study enrolled 943 individuals registered for the regional smoking cessation program at the Busan Smoking Cessation Center in 2018–2019 who maintained smoking cessation for 6 months. A survey was conducted using a smartphone link or through phone calls, and the data for 305 participants who finally completed the survey were analyzed. The questionnaire addressed individual, inter-individual, organizational, and community-level factors related to smoking relapse. Multivariate logistic regression analysis was performed to evaluate the factors associated with smoking relapse by period. The Cox proportional hazard regression model was used for the factors associated with smoking relapse for the entire period.The smoking relapse rate at the time of the survey was 25.4%. In the analysis of smoking relapse by period, relapse was associated with the belief that smoking relieves stress, the number of single-person households, and poor subjective health status. In the analysis of smoking relapse during the entire period, we observed a significant association with the belief that smoking relieves stress (hazard ratio [HR]: 2.65, 95% confidence interval [CI]: 1.52–4.61), single-person households (HR: 1.95, 95% CI: 1.16–3.26), and high levels of emotional stress (HR: 1.72, 95% CI: 1.04–2.85).Long-term follow-up is necessary to prevent smoking relapse in single-person households, individuals who believe that smoking relieves stress, and those experiencing high levels of subjective emotional stress. Interventional therapies for stress relief and awareness improvement in smokers need to be developed.     

A randomized, controlled trial of smoking cessation counseling provided during child hospitalization for respiratory illness

The impact of parental smoking on children is enormous. Injury and illness related to parental smoking result in 6,200 excess pediatric deaths per year, which places smoking as the leading preventable cause of death in US children. Parental smoking doubles the risk of child hospitalization for respiratory illness therefore pediatricians have frequent contact with smoking parents. A single study has previously investigated the effect of child hospitalization on parental smoking cessation. Smoking caregivers of children hospitalized for respiratory illness at the University of New Mexico were offered a smoking cessation intervention during the child's hospitalization. Participants were randomized to receive either a brief anti-smoking message or more extensive counseling based on current clinical practice guidelines. Forty-two parents enrolled in the study. Fourteen percent of participants in the counseling group and 5% in the brief message group were self-reported quitters at 6 months. A significant percentage of smoking parents of children hospitalized for respiratory illness are willing to receive smoking cessation counseling while their child is in the hospital. Abstinence rates appear similar to other pediatric office-based interventions. Child hospitalization should be considered an important opportunity to provide parents with smoking cessation services, particularly since many smoking parents will not have access to these services elsewhere.     

Assessment of factors associated with smoking cessation at diagnosis or during follow‐up of Crohn's disease

Background and Aim

Smoking cessation is known to improve the course of Crohn's disease (CD). However, the factors associated with smoking cessation after CD diagnosis have not been well established.

Methods

Clinical characteristics and change in smoking status were evaluated in 445 current smokers at the time of CD diagnosis. Patients were classified into three subgroups based on their final smoking status and time of smoking cessation: non‐quitters, quitters at diagnosis, and quitters during follow‐up.

Results

The overall smoking cessation rate was 55.7% (248 of 445 patients). The diagnosis of CD was the main reason for quitting (41.5%, 103 of 248 patients). Smoking cessation at the time of CD diagnosis was associated with intestinal resection within 3 months from CD diagnosis (odds ratio [OR] 2.355, 95% confidence interval [CI] 1.348–4.116, P = 0.003), light smoking (OR 2.041, 95% CI 1.157–3.602, P = 0.014), and initiation of smoking before 18 years of age (OR 0.570, 95% CI 0.327–0.994, P = 0.047). Light smoking (OR 1.762, 95% CI 1.019–3.144, P = 0.043) and initiation of smoking before 18 years (OR 0.588, 95% CI 0.381–0.908, P = 0.017) were also associated with overall smoking cessation.

Conclusion

Quitters after CD diagnosis, including quitters at diagnosis and quitters during follow‐up, had features distinct from those of non‐quitters. Given the motivation at CD diagnosis, a detailed history of smoking habits should be taken and all current smokers should be encouraged to quit smoking at the time of CD diagnosis.     

Early predictors of smoking cessation after myocardial infarction

The determinants of long-term smoking cessation were evaluated in 80 patients who smoked cigarettes and survived a myocardial infarction. All patients underwent a program of rehabilitation and secondary prevention including in-hospital counseling and physician-guided reinforcing sessions at 1, 3, and 6 months after discharge. At 18 months of follow-up, 53 patients (66.3%) had quit smoking. Variables associated with smoking cessation were duration of hospital stay greater than or equal to 19 days (79 vs. 48%; p less than 0.005) and peak creatine phosphokinase (CPK) elevation greater than or equal to 500 U/l (76 vs. 54%; p less than 0.05). Males tended to quit in higher proportion than females (68 vs. 44%). Age, prior myocardial infarction, other cardiovascular risk factors, infarction location, Killip class at entry, and duration of stay in coronary care unit did not significantly affect the quitting rates. Logistic regression analysis singled out the duration of hospital stay as a significant predictor of smoking cessation (p less than 0.005). Early and intensive secondary prevention during the hospital stay is crucial in promoting sustained smoking cessation after myocardial infarction.     

Cardiovascular comorbidities are increased in US patients with haemophilia A: a retrospective database analysis

There is conflicting evidence in the literature on whether individuals with haemophilia in the USA have greater, reduced, or similar risks for cardiovascular disease as the general population. This study evaluated the prevalence of cardiovascular comorbidities among USA males with haemophilia A, relative to an unaffected general male population with similar characteristics. Males with haemophilia A and continuous insurance coverage were identified by ICD‐9‐CM code 286.0 (1 January 2007–31 December 2009) using the MarketScan^® Commercial and Medicare Research Databases. Individuals with haemophilia A were exact matched 1:3 with males without a diagnosis of haemophilia A. The prevalence of cardiovascular comorbidities identified by ICD‐9‐CM code was determined for matched cohorts. Of the study population, 2506 were grouped in the haemophilia A cohort and 7518 in the general cohort. Proportions of individuals with haemorrhagic stroke (2.0% vs. 0.5%, P < 0.001), ischemic stroke (4.7% vs. 2.7%, P < 0.001), coronary artery disease (10.7% vs. 5.8%, P < 0.001), myocardial infarction (0.8% vs. 0.3%, P = 0.003), hypertension (22.6% vs. 15.5%, P < 0.001), hyperlipidaemia (15.9% vs. 11.9%, P < 0.001), arterial thrombosis (12.1% vs. 5.9%, P < 0.001), and venous thrombosis (4.4% vs. 1.1%, P < 0.001) were significantly greater for the haemophilia A cohort. Results were consistent across most age groups, and comorbidities appeared at an earlier age in those with haemophilia A than in the general population. Among the USA haemophilia A population cardiovascular comorbidities are more prevalent and they appear earlier in life in comparison to the general male population, suggesting the need for earlier, enhanced screening for age‐related comorbidities in the haemophilia community.     

慢性肺病住院患者戒烟成功影响因素研究

目的研究住院慢性肺病患者相对于其他住院患者吸烟行为特征的特点及戒烟成功相关影响因素。方法在2014年6月至2015年6期间肺病科连续的慢性肺病住院患者,配对抽取同期于其他科室住院的非慢性肺病患者,填写调查表进行数据分析。结果本调查中吸烟患者均以控制不住烟瘾为继续吸烟主要原因;在慢性肺病患者分组中主要以经济原因为主要戒烟原因,而在非慢性肺病分组中主要以防未病为主;吸烟人群中,大家对戒烟行为的认知是一致的,在戒烟过程中不仅取决于本人的态度是否坚决,还与其对整个过程的信心及外界环境息息相关;在戒烟过程中,戒烟持续时间在很大程度上决定戒烟是否成功。多因素Logistic回归分析发现年龄、月经济收入、饮酒、是否患有其他慢性病、自觉健康状况、尼古丁依赖均影响是否戒烟成功。结论目前慢性肺病患者戒烟能够成功很大程度上是因为随着年龄增大及疾病的进行性加重及经济条件不佳所"被迫"成功的,提示我们在今后的戒烟治疗中,应早期干预,变被动戒烟为主动戒烟。     

The effectiveness of smoking cessation groups offered to hospitalised patients with symptoms of exacerbations of chronic obstructive pulmonary disease (COPD)

Introduction: Chronic obstructive pulmonary disease (COPD) is a major contributor to morbidity and mortality. Smoking is the leading cause of COPD. Results from randomised trials regarding smoking cessation in hospitalised patients with COPD are few. Objectives: To assess the effect of smoking cessation groups (SCG) in patients with COPD admitted to hospital. Methods: Two hundred and twenty‐three patients admitted to hospital were assigned to either a control group (n = 102) or an intervention group (n = 121) by matter of vacancy. The smokers in the intervention group were offered participation in an SCG. Smoking status and change in self‐reported symptoms were assessed after 1 year. Smoking status was self‐reported and verified with carbohemoglobin measurement. Survival and hospital admissions were assessed after 5 years through national registers. Results: Forty‐eight patients participated in an SCG. After 1 year, 36 (30%) patients in the intervention group were abstinent compared with 13 (13%) patients in the control group [odds ratio (95% confidence interval): 2.83 (1.40–5.74)]. There was a significant difference between the intervention group and the control group regarding change in self‐reported phlegm. There was a non‐significant tendency towards better survival in the intervention group (50.4%) compared with the control group (43.1%). After 3 years, the intervention group had a significantly fewer total number of days admitted to hospital and number of days hospitalised with COPD. Conclusion: This study shows that an intervention consisting of offering participation in an SCG to chronic patients makes it possible to obtain higher abstinence rates. Furthermore, this intervention showed impact on phlegm, survival and hospital readmissions. Please cite this paper as: Borglykke A, Pisinger C, Jørgensen T and Ibsen H. The effectiveness of smoking cessation groups offered to hospitalised patients with symptoms of exacerbations of chronic obstructive pulmonary disease (COPD). The Clinical Respiratory Journal 2008; 2: 158–165.     

Common predictors of smoking cessation in clinical practice

Although smoking cessation is clearly beneficial, many smokers respond poorly to smoking cessation efforts with rather disappointing overall success rate of long-term abstinence. The perceived lack of effectiveness of smoking cessation may well influence how physicians set their priorities with regard to an effective use of their consultation time. Negative beliefs and attitudes can be resolved by advancing the general understanding of the natural history of quitting, by making sensible use of smoking cessation services, and by being aware of the correct use of drugs for nicotine dependence when prescribed. In particular, a better understanding of predictors of success in smoking cessation can help physicians in identifying smokers who stand a fair chance of quitting. The purpose of the present article is to review those predictors of smoking cessation that can be of help in routine clinical consultation.     

How to address smoking cessation in HIV patients

Tobacco consumption is the modifiable risk factor contributing most to the development of non‐AIDS‐defining events among persons living with HIV/AIDS (PLWHA). Clinicians' awareness of this problem is critical and not yet adequate. Practical information issued by public health authorities or contained in experts' clinical guidelines regarding how to address smoking cessation in PLWHA is scarce. The aim of this review is to provide physicians with comprehensive and practical information regarding how to identify HIV‐positive patients willing to stop smoking and those more likely to succeed, how to choose the most suitable strategy for an individual patient, and how to help the patient during the process. In the light of current evidence on the efficacy and benefits of stopping smoking in PLWHA, physicians must actively pursue smoking cessation as a major objective in the clinical care of PLWHA.     

Parents who quit smoking and their adult children's smoking cessation: a 20-year follow-up study

Aims   Extending our earlier findings from a longitudinal cohort study, this study examines parents' early and late smoking cessation as predictors of their young adult children's smoking cessation.
Design   Parents' early smoking cessation status was assessed when their children were aged 8 years; parents' late smoking cessation was assessed when their children were aged 17 years. Young adult children's smoking cessation, of at least 6 months duration, was assessed at age 28 years.
Setting   Forty Washington State school districts.
Participants and measurements   Participants were 991 at least weekly smokers at age 17 whose parents were ever regular smokers and who also reported their smoking status at age 28. Questionnaire data were gathered on parents and their children (49% female and 91% Caucasian) in a longitudinal cohort (84% retention).
Findings   Among children who smoked daily at age 17, parents' quitting early (i.e. by the time their children were aged 8) was associated with a 1.7 times higher odds of these children quitting by age 28 compared to those whose parents did not quit [odds ratio (OR) 1.70; 95% confidence interval (CI) 1.23, 2.36]. Results were similar among children who smoked weekly at age 17 (OR 1.91; 95% CI 1.41, 2.58). There was a similar, but non-significant, pattern of results among those whose parents quit late.
Conclusions   Supporting our earlier findings, results suggest that parents' early smoking cessation has a long-term influence on their adult children's smoking cessation. Parents who smoke should be encouraged to quit when their children are young.     

The cost-effectiveness of antidepressants for smoking cessation in chronic obstructive pulmonary disease (COPD) patients

Objectives In healthy smokers, antidepressants can double the odds of cessation. Because of its four times lower costs and comparable efficacy in healthy smokers, nortriptyline appears to be favourable compared to bupropion. We assessed which of both drugs was most effective and cost‐effective in stopping smoking after 1 year compared with placebo among smokers at risk or with existing chronic obstructive pulmonary disease (COPD). Methods A total of 255 participants, aged 30–70 years, received smoking cessation counselling and were assigned bupropion, nortriptyline or placebo randomly for 12 weeks. Prolonged abstinence from smoking was defined as a participant's report of no cigarettes from week 4 to week 52, validated by urinary cotinine. Costs were calculated using a societal perspective and uncertainty was assessed using the bootstrap method. Results The prolonged abstinence rate was 20.9% with bupropion, 20.0% with nortriptyline and 13.5% with placebo. The differences between bupropion and placebo [relative risk (RR) = 1.6; 95% confidence interval (CI) 0.8–3.0] and between nortriptyline and placebo (RR = 1.5; 95% CI 0.8–2.9) were not significant. Severity of airway obstruction did not influence abstinence significantly. Societal costs were €1368 (2.5th–97.5th percentile 193–5260) with bupropion, €1906 (2.5th–97.5th 120–17 761) with nortriptyline and €1212 (2.5th–97.5th 96–6602) with placebo. Were society willing to pay more than €2000 for a quitter, bupropion was most likely to be cost‐effective. Conclusions Bupropion and nortriptyline seem to be equally effective, but bupropion appears to be more cost‐effective when compared to placebo and nortriptyline. This impression holds using only health care costs. As the cost‐effectiveness analyses concern some uncertainties, the results should be interpreted with care and future studies are needed to replicate the findings.