ABSTRACT
Introduction: There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. Material and methods: 12 PICO questions are formulated from a GLOBAL PICO question: Efficacy and safety of pharmacological treatment of tobacco dependence. A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. Results: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. Conclusions: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence. (AU)
Subject(s)
Humans , Female , Pregnancy , Adolescent , Pulmonary Medicine , Smoking Cessation , Thoracic Surgery , Tobacco Use Disorder/therapy , Bupropion/therapeutic use , Nicotinic Agonists/therapeutic use , Tobacco Use Cessation Devices , Varenicline/therapeutic useABSTRACT
INTRODUCTION: There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. MATERIAL AND METHODS: 12 PICO questions are formulated from a GLOBAL PICO question: "Efficacy and safety of pharmacological treatment of tobacco dependence". A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. RESULTS: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. CONCLUSIONS: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence.
Subject(s)
Alcoholism , Pulmonary Medicine , Smoking Cessation , Thoracic Surgery , Tobacco Use Disorder , Pregnancy , Female , Humans , Adolescent , Tobacco Use Disorder/drug therapy , Varenicline/therapeutic use , Nicotinic Agonists/therapeutic use , Tobacco Use Cessation Devices , Bupropion/therapeutic useABSTRACT
El uso de productos del tabaco novedosos, en especial el cigarrillo electrónico y los dispositivos de combustión parcial de tabaco (sistemas Heat not Burn), han aumentado de forma exponencial, sobre todo en jóvenes y adolescentes. Las autoridades sanitarias y las sociedades científicas han mostrado preocupación ante las dudas que existen sobre su seguridad y eficacia (como método de abandono del tabaco). Tras el estudio de la evidencia científica disponible no es posible asegurar la inocuidad de los vapores o humos que inhalan los usuarios de estos dispositivos. Respecto a la eficacia no pueden recomendarse tras los resultados contradictorios de diferentes ensayos clínicos y metaanálisis, máxime cuando existen tratamientos seguros y eficaces para ayudar a dejar de fumar (vareniclina, terapia sustitutiva con nicotina y bupropion, unido al asesoramiento psicológico)
The use of novel tobacco products, particularly the electronic cigarette (EC) and partial tobacco combustion devices (HnB systems: Heat not Burn), has increased exponentially, particularly among adolescents and young people. The health authorities and scientific societies have shown concern about issues surrounding safety and effectiveness (as a method of smoking cessation). A study of the available scientific evidence has concluded that the safety of the vapor or fumes inhaled by the users of these devices cannot be guaranteed. Contradictory results from various clinical trials and meta-analyses also mean that these devices cannot be recommended for their effectiveness in cessation, especially when safe and effective treatments are available to help quit smoking (varenicline, nicotine replacement therapy, and bupropion, combined with psychological counseling)
Subject(s)
Humans , Adult , Societies, Medical/standards , Electronic Nicotine Delivery Systems/methods , Treatment Outcome , Electronic Nicotine Delivery Systems/standards , Tobacco Use CessationABSTRACT
The use of novel tobacco products, particularly the electronic cigarette (EC) and partial tobacco combustion devices (HnB systems: Heat not Burn), has increased exponentially, particularly among adolescents and young people. The health authorities and scientific societies have shown concern about issues surrounding safety and effectiveness (as a method of smoking cessation). A study of the available scientific evidence has concluded that the safety of the vapor or fumes inhaled by the users of these devices cannot be guaranteed. Contradictory results from various clinical trials and meta-analyses also mean that these devices cannot be recommended for their effectiveness in cessation, especially when safe and effective treatments are available to help quit smoking (varenicline, nicotine replacement therapy, and bupropion, combined with psychological counseling).
Subject(s)
Electronic Nicotine Delivery Systems , Pulmonary Medicine , Societies, Medical , Thoracic Surgery , Tobacco Use Cessation Devices/adverse effects , Aerosols , Cardiovascular Diseases/etiology , Electronic Nicotine Delivery Systems/statistics & numerical data , Humans , Neoplasms/etiology , Respiratory System/drug effects , Smoking Cessation , Spain , Tobacco Use Cessation Devices/statistics & numerical dataABSTRACT
BACKGROUND: The MPOWER strategy encourages suitable monitoring of the tobacco epidemic among health professionals in all countries. OBJECTIVE: To analyse the prevalence of and attitudes towards tobacco use among Spanish health professionals. METHODS: A study was conducted based on an online survey. The study population consisted of health professionals (primary care physicians, specialist physicians and nurses). The questionnaire used included questions about tobacco consumption, knowledge of and attitudes towards smoking. The sample size was calculated according to a database with 9,500 e-mail addresses and listings of health centres and hospitals all over Spain. Statistical analysis was done using the SPSS software programme. RESULTS: The study group comprised a total of 612 health professionals: 322 were women (52.6%), 196 were nurses and 416 were physicians. 11.7% of health professionals were smokers (9.6% regular smokers and 2.1% occasional smokers) and 41.3% were ex-smokers. Within the group of daily smokers, differences were observed between the nurses and the physicians: 11.2 versus 8.9% (p = 0.009). Smoking was recognized as a chronic disorder by 58.2% of health professionals, and 54.6% knew that the most effective intervention to help quit is a combination of psychological and pharmacological treatment. 56% of health professionals always asked their patients about their tobacco consumption. CONCLUSIONS: 11.7% of Spanish health professionals are smokers. We found that they have low knowledge about strategies to quit smoking and that there is a low level of therapeutic intervention on smokers.
Subject(s)
Attitude of Health Personnel , Nurses/statistics & numerical data , Physicians/statistics & numerical data , Smoking/epidemiology , Adult , Aged , Clinical Competence , Female , Humans , Male , Middle Aged , Prevalence , Smoking Cessation , Spain/epidemiology , Surveys and QuestionnairesABSTRACT
No disponible
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/complications , Smoking/drug therapy , Bupropion/therapeutic use , Cholinergic Agents/therapeutic use , Nicotine/therapeutic useSubject(s)
Pulmonary Disease, Chronic Obstructive/complications , Smoking/therapy , Benzazepines/therapeutic use , Bupropion/therapeutic use , Clinical Trials as Topic/statistics & numerical data , Cognitive Behavioral Therapy , Combined Modality Therapy , Double-Blind Method , Follow-Up Studies , Humans , Motivation , Multicenter Studies as Topic/statistics & numerical data , Program Evaluation , Quinoxalines/therapeutic use , Randomized Controlled Trials as Topic , Reward , Severity of Illness Index , Smoking/psychology , Smoking Cessation , Spain , Surveys and Questionnaires , Tobacco Use Cessation Devices , Tobacco Use Disorder/diagnosis , Tobacco Use Disorder/drug therapy , Tobacco Use Disorder/psychology , Tobacco Use Disorder/therapy , VareniclineABSTRACT
INTRODUCTION: Smoking is the main cause of chronic obstructive pulmonary disease (COPD), and smoking cessation is the only treatment shown to be effective in arresting the progression of COPD. Different epidemiological and population-based studies have shown smokers with COPD to have specific smoking characteristics that differentiate them from the rest of smokers and which complicate smoking cessation. The main objective of this study is to analyze the effectiveness and safety of drug treatments for smoking cessation in smokers with severe or very severe COPD. METHODS: Smokers with severe or very severe COPD (Global Initiative for Chronic Obstructive Lung Disease stages III and IV) received treatment for smoking cessation. The treatment program consisted of a combination of behavioral therapy and drug treatment. Patients were followed up at 1, 2, 4, 6, 8, 10, 12, 18, and 24 weeks after the quit date. RESULTS: Four hundred seventy-two patients were seen, 65% were male, and their mean age was 58.3 (9.8). They smoked an average of 29.7 (13.4) cigarettes/day, and their mean Fagerström test for nicotine dependence score was 7.4 (2.1). Continuous abstinence rate from 9 to 24 weeks (CAR 9-24) was 48.5%. According to type of treatment used, CAR 9-24 for nicotine replacement therapy (NRT), bupropion, and varenicline were 38.2%, 55.6%, and 58.3%, respectively. Varenicline was more effective than nicotine patches: 61% versus 44.1% (odds ratio: 1.98; 95% CI: 1.25-3.12; p = .003). NRT was the treatment producing the fewest adverse effects. The onset of psychiatric symptoms due to medication was rare and evenly distributed across groups. CONCLUSIONS: This study shows that smokers with severe or very severe COPD are predominantly males with a high degree of physical dependence upon nicotine. CAR 9-24 was 48.5%. Varenicline and bupropion yielded higher abstinence rates than NRT. Varenicline was more effective than nicotine patches: all types of treatments were safe.
Subject(s)
Nicotinic Agonists/administration & dosage , Pulmonary Disease, Chronic Obstructive/drug therapy , Smoking Cessation/methods , Smoking Prevention , Tobacco Use Cessation Devices/statistics & numerical data , Tobacco Use Disorder/drug therapy , Adult , Aged , Benzazepines/administration & dosage , Causality , Comorbidity , Female , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/epidemiology , Quinoxalines/administration & dosage , Risk Factors , Sex Distribution , Smoking/epidemiology , Spain , Tobacco Use Disorder/epidemiology , VareniclineABSTRACT
No disponible
No disponible
Subject(s)
Humans , Tobacco Use Disorder/drug therapy , Tobacco Use Disorder/economics , Tobacco Use Disorder/epidemiology , Healthcare Financing , Treatment Outcome , Norepinephrine/therapeutic use , Nicotine/analysis , Tobacco Use Disorder/complications , Bupropion/analysis , Patch TestsABSTRACT
No disponible
No disponible
