Behavioral anti-smoking trial in chronic obstructive pulmonary disease patients. Effectiveness of pharmacotherapy and behavioral interventions for smoking cessation in actual clinical practice. Humanistic outcomes in the hypertension and COPD arms of a multicenter outcomes study. A randomised controlled trial to evaluate the efficacy of a nurse-provided intervention for hospitalised smokers.
Smoking causes chronic obstructive pulmonary disease (COPD), but few controlled studies have tested anti-smoking treatments in COPD. With procedures likely to attract unmotivated persons we recruited 49 quite-ill, smoking COPD patients. During one or two daily home visits for 85 days, breath carbon monoxide (CO) and self-reports of daily smoking were obtained. Patients, given quit dates and nicotine gum (2-mg pieces, up to 30 per day), were assigned randomly to three groups: Experimentals were reinforced with lottery tickets for CO < 10 ppm. Cigarette Self Report (CSR) patients were reinforced for reporting no smoking that day. Controls received non-contingent payments. Each group's mean CO level fell at the quit date. Thereafter, reinforced patients maintained significantly lower CO levels than Controls. Although many more 24-h abstentions occurred in the intervention period than in baseline, few patients sustained abstinence; the groups did not differ in that regard. Outcome was predicted by decisions to throw away cigarettes when intervention began, but not by motivation scales nor Fagerstrom dependence scores. Pay schedules apparently exaggerated self-reports of reduced smoking. Although results are statistically significant, there is still no proven, practical treatment for smoking in advanced COPD. This study evaluated the effectiveness of behavioral interventions (brief counseling, nonspecific psychological support in groups - NSGS and cognitive behavioral group therapy - CBGT) in combination with bupropion SR for smoking cessation in the field, through a smoking cessation clinic.
                Two-hundred-and-five smokers were enrolled in a 19-week course during 2007/ 2008, and were randomly assigned to: bupropion SR combined with brief counseling (group A), bupropion SR combined with NSGS (group B), bupropion SR combined with CBGT (group C), or CBGT as the only approach (group D).
                Continuous abstinence rates at the end of therapy were 53.2% for group A, 62.9% for group B, 50.0% for group C, and 22.2% (p < 0.05) for group D. Sustained abstinence rates in 12 months were 29.6%, 28.1%, 34.3% and 19.4% (p > 0.05), respectively.
                Bupropion SR is an effective aid for smoking cessation in clinical practice. NSGT increased the chances for success at the end of therapy when combined with bupropion SR, while CBGT as monotherapy was less effective compared with the approaches including pharmacotherapy. It is suggested that smoking cessation interventions in real-life healthcare settings should be implemented through comprehensive programs using pharmacotherapy where applicable, combined with NSGT, and integrated by specialized healthcare professionals. To evaluate the effects of pharmaceutical care on selected humanistic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD).
                Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment, 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment, 55 control) in the COPD study arm. The Pharmaceutical Care Questionnaire evaluated patient satisfaction with care. Tests specific to the disease states assessed disease and disease management knowledge. Quality of life (QOL) was evaluated using the Health Status Questionnaire 2.0 (HSQ 2.0) in the COPD arm; in the hypertension arm, the Hypertension/Lipid TyPE Specification Form 5.1 was used.
                Ambulatory care centers of 10 Department of Veterans Affairs (DVA) medical centers and 1 university medical center.
                Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents.
                Satisfaction with pharmaceutical care, disease and disease management knowledge, and QOL.
                Statistically significant differences in most satisfaction items were found, with treatment patients expressing greater satisfaction. Treatment groups in both arms strongly agreed that pharmacists helped them with confidence in use of their medication and understanding of their illness, gave complete explanations about their medications, made them feel that their care was a priority, and followed up on their questions and concerns. In the hypertension arm, treatment patients demonstrated significant increases in knowledge scores. Trends in QOL were positive for both hypertension groups, with a significant decrease found in number of treatment patients reporting problems with sexual function. In the COPD arm, improvement trends were significantly stronger for treatment patients.
                Although patients were not dissatisfied with traditional pharmacy care, they were more satisfied overall with the pharmaceutical care model. Does the provision of a nurse-based intervention lead to smoking cessation in hospital patients?
                At tertiary teaching hospital in Newcastle, Australia, 4,779 eligible (aged 18-80, admitted for at least 24 hours, and able to provide informed consent) and consenting (73.4%) in-patients were recruited into a larger cross-sectional survey. 1,422 (29.7%) smokers (in the last 12 months) were randomly assigned to control (n = 711) or intervention group (n = 711). The brief nurse-delivered intervention incorporated: tailored information, assessment of withdrawal, offer of nicotine replacement therapy, booklets, and a discharge letter. Self-reported cessation at 12 months was validated with CO and salivary cotinine.
                There were no significant differences between groups in self-reported abstinence at three or 12 months post intervention, based on an intention to treat analysis. At three months, self-reported abstinence was 27.3% (I) and 27.5% (C); at 12 months was 18.5% (I) and 20.6% (C). There were no differences in validation of self-report between intervention and control groups at 12 months.
                This brief nurse-provided in-patient intervention did not significantly increase the smoking cessation rates compared with the control group at either three or 12-month follow-up.
                A systematic total quality improvement model of accountable outcome-focused treatment, incorporating assertive physician-led pharmacotherapy, routine assessment and recording of nicotine dependence (ICD 10 coding), in- and outpatient services and engagement from multidisciplinary teams of health professionals may be required to improve treatment modalities for this chronic addictive disorder.
Based on this systematic review, the authors found evidence that a combination of psychosocial interventions and pharmacological interventions is superior to no treatment or to psychosocial interventions alone. Furthermore we conclude that there is no clear or convincing evidence for the effectiveness of any psychosocial intervention for patients with COPD due to lack of a sufficient number of high-quality studies.