The progression of chronic obstructive pulmonary disease
(COPD) can often be slowed with smoking cessation. However, among socioeconomically disadvantaged groups, many patients with COPD continue to smoke and have the lowest quit rates.
A recent study
investigated bupropion and varenicline—which can substantially improve the chances of smoking cessation in patients with COPD—and their use among different socioeconomic patterns. A total of 4741 patients, who were reported to be current smokers in the Danish register of COPD from 2008 to 2012, were included in the study. The patients were followed for 6 months in the National Prescription Registry.
“Despite the well-documented effectiveness of bupropion and varenicline for smoking cessation among persistent smokers with COPD, studies on the use of these medications among patients initiating specialized outpatient care are virtually nonexisting,” the study stated. “This exact time in the patient’s history of disease is a relevant point of intervention as patients who continue to smoke despite the progression of their disease likely have special needs in order to quit.”
The analysis of the patients included whether the patients redeemed a prescription for any of the smoking cessation medications, such as bupropion and varenicline. Throughout the 6 months from first consultation, only 5% redeemed a prescription for bupropion or varenicline.
Additionally, when considering the demographics of the patients, the study found that younger age, female sex, higher education, and higher income were associated with a higher likelihood. Non-Danish ethnicity, living along, and very severe COPD were factors associated with a lower likelihood of redeeming the smoking cessation medications (SCMs).
“Smoking cessation is beneficial in COPD patients of all ages, and to our knowledge, SCMs have not been shown less efficacious in older compared with younger smokers,” noted the study. “It is possible that conscious or subconscious ageism by physicians may explain the lower SMC prescription rate among older patients.”
The study emphasized the importance of smoking cessation among patients with COPD; however, in order to improve prognosis and slow COPD progression of this high-risk population, there needs to be ongoing efforts for equal and timely access to effective smoking cessation medications.
“Despite their proven effectiveness, bupropion and varenicline are sparingly used among COPD patients followed in the hospital outpatient setting with the lowest use among the socioeconomically disadvantaged. This highlights a missed opportunity for intervention,” concluded the researchers.
Tøttenborg SS, Clark AJ, Thomsen RW, Johnsen SP, Lange P. Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study. [published online May 29, 2018]. Int J Chron Obstruct Pulmon Dis.