No Difference Found in Smokers With COPD Trying Different Cessation Techniques

December 26, 2018

Long-term nicotine replacement therapy (LT-NRT) provides 1 way for smokers with chronic obstructive pulmonary disease (COPD) to try to quit, but does not result in greater rates of cessation or harm reduction, according to a recently published study.

Long-term nicotine replacement therapy (LT-NRT) provides 1 way for smokers with chronic obstructive pulmonary disease (COPD) to try to quit, but does not result in greater rates of cessation or harm reduction, according to a recently published study.

It had been theorized that compared with standard cessation approaches, LT-NRT could lead to higher quit rates in this population. Most COPD cases can be traced to smoking, but persistent smokers have particularly high levels of nicotine dependence. In addition, patients with COPD who continue to smoke have higher mortality and more rapid decline in pulmonary function.

In a randomized clinical trial of 398 smokers with COPD, 23 of 197 (11.7%) receiving a standard smoking cessation (SSC) intervention had quit at 12 months, compared with 24 of 197 (12.2%) receiving long-term nicotine replacement therapy. Both groups had comparable reductions in carcinogen and smoke exposure.

The study recruited smokers who self-reported a diagnosis of COPD from May 23, 2014, through November 30, 2015. The 12-month follow-up was completed December 6, 2016. Patients were recruited at a clinical research unit of an academic medical center.

SSC treatment included 10 weeks of LT-NRT and 4 follow-up counseling sessions for those willing to make a quit attempt.

LT-NRT included 12 months of NRT and 6 follow-up counseling sessions regardless of initial willingness to quit. Overall, 198 patients were randomized to SSC, and 197 were included in the primary analysis; 200 patients were randomized to LT-NRT, and 197 were included in the primary analysis.

The primary outcome was 7-day abstinence from smoking verified by carbon monoxide (CO) levels at 12 months. Secondary outcomes included cigarettes smoked per day (CPD), exposure to CO, urinary excretion of a smoking-related carcinogen called 4-methylnitrosamino-1-3-pyridyl-1-butanol (NNAL), and adverse events.

Among the 398 patients, (59.8% female; mean age, 56) the mean CPD was 23.1 (12.3).

Twelve-month follow-up was completed by 373 participants (93.7%), and 394 (99%) were included in the primary analysis.

At 12 months, CO-verified abstinence occurred in 23 of 197 participants (11.7%) in the SSC arm and 24 of 197 (12.2%) in the LT-NRT arm (risk difference, 0.5%; 95% CI, −5.9% to 6.9%).

Continuing smokers in the SSC and LT-NRT arms had similar, significantly reduced harms caused by smoking, including cigarette consumption by 12.4 and 14.5 CPD, respectively, exhaled CO level by 5.5 and 7.8 ppm, respectively, and mean urinary NNAL excretion by 21.7% and 23%, respectively.

In multivariate analyses, continuing smokers with greater adherence to NRT experienced less reduction in NNAL exposure. The frequency of major adverse cardiac events was similar in both groups.

Similar rates of cessation and similar reductions in exposure to tobacco smoke resulted with LT-NRT and SSC. Among continuing smokers, ongoing use of NRT was not associated with reductions in smoke exposure.

The low overall rate of cessation in this study suggests the need for better strategies to help patients with COPD quit smoking, the authords wrote.

Reference

Ellerbeck EF, Nollen N, Hutcheson TD, et al. Effect of long-term nicotine replacement therapy vs standard smoking cessation for smokers with chronic lung disease. [published online September 7, 2018]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2018.1843.