Speciality
Spotlight

 




 


Respiratory – Pulmonary – Asthma


 

 





Respiratory
Medicine

      

  • D P Tashkin, R Kanner, W Bailey, et al

    Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial.

    Lancet 2001, 357: 1571-75, May 19, 2001.



    Tobacco smoking is associated with chronic obstructive pulmonary disease (COPD) in more than 80% of cases. Aim of the study was to investigate the effect of sustained release bupropion (amfebutamone) (SR) in promoting abstinence from smoking in patients with COPD.



    In a double-blind, randomised, placebo-controlled trial 404 individuals with mild or moderate COPD who smoked 15 or more cigarettes per day, were assigned bupropion SR (150mg twice daily) or placebo for 12 weeks. All patients received smoking cessation counseling. Study medication was taken for 1 week before patients attempted to stop smoking. The primary efficacy endpoint was the complete and continuous abstinence from smoking from the beginning of week 4 to the end of week 7. Participants were followed up at month 6. Analysis was by intention to treat.



    Interpretation of the study was that Bupropion SR is a well-tolerated and effective aid to smoking cessation in people with mild to moderate
    COPD.       

                   
  • Chris Silagy, Neil Formica

    Place of bupropion in smoking-cessation therapy.

    The Lancet, vol.357, May 19, 2001, pg.1550



    Reducing the number of current smokers is the single most important behavioural change that would substantially reduce morbidity and mortality associated with cigarette smoking. However, no effort to find a cure for tobacco dependence has led to strategies (pharmacological or non-pharmacological) close to fulfilling this role. The mainstays of therapy for tobacco dependence have focused on increasing successful quit attempts through the use of behavioural approaches and/or some form of nicotine-replacement therapy. Although such strategies have relative effectiveness approaching twice that of placebo, the absolute success rates are still small (5-15%), with increasing absolute success related to the intensity of therapy and follow-up. There has been little to differentiate the various forms of nicotine-replacement therapy from each other in clinical effectiveness, mainly because of lack of head-to-head trials with adequate follow-up.



    In recent years interest has grown in the potential role of antidepressants as an effective aid to smoking cessation. Despite lack of evidence to support an effect of some of these agents (such as fluoxetine), others (such as nortryptiline and bupropion) have shown more promise. Their exact mode of action in smoking cessation is unclear but is thought to reflect their capacity to inhibit neuronal uptake of norepinephrine and dopamine rather than antidepressant activity.



    Bupropion is the first antidepressant to be formally registered for use as a treatment for tobacco dependence.



    The study reported in Lancet by D P Tashkin and colleagues is a placebo-controlled trial of bupropion among heavy smokers with chronic obstructive pulmonary disease. Although the relative effectiveness of the drug is similar to that in published studies, the absolute cessation rates are smaller (despite similar levels of counseling and only 6 months of follow-up data available so far). When taken into account with the existing data on the drug, this study provides further confirmation that bupropion is more effective than placebo.



    Until the required research is done, the choice of whether or not to use bupropion as a first-line agent for smoking cessation will depend as much on whether it is available locally (and at what cost), as it will on the delicate trade-offs between the apparent evidence of benefit, set against the potential risk of serious side-effects, the need for supportive counseling, and the relative effectiveness compared with the more accessible and established forms of nicotine-replacement therapy.    


 



 

 

Speciality Spotlight

 

 

Respiratory Medicine
      

  • D P Tashkin, R Kanner, W Bailey, et al
    Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial.
    Lancet 2001, 357: 1571-75, May 19, 2001.

    Tobacco smoking is associated with chronic obstructive pulmonary disease (COPD) in more than 80% of cases. Aim of the study was to investigate the effect of sustained release bupropion (amfebutamone) (SR) in promoting abstinence from smoking in patients with COPD.

    In a double-blind, randomised, placebo-controlled trial 404 individuals with mild or moderate COPD who smoked 15 or more cigarettes per day, were assigned bupropion SR (150mg twice daily) or placebo for 12 weeks. All patients received smoking cessation counseling. Study medication was taken for 1 week before patients attempted to stop smoking. The primary efficacy endpoint was the complete and continuous abstinence from smoking from the beginning of week 4 to the end of week 7. Participants were followed up at month 6. Analysis was by intention to treat.

    Interpretation of the study was that Bupropion SR is a well-tolerated and effective aid to smoking cessation in people with mild to moderate COPD.       
                   
  • Chris Silagy, Neil Formica
    Place of bupropion in smoking-cessation therapy.
    The Lancet, vol.357, May 19, 2001, pg.1550

    Reducing the number of current smokers is the single most important behavioural change that would substantially reduce morbidity and mortality associated with cigarette smoking. However, no effort to find a cure for tobacco dependence has led to strategies (pharmacological or non-pharmacological) close to fulfilling this role. The mainstays of therapy for tobacco dependence have focused on increasing successful quit attempts through the use of behavioural approaches and/or some form of nicotine-replacement therapy. Although such strategies have relative effectiveness approaching twice that of placebo, the absolute success rates are still small (5-15%), with increasing absolute success related to the intensity of therapy and follow-up. There has been little to differentiate the various forms of nicotine-replacement therapy from each other in clinical effectiveness, mainly because of lack of head-to-head trials with adequate follow-up.

    In recent years interest has grown in the potential role of antidepressants as an effective aid to smoking cessation. Despite lack of evidence to support an effect of some of these agents (such as fluoxetine), others (such as nortryptiline and bupropion) have shown more promise. Their exact mode of action in smoking cessation is unclear but is thought to reflect their capacity to inhibit neuronal uptake of norepinephrine and dopamine rather than antidepressant activity.

    Bupropion is the first antidepressant to be formally registered for use as a treatment for tobacco dependence.

    The study reported in Lancet by D P Tashkin and colleagues is a placebo-controlled trial of bupropion among heavy smokers with chronic obstructive pulmonary disease. Although the relative effectiveness of the drug is similar to that in published studies, the absolute cessation rates are smaller (despite similar levels of counseling and only 6 months of follow-up data available so far). When taken into account with the existing data on the drug, this study provides further confirmation that bupropion is more effective than placebo.

    Until the required research is done, the choice of whether or not to use bupropion as a first-line agent for smoking cessation will depend as much on whether it is available locally (and at what cost), as it will on the delicate trade-offs between the apparent evidence of benefit, set against the potential risk of serious side-effects, the need for supportive counseling, and the relative effectiveness compared with the more accessible and established forms of nicotine-replacement therapy.    

 

 

By |2022-07-20T16:41:49+00:00July 20, 2022|Uncategorized|Comments Off on Respiratory – Pulmonary – Asthma

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