Tobacco Treatment Guideline for High Risk Groups: A pilot study in patients with Chronic Obstructive Pulmonary Disease
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University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
Faculty of Medicine, University of Ottawa, Ottawa, Canada
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Clinical Hospital of Pulmonary Diseases Iasi, Romania
George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
Hellenic Centre for Disease Control and Prevention, Athens, Greece
Institute of Public Health, American College of Greece, Athens, Greece
Publish date: 2018-04-12
Tob. Induc. Dis. 2018;16(April):13
Smoking cessation is a key clinical intervention for reducing progressive lung destruction and lung function deterioration in patients with Chronic Obstructive Pulmonary Disease (COPD). Specialised Tobacco Cessation Guidelines for High-risk Groups (TOB-G) were developed and published in 2017 that present evidence-based recommendations to support smoking cessation in COPD patients. The purpose of this pilot study was to examine the real world effectiveness of the TOB-G guideline recommendations among a sample of COPD patients.

A pilot study was conducted among a sample of COPD patients who smoke and were interested in quitting. Participants were recruited from inpatient and outpatient hospital admissions between October and December 2016 in Iasi, Romania. The intervention program was designed based on the recommendations of the TOB-G guidelines for COPD patients. Patients received a total of four contacts: at baseline, 1, 2, and 6 months. The primary outcome measure was biochemically validated point prevalence smoking abstinence measured at 6 months.

Fifty patients (74% male; age mean±SD = 60.2±7.8) with diagnosed COPD took part in the pilot study. Self-reported rates of point prevalence smoking abstinence were 30.6%, 44.9% and 64.6% at the 1-, 2-, and 6-month follow-up, respectively. Carbon monoxide testing was completed with 51.6% of the sample at 6 months. The biochemically verified abstinent rate was 33.3% at the 6-month follow-up.

This pilot testing of the TOB-G Clinical Practice Guidelines for COPD patients was associated with high rates of patient smoking abstinence, which are of clinical importance. Further research is needed to evaluate the guidelines large-scale effectiveness in clinical practice.

Anthonisen NR, Connett JE, Murray RP. Smoking and lung function of Lung Health Study participants after 11 years. Am J Respir Crit Care Med. 2002;166:675-679. doi:10.1164/rccm.2112096
Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142(4):233-239. doi:10.7326/0003-4819-142-4-200502150-00005
Godtfredsen NS, Lam TH, Hansel TT, Leon ME, Gray N, Dresler C, et al. COPD-related morbidity and mortality after smoking cessation: status of the evidence. Eur Respir J. 2008;34(4):844-853. doi:10.1183/09031936.00160007
Vozoris NT, Stanbrook MB. Smoking prevalence, behaviours, and cessation among individuals with COPD or asthma. Respir Med. 2011;105:477-484. doi:10.1016/j.rmed.2010.08.011
Shahab L, Jarvis MJ, Britton J, West R. Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax. 2006;61(12):1043-1047. doi:10.1136/thx.2006.064410
Tønnesen P. Smoking cessation and COPD. Eur Respir Rev. 2013;22(127):37-43. doi:10.1183/09059180.00007212
Global Strategy for the Diagnosis, Management and Prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Published, 2010. Updated January, 2015. Accessed August 30, 2017.
Jiménez-Ruiz CA, Andreas S, Lewis KE, Tonnesen P, van Schayck CP, Hajek P, et al. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J. 2015;46(1):61-79. doi:10.1183/09031936.00092614
Hersh CP, DeMeo DL, Al-Ansari E, Carey VJ, Reilly JJ, Ginns LC, et al. Predictors of survival in severe, early onset COPD. Chest. 2004;126(5):1443-1451. doi:10.1378/chest.126.5.1443
Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-555. doi:10.1164/rccm.201204-0596PP
Kanner RE, Connett JE, Williams DE, Buist AS. Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease: the Lung Health Study. Am J Med. 1999;106(4):410-416. doi:
Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS. Smoking Cessation and Lung Function in Mild-to-Moderate Chronic obstructive Pulmonary Disease. The Lung Health Study. Am J Respir Crit Care Med. 2000;161(2):381-390. doi:10.1164/ajrccm.161.2.9901044
Au DH, Bryson CL, Chien JW, Sun H, Udris EM, Evans LE, et al. The Effects of Smoking Cessation on the Risk of Chronic Obstructive Pulmonary Disease Exacerbations. J Gen Intern Med. 2009;24(4):457-463. doi:10.1007/s11606-009-0907-y
Tønnesen P, Carrozzi L, Fagerström KO, Gratziou C, Jimenez-Ruiz C, Nardini S, et al. Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy. Eur Respir J. 2007;29(2):390-417. doi:10.1183/09031936.00060806
van Schayck OC, Haughney J, Aubier M, Selroos O, Ekström T, Ostinelli J, et al. Do asthmatic smokers benefit as much as non-smokers on budesonide/formoterol maintenance and reliever therapy? Results of an open label study. Respir Med. 2012;106(2):189-96. doi:10.1016/j.rmed.2011.10.017
van Eerd EA, van Rossem CR, Spigt MG, Wesseling G, van Schayck OC, Kotz D. Do we need tailored smoking cessation interventions for smokers with COPD? A comparative study of smokers with and without COPD regarding factors associated with tobacco smoking. Respiration. 2015;90:211-219. doi:10.1159/000398816
van Eerd EA, Risor MB, van Rossem CR, van Schayck OC, Kotz D. Experiences of tobacco smoking and quitting in smokers with and without chronic obstructive pulmonary disease-a qualitative analysis. BMC Fam Pract. 2015;16:164. doi:10.1186/s12875-015-0382-y
Jiménez-Ruiz CA, Masa F, Miravitlles M, Gabriel R, Viejo JL, Villasante C, et al. Smoking characteristics: differences in attitudes and dependence between healthy smokers and smokers with COPD. Chest. 2001;119(5):1365-1370. doi:
Pascal OI, Trofor A, Lotrean M, Filipeanu D,Trofor L. Depression, anxiety and panic disorders in chronic obstructive pulmonary disease patients: correlations with tobacco use, disease severity and quality of life. Tobacco Induced Diseases. 2017;15:23. doi:10.1186/s12971-017-0128-9
Wagena EJ, Arrindell WA, Wouters EF, van Schayck CP. Are patients with COPD psychologically distressed? Eur Respir J. 2005;26(2):242-248. doi:10.1183/09031936.05.00010604
Antoniu SA, Trofor A. Varenicline for smoking cessation intervention in chronic obstructive pulmonary disease. Expert Opinion on Pharmacotherapy. 2011;12(16):2595-2597. doi:10.1517/14656566.2011.605786
Behrakis P, Vardavas C, Papadakis S, eds. Tobacco Cessation Guidelines for High Risk Populations. Athens, Greece: Hellenic Center for Disease Control and Prevention (KEELPNO); 2017.
Behrakis P. TOB-G: Tobacco Cessation Guidelines for High risk Populations. Tob. Prev. Cessation. 2016;2(April Supplement):39. doi:10.18332/tpc/62428
Yap SY, Lunn S, Pang E, Croft C, Stern M. A psychological intervention for smoking cessation delivered as treatment for smokers with chronic obstructive pulmonary disease: Multiple needs of a complex group and recommendations for novel service development. Chron Respir Dis. 2015;12(3):230-237. doi:10.1177/1479972315586198
Coronini-Cronberg S, Heffernan C, Robinson M. Effective smoking cessation interventions for COPD patients: a review of the evidence. JRSM Short Rep. 2011;2(10):78. doi:10.1258/shorts.2011.011089
Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991;86(9):1119-1127. doi:10.1111/j.1360-0443.1991.tb01879.x
West R, Hajek P, Stead L, Stapleton. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005;100:299-303. doi:10.1111/j.1360-0443.2004.00995.x
Joly B, D'Athis P, Gerbaud L, Hazart J, Perriot J, Quantin C. Smoking cessation attempts: is it useful to treat hard core smokers? Tob Induc Dis. 2016;14(34). doi:10.1186/s12971-016-0100-0
Criner GJ, Bourbeau J, Diekemper RL, Ouellette DR, Goodridge D, Hernandez P, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest. 2015;147(4):894-942. doi:10.1378/chest.14-1676
Qaseem A, Wilt T, Weinberger SE, Hanania NA, Criner G, van der Molen T, et al. Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Annals of Internal Medicine. 2011;155(3):179-191. doi:10.7326/0003-4819-155-3-201108020-00008
Katz DA, Muehlenbruch DR, Brown RB, Fiore MC, Baker TB; AHRQ Smoking Cessation Guideline Study Group. Effectiveness of a clinic-based strategy for implementing the AHRQ Smoking Cessation Guideline in primary care. Prev. Med. 2002;35:293-301. doi:10.1006/pmed.2002.1073
Katz DA, Muehlenbruch DR, Brown RL, Fiore MC, Baker TB; AHRQ Smoking Cessation Guideline Study Group. Effectiveness of implementing the agency for healthcare research and quality smoking cessation clinical practice guideline: a randomized, controlled trial. J. Natl. Cancer Inst. 2004:96;594-603. doi:10.1093/jnci/djh103
van Eerd EAM, van der Meer RM, van Schayck OCP, Kotz D. Smoking cessation for people with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2016;(8): CD010744. doi:10.1002/14651858.CD010744.pub2
Benson F, Nierkens V, Stronks K, Willemsen M. Effects of different types of smoking cessation behavioral therapy in disadvantaged areas in the Netherlands: an observational study. Tob. Prev. Cessation. 2016;2(14). doi:10.18332/tpc/61616
Aumann I, Tedja L, von der Schulenburg JM. Experiences of COPD patients with existing smoking cessation programs and their preferences for improvement - a qualitative analysis. Tob Induc Dis. 2016;14(31). doi:10.1186/s12971-016-0097-4
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