Smoking cessation for chronic obstructive pulmonary disease

 

Abstract

Background

Smoking cessation is the most important treatment for smokers with chronic obstructive pulmonary disease (COPD), but little is known about the effectiveness of different smoking cessation interventions for this particular group of patients.

Objectives

To determine the effectiveness of smoking cessation interventions in people with COPD.

Search methods

Electronic searches were undertaken on MEDLINE (from 1966 to March 2002), EMBASE (from 1989 to March 2002) and Psyclit (from 1971 to March 2002), and CENTRAL (Issue 1, 2002). Searches were current as of October 2003.

Selection criteria

Randomised controlled trials in which smoking cessation was assessed in participants with confirmed COPD.

Data collection and analysis

Two authors extracted the data and performed the methodological quality assessment independently for each study, with disagreements resolved by consensus. High-quality was defined, based on pre-set criteria according to the DelphiList.

Main results

Five studies were included in this systematic review, two of which were of high-quality. The high-quality studies show the effectiveness of psychosocial interventions combined with pharmacological intervention compared to no treatment: psychosocial interventions combined with nicotine replacement therapy (NRT) and a bronchodilator versus no treatment at a 5 year follow-up (RD = 0.16, 95% CI 0.14 to 0.18), (RR = 4.0, 95% CI 3.25 to 4.93), psychosocial interventions combined with NRT and placebo versus no treatment at a 5 year follow-up (RD = 0.17, 95% CI 0.14 to 0.19), (RR = 4.19, 95% CI 3.41 to 5.15). Furthermore the results show the effectiveness of various combinations of psychosocial and pharmacological interventions at a 6 months follow-up (RD = 0.07, 95% CI 0.0 to 0.13), (RR = 1.74, 95% CI 1.01 to 3.0). Unfortunately, none of the included studies compared psychosocial interventions with no treatment. Therefore we found no evidence with regard to the effectiveness of these interventions. An update search in October 2003 did not identify any new studies for inclusion in the review.

Authors' conclusions

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.

 

Plain language summary

Psychosocial interventions to help people with chronic bronchitis and emphysema to quit smoking.

Smoking cessation is the most important treatment for smokers with chronic bronchitis and emphysema. Smoking cessation interventions can be divided into psychosocial interventions (e.g. counselling, self-help materials, and behavioral therapy) and pharmacotherapy (e.g. nicotine replacement therapy, bupropion). Although a lot of research has been done on the effectiveness of interventions for "healthy" smokers, the effectiveness of smoking cessation interventions for smokers with chronic bronchitis and emphysema has so far gained far less attention. However, there is some evidence that combining psychosocial intervention with pharmacotherapy could be effective for this group of smokers trying to quit smoking. More research is needed to determine what kinds of interventions are most effective for which kind of patient.

 

摘要

背景

戒菸於慢性阻塞性肺病

戒菸是抽菸的慢性阻塞性肺病()患者最重要的治療，但對為這類病人所設計不同的戒菸介入措施之效果卻所知不多。

目標

確認戒菸措施對患者的效應。

搜尋策略

於(自年至年月)、(自年至年月)、(自年至年月)及(年第一期)執行電子搜尋。目前搜尋至年月。

選擇標準

以確認為患者為參與者評估戒菸之隨機對照試驗。

資料收集與分析

兩名作者獨立地摘錄數據及評估方法學品質，不同意見則以共識解決。高品質是依的預設標準來定義。

主要結論

有五項研究納入本項系統性回顧，其中兩項屬高品質。在高品質研究之心理學介入合併藥理學介入在與沒有治療相較下顯出效益：心理學介入合併尼古丁替換治療()及一種支氣管擴張劑與沒有治療相較，在追蹤年時；95% CI 0.14至 0.18 ， RR = 4.0 ； 95% CI 3.25至 4.93。心理學介入合併尼古丁替換治療(NRT)及安慰劑與沒有治療相較，在追蹤 5年時 RD = 0.17； 95% CI 0.14至 0.19， RR = 4.19； 95% CI 3.41至 5.15。此外，不同組合的心理學及藥理學介入在追蹤 6個月時的效果為 RD = 0.07； 95% CI 0.0至 0.13， RR = 1.74； 95% CI 1.01至 3.0。然而，沒有納入的研究比較心理學介入與沒有治療。因此，我們沒有找到這些介入各自效益的證據。在 2003年 10月的更新搜尋未找到新的研究以納入回顧。

作者結論

基於本系統性回顧，作者發現的證據顯示，合併心理學介入與藥理學介入優於沒有治療或單獨心理學介入。此外，由於高品質的研究數目不足，我們結論沒有清楚或具說服性的證據顯示任何心理學介入對患者具有效益。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan)統籌。

總結

心理學介入合併藥理學介入有助於抽菸的慢性支氣管炎及肺氣腫患者戒菸。戒菸是抽菸的慢性支氣管炎及肺氣腫患者最重要的治療抽菸的介入分為心理學介入(如諮商、自助物品及行為治療)及藥物治療(如尼古丁替換治療、 bupropion)。雖然已有很多研究探討「健康」抽菸者介入措施的效果，但對抽菸的慢性支氣管炎及肺氣腫患者的戒菸介入措施的效果至今受到的注意仍較少。然而，有一些證據顯示合併心理學介入與藥理學介入對此一族群的嘗試戒菸者是有效益的。需要有更多的研究來確認那些介入對那類病人最為有效。