Smoking cessation for chronic obstructive pulmonary disease

  • Review
  • Intervention

Authors


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.

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