Pharmacological strategies for smoking cessation in patients with chronic obstructive pulmonary disease: a pragmatic review

ABSTRACT

Introduction: Chronic obstructive pulmonary disease (COPD) is progressive inflammatory disease of the lungs in which smoking plays a significant pathogenic role. Smoking cessation is the only therapeutic intervention which was demonstrated to interfere with disease progression. Smoking cessation intervention can benefit from pharmacological therapies such as nicotine replacement therapies, bupropion, or varenicline which can be given individually or in combination, their effectiveness being demonstrated in various clinical trials enrolling COPD patients.

Areas covered: The authors provide a pragmatic discussion of the clinical data of the main studies evaluating therapies for smoking cessation within COPD starting with the seminal Lung Health Study and continuing with more recent ones.

Expert opinion: Smoking cessation is one of the most difficult therapeutic interventions in COPD, despite having the highest impact on disease progression and despite the demonstrated benefit of the discussed pharmacological therapies. Potential approaches to maximize its chance of success might be represented by prolonging the time of administration, combinational options, or sequential pharmacotherapy.

KEYWORDS:

• COPD-smoking cessation-tobacco-nicotine replacement therapies-bupropion-varenicline-smoking cessation

Article Highlights

• In COPD smoking is recognized as the main risk factor

• COPD patients who are current smokers are recognized as a high-risk difficult to treat population as far as smoking cessation is concerned and this can be due to longer and bigger smoking exposure, reduced motivation to quit, etc.

• Pharmacotherapy of smoking cessation for COPD patients commonly relies on the same so-called first-line medications such as those used in the general population: NRT, varenicline, and bupropion which proved this efficacy in this setting too.

• Varenicline and combined NRT (regular patch and on-demand gum) represents the most effective ‘intensive’ pharmacological intervention for smoking cessation

• Other combinations given on sequential basis or concomitantly might be also able to induce a sustained abstinence, but further studies evaluating them are needed in COPD patients

This box summarizes key points contained in the article.

Declaration of interest

S Antoniu has received congress fees from Chiesi Farmaceutici and Angellini. A Trofor has received congress and speaker fees from Chiesi, AstraZeneca and Boehringer Ingelheim. RC Dabija has received speaker fees from Boehringer Ingelheim, Chiesi, AstraZeneca and Roche and congress fees from AstraZeneca and Boehringer Ingelheim. Meanwhile. F Mihaltan has received congress and speaker fees from Boehringer Ingelheim, Chiesi, AstraZeneca and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.