Adherence and Efficacy of Smoking Cessation Treatment Among Patients with COPD in China

Abstract

Background

Smoking cessation is a key intervention for all smokers with chronic obstructive pulmonary disease (COPD). Poor treatment adherence is a challenge in clinical practice that might contribute to the lower efficacy of medication (eg, oral drug). However, it is unclear what factors will influence adherence among smokers with COPD.

Methods

This study was based on an open-label randomized controlled trial (RCT) of varenicline and bupropion for smoking cessation among patients with COPD in China. The medication was given for 12 weeks, and visits and assessments were conducted at weeks 0, 1, 2, 4, 6, 9, 12, and 24. We assessed whether the adherence to smoking cessation treatment affects the smoking cessation efficacy and evaluated predictors of adherence.

Results

A total of 136 participants were recruited from February 2019 to June 2020, and analyzed using the intention-to-treat (ITT) method. In this study, 48.5% (66/136) of the total participants had good adherence to smoking cessation, and good adherence significantly improved the efficacy of smoking cessation (OR=9.60, 95% CI 4.02–22.96, P < 0.001). After adjusting for age, gender, nationality, education, and marital status, we found older age, higher education level, having more previous quitting attempts, stronger self-efficacy and preparation in quitting smoking, recognizing hazards of smoking, longer duration of COPD, and higher St. George’s Respiratory Questionnaire (SGRQ) scores were relevant to good adherence (P < 0.05).

Conclusion

To our best knowledge, this is the first study to evaluate adherence to smoking cessation treatment among patients with COPD in China. Our study found that good adherence to smoking cessation treatment significantly improved the smoking cessation efficacy, and predictors of adherence were evaluated. We call on the medical community to pay attention to the adherence to smoking cessation among patients with COPD.

Keywords:

• COPD
• smoking cessation
• adherence
• China

Abbreviations

COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; RCT, randomized controlled trial; FEV1, forced expiratory volume in 1s; FVC, forced vital capacity; SGRQ, St. George’s Respiratory Questionnaire; ECO, Exhaled carbon monoxide; FTND, Fagerstrom Test for Nicotine Dependence; OR, odds ratio; CI, confidence interval.

Data Sharing Statement

The data analyzed in the current study are not publicly available but may be available from the corresponding author Dr Xiao upon reasonable request.

Acknowledgment

We thank all the patients for their participation in this study.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the Capital Health Development Research Project in China (Grant No. 2018-2-4066), the National Natural Science Foundation of China (Grant No. 81720108001) and the National Key R&D Program of China (Grant No. 2017YFC1309400).