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Two New Studies Suggest an Intensive Disease Management Approach to Smoking Cessation

This study also is the subject of an American College of Physicians video news story

Philadelphia, April 7, 2009 -- According to two new studies being published in the April 7 issue of Annals of Internal Medicine, physicians should treat smoking as a chronic disease if they want to help their patients quit successfully. Patients may require repeated or intensive interventions that include pharmacotherapy and counseling, as well as continued dialogue with their physicians.

In the first study, researchers studied 750 primary care patients who smoked at least 10 cigarettes a day to determine which interventions worked best to help them quit. Participants were randomly assigned to pharmacotherapy (nicotine patch or bupropion), pharmacotherapy supplemented with up to two calls from trained counselors, or pharmacotherapy supplemented with up to six counseling calls. During the two-year study, patients in the high-intensity counseling group were the most successful.

“These studies show the importance of taking a disease management approach to smoking cessation,” said Edward Ellerbeck, M.D., Associate Professor and Chair of the Department of Preventive Medicine and Public Health at the University of Kansas, and lead author of the study. “We found that smokers are willing to make repeated medically-assisted attempts at quitting smoking, resulting in progressively greater smoking abstinence. Physicians should talk to their patients continually about quitting, and should facilitate access to a smoking cessation medication.”

In the second study, researchers studied 127 smokers with chronic conditions such as cardiovascular disease or COPD. The smokers were randomly assigned to receive a nicotine patch for 10 weeks (standard treatment) or a combination of a nicotine patch, a nicotine oral inhaler, and bupropion (combination treatment) for as long as required. At about six months, the patients in the combination therapy group had a success rate of approximately 35 percent. The nicotine patch group achieved a 19 percent success rate.

“Medically ill smokers are often highly addicted and at great risk for complications from continued smoking,” said Michael B. Steinberg, M.D., M.P.H., Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, and lead study author. “Our trial demonstrates that intensive treatment with a triple combination of medications could work well for them.”

Both studies suggest that continued, intensive interventions could be the key to helping patients quit successfully, even if they’ve tried to stop unsuccessfully in the past.

Annals of Internal Medicine is one of the five most widely cited peer-reviewed medical journals in the world. The journal has been published for 82 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians, the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.

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