Combined behavioural and drug treatments can help people living with chronic obstructive pulmonary disease quit smoking

Wei X, Guo K, Shang X, et al. Effects of different interventions on smoking cessation in chronic obstructive pulmonary disease patients: A systematic review and network meta-analysis Int J Nurse Stud. 2022; 136:104362.

Review question

Do behavioural and/or drug treatments help people living with chronic obstructive pulmonary disease (COPD) quit smoking?

Background

Smoking tobacco is the cause of nine out of ten deaths related to COPD. Quitting smoking can help to reduce deaths and improve health and quality of life. Drug and behavioural treatments are common strategies used to help people quit smoking. However, there have been limited studies on the effectiveness of these treatments in people living with COPD.

How the review was done

This is a systematic review and network meta-analysis of 23 randomized controlled trials. The studies were published between 1991and 2021 and included 13,480 participants.

Key features of the studies included:

• Participants were smokers living with COPD who were generally over the age of 50.
• Study participants received drug treatments (such as nicotine replacement therapy [NRT], bupropion, nortriptyline, and varenicline), behavioural treatments (such as education, cognitive behaviour therapy (CBT), and counseling), or a combination of both.
• For the most part, participants received drug treatments for 12 weeks and behavioural treatments for more than 6 months.
• Researchers measured how many participants quit smoking at the end of the treatment, as well as any side effects reported.
• Results were compared to control groups who received usual care only or a placebo.

What the researchers found

Compared to usual care or placebo, most behavioural treatments alone and drug treatments alone may help people living with COPD quit smoking. However, the combination of a behavioural intervention with a drug treatment was more effective than individual treatments. More specifically, the combination of CBT and bupropion was most effective, followed closely by counseling plus varenicline. Studies that did report on safety noted that drug treatments, including varenicline, bupropion, and nicotine replacement therapy, may come with side effects such as insomnia, dry mouth, and cardiac-related issues.

Given that most of the included studies were of low or unclear quality, more high-quality research is needed to be certain of these results.

Conclusion

The combination of behavioural and drug treatments, such as CBT and bupropion, may be an effective strategy for helping people living with COPD quit smoking.