Smoking cessation is the most important intervention in chronic
obstructive pulmonary disease (COPD) and delivery of smoking cessation
should be an integral part of pulmonary departments. It is generally not
integrated into European healthcare systems, although some countries are
now making a start. Regarding smoking cessation, nicotine replacement
therapy (NRT) and bupropion sustained release (SR) enhance cessation
outcomes. However, cessation counselling and behavioural strategies are
important adjuncts for maintaining long-term smoking cessation. The
relative effect of NRT is a doubling of the long-term success rate.
Nicotine gum, patch, mouth tablets and inhaler are first-line drugs,
whereas nicotine nasal spray is suitable for more heavily dependent
smokers. The patch might not be the first choice for heavily dependent
smokers and, at the very least, higher patch doses should be used. The
duration of NRT treatment is similar to 6-12 weeks with individual
variations up to 1 yr. Combination therapy with NRT and bupropion SR
should be used in COPD smokers, as many are hard-core smokers and a
repeated smoking cessation course every 34 months is indicated.
Physicians have to realise that nicotine addiction is a chronic
condition that needs a long-term management with interventions that are
extremely cost-effective but underused. A much more aggressive smoking
cessation approach should be offered to COPD.
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