Pharmacological interventions alone for smoking cessation
In this section:
- For GRADE evaluation of interventions for COPD, see table.
- Combined psychosocial and pharmacological interventions for smoking cessation can slow the deterioration of lung function, but have not been shown to reduce long-term mortality compared with usual care.
- We found no direct information from RCTs about the effects of pharmacological interventions alone for smoking cessation in people with COPD.
Benefits and harms
Pharmacological interventions alone for smoking cessation:
We found one systematic review (search date 2002). It found no RCTs examining the effects of pharmacological smoking cessation interventions alone for the outcomes of interest in this review (FEV1, peak expiratory flow, exacerbations, dyspnoea score, quality of life, or survival) specifically in people with COPD. The review identified two RCTs, both of which examined pharmacological interventions plus psychosocial interventions (see option on psychosocial plus pharmacological interventions).
Further information on studies
One systematic review (search date 2001, 157 studies) assessed the effectiveness of bupropion and nicotine replacement treatment for smoking cessation, but did not focus solely on people with COPD. It found a low incidence of adverse events with nicotine replacement therapy, irrespective of the type of replacement. The most common adverse effects were localised reactions: skin sensitivity and irritation (with patches); throat irritation, nasal irritation, and runny nose (with nasal spray); hiccups, burning and smarting sensation in the mouth, sore throat, coughing, dry lips, and mouth ulcers (with nicotine sublingual tablets); and hiccups, gastrointestinal disturbances, jaw pain, and orodental problems (with nicotine gum). Sleep disturbances and alteration of mood may arise because of nicotine withdrawal. A small number of studies were done in specific subgroups (including smokers with lung disease). Results for individual subgroups were generally non-significant, but their direction was consistent with the overall pooled results. The systematic review did not report results separately in people with COPD. Regarding the safety of bupropion, the review concluded that seizure is the most significant and important potential adverse effect. However, this review did not identify RCTs that reported any seizures. Common adverse events of bupropion are: rash, pruritus, urticaria, irritability, insomnia, dry mouth, headache, and tremor. The adverse-effect profile of slow-release bupropion seems better than that of immediate-release bupropion. The results for specific subgroups (including smokers with pulmonary disease) were generally consistent with the overall pooled results, although results in people with COPD were not reported separately.
Drug safety alert
A drug safety alert has been issued on the risk of serious neuropsychiatric symptoms, which include changes in behaviour, hostility, agitation, depressed mood, suicidal thoughts and behaviour, and attempted suicide, associated with bupropion (www.fda.gov).