SAN FRANCISCO -- Smokers with chronic obstructive pulmonary disease are more likely to kick the habit with the help of sustained-release bupropion, Dr. Donald P. Tashkin reported at the annual meeting of the American College of Chest Physicians.
Women, heavier smokers, and patients with moderate, rather than mild, COPD got the greatest benefit from treatment with sustained-release bupropion (Zyban) in a randomized, placebo-controlled study that included 411 patients, said Dr. Tashkin of the University of California, Los Angeles.
Previous data had established that Zyban was an effective first-line aid for smokers without COPD who were trying to quit, he noted.
All patients in the current study had mild (stage I) or moderate (stage II) COPD diagnosed by spirometry and were randomized to 12 weeks of treatment with Zyban (206 patients) or placebo (205 patients) and followed for 26 weeks. Patients in both treatment arms had smoked 25-2 6 years and made more than three attempts to quit, on average.
Patient diaries and tests of exhaled carbon dioxide at clinic visits showed that patients using Zyban were more likely to abstain from smoking. At 4 weeks, 32% in the Zyban group and 18% in the placebo group were abstinent, rates that fell by week 26 to 16% of patients in the Zyban group and 9% on placebo, Dr. Tashkin said.
Patients with mild COPD found it easier to quit than did patients with moderate COPD-quir rates were higher for patients with stage I disease in both the Zyban and placebo groups, compared with patients with stage II COPD. Among smokers with stage I COPD, 29% on Zyban and 18% on placebo achieved abstinence. Quit rates were 19% and 7%, respectively, for patients with stage II COPD.
Zyban proved to be more helpful for patients with stage II COPD, increasing the odds of abstinence more than threefold if they took Zyban rather than placebo. Among patients with stage I COPD, Zyban doubled the odds of abstinence, compared with the placebo group, Dr. Tashkin reported.
The difference in abstinence rates between Zyban and placebo was greater for women with COPD than for men. The drug nearly tripled the odds of quitting for women and doubled the odds of quitting for men.
Heavier smokers (those with more than a 30-pack-year history of smoking) were more than twice as likely to quit using Zyban, compared with placebo, and lighter smokers improved their chances of quitting by an odds ratio of 1.5 using Zyban instead of placebo.
An equal proportion of patients in each group discontinued treatment: 14 with Zyban and 13 with placebo. Patients on placebo had more craving for cigarettes and more withdrawal symptoms such as anger, anxiety, sadness, and difficulty concentrating.
Age (older or younger than 60 years) did not affect abstinence rates, Dr. Tashkin said.
Rates of insomnia were higher in the Zyban group in the first few weeks but then leveled off, Dr. Tashkin said. Overall, insomnia affected 25% of patients on Zyban and 13% of patients on placebo but rarely caused discontinuation of treatment.
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