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Varenicline is an orally administered small molecule with partial agonist activity at the alpha4beta2 nicotinic acetylcholine receptor. Varenicline was approved by both the US FDA and the European Medicines Agency of the EU in 2006 as an aid to smoking cessation. Subsequently, varenicline has been approved in over 80 other countries. Varenicline is almost entirely absorbed following oral administration, and absorption is unaffected by food, smoking or the time of day. Varenicline undergoes only minimal metabolism and approximately 90% of the drug is excreted in the urine unchanged. Varenicline has a mean elimination half-life after repeated administration of approximately 24 hours in smokers. The area under the plasma concentration-time curve is increased in patients with moderate or severe renal failure. No clinically relevant varenicline-drug interactions have been identified. In two identical, randomized, double-blind, phase III clinical trials in healthy, motivated-to-quit, mainly Caucasian smokers aged 18-75 years in the US, 12 weeks of treatment with varenicline 1 mg twice daily was associated with significantly higher abstinence rates over weeks 9-12 than sustained-release bupropion 150 mg twice daily or placebo. In a separate phase III trial, an additional 12 weeks of treatment in smokers achieving abstinence in the first 12 weeks was associated with greater abstinence through to week 52 than placebo treatment. Varenicline treatment was also associated with significantly higher rates of abstinence than placebo treatment in randomized, double-blind, clinical trials in smokers in China, Japan, Korea, Singapore, Taiwan and Thailand. In a randomized, open-label, multi-national, phase III trial, varenicline treatment was associated with a significantly higher rate of abstinence than transdermal nicotine-replacement therapy. In these trials, varenicline treatment was associated with lower urge to smoke and satisfaction from smoking in relapsers than placebo or active comparators. In the two US phase III trials, 12 weeks of treatment with varenicline 1 mg twice daily had an acceptable safety and tolerability profile. Nausea and abnormal dreams were the most common adverse events that occurred in more varenicline than placebo recipients. The incidence and prevalence of nausea were greatest in weeks 1 and 2 of treatment, and declined thereafter. The prevalence of early adverse effects can be reduced by individual dose titration. Adverse events associated with varenicline therapy have been reported in post-marketing surveillance, including neuropsychiatric events such as depressed mood, agitation, changes in behaviour, suicidal ideation and suicide. Currently, it is unclear whether the association of varenicline therapy with these adverse events is causal, coincidental or related to smoking cessation. Given the greater efficacy of varenicline compared with other pharmacotherapies, and the high risk of morbidity and mortality associated with continued smoking, varenicline is a valuable pharmacological aid to smoking cessation. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the differences in smoking characteristics between a group of smokers with COPD and another group of healthy smokers, both of which were identified in a population-based epidemiologic study.Design and Participants: This is an epidemiologic, multicenter, population-based study conducted in seven areas of SPAIN: A total of 4,035 individuals, men and women aged 40 to 69 years, who were selected randomly from a target population of 236,412 subjects, participated in the study.Interventions: Eligible subjects answered the European Commission for Steel and Coal questionnaire. Spirometry was performed followed by a bronchodilator test when bronchial obstruction was present. The Fagerström questionnaire was used for study of the degree of physical nicotine dependence, and the Prochazka model was followed for analysis of the smoking cessation phase.Results: Of 1,023 active smokers, 153 (15%) met the criteria for COPD. Smokers with COPD were more frequently men (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.21 to 3.95), were > or = 46 years of age (OR, 1.97; 95% CI, 1.18 to 3.31), had a lower educational level (OR, 1.96; 95% CI, 1.23 to 3.14), and had smoked > 30 pack-years (OR, 3.70; 95% CI, 2.42 to 5.65). Smokers with COPD showed a higher dependence on nicotine than healthy smokers (mean [+/- SD] Fagerström test score, 4.77 +/- 2.45 vs 3.15 +/- 2.38, respectively; p < 0.001) and higher concentrations of CO in exhaled air (mean concentration, 19.7 +/- 16.3 vs 15.4 +/- 12.1 ppm, respectively; p < 0.0001). Thirty-four percent of smokers with COPD and 38.5% of smokers without COPD had never tried to stop smoking.Conclusions: Smokers with COPD have higher tobacco consumption, higher dependence on nicotine, and higher concentrations of CO in exhaled air, suggesting a different pattern of cigarette smoking. Cases of COPD among smokers predominate in men and in individuals with lower educational levels. A significant proportion of smokers have never tried to stop smoking; thus, advice on cessation should be reinforced in both groups of smokers. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain the prevalence, diagnostic level, and treatment of COPD in Spain through a multicenter study comprising seven different geographic areas.Design and Participants: This is an epidemiologic, multicenter, population-based study conducted in seven areas of Spain. A total of 4,035 men and women (age range, 40 to 69 years) who were randomly selected from a target population of 236,412 subjects participated in the study.Interventions: Eligible subjects answered the European Commission for Steel and Coal questionnaire. Spirometry was performed, followed by a bronchodilator test when bronchial obstruction was present.Results: The prevalence of COPD was 9.1% (95% confidence interval [CI], 8.1 to 10.2%), 15% in smokers (95% CI, 12.8 to 17.1%), 12.8% in ex-smokers (95% CI, 10.7 to 14.8%), and 4.1% in nonsmokers (95% CI, 3.3 to 5.1%). The prevalence in men was 14.3% (95% CI, 12.8 to 15. 9%) and 3.9% in women (95% CI, 3.1 to 4.8%). Marked differences were observed between sexes in smoking; the percentage of nonsmokers was 23% in men and 76.3% in women (p<0.0001). The prevalence of COPD varied among the areas, ranging from 4.9% (95% CI, 3.2 to 7.0%) in the area of the lowest prevalence to 18% (95% CI, 14.8 to 21.2%) in the area of the highest. There was no previous diagnosis of COPD in 78.2% of cases (284 of 363). Only 49.3% of patients with severe COPD, 11.8% of patients with moderate COPD, and 10% of patients with mild COPD were receiving some kind of treatment for COPD. Multivariate analysis showed that individuals had a higher probability of having received a previous diagnosis of COPD if they lived in urban areas, were of male gender, were > 60 years old, had higher educational levels, had > 15 pack-year smoking history, or had symptoms of chronic bronchitis.Conclusions: COPD is a very frequent disease in Spain, and presents significant geographic variations and a very low level of previous diagnosis and treatment, even in the most advanced cases. [ABSTRACT FROM AUTHOR]

Fundamento: El tabaquismo es el principal factor de riesgo en salud pública y una de las causas que ocasionan una mayor carga económica para la sociedad. El presente trabajo tiene por objeto conocer los resultados de un programa de deshabituación tabáquica en el medio laboral. Métodos: Se diseñó un programa con dos fases. La primera consistió en la realización de una encuesta para conocer la prevalencia y actitudes respecto al tabaco de los trabajadores del Ayuntamiento de Salamanca. La segunda en un programa de tratamiento especializado destinado a todos los trabajadores que deseasen dejar de fumar Resultados: Respondieron a la encuesta 384 trabajadores, de los cuales 135 (35,1%) eran fumadores. El 80,5% de estos (n = 113) deseaban dejar el tabaco y recibir ayuda médica para lograrlo. Iniciaron el programa de tratamiento 73 trabajadores. Al año de tratamiento se observó una tasa de abandono del tabaco del 41% de los trabajadores que lo iniciaron. El nivel de satisfacción de los trabajadores con el programa fue de una media de 2,9 sobre 3.

The aim of this study was to evaluate stages of self-change in smoking behavior in a group of young people. From May 1999 to October 2002, successive surveys were made, consisting of an anonymous, personal, and voluntary questionnaire that was distributed among enlisted personnel at military bases in Burgos and Madrid, Spain. The survey contained questions about personal data, characteristics of their smoking habit, reasons to stop smoking, and attempts to stop smoking. A descriptive statistical study was made 195% confidence interval). The questionnaire was given to 1,886 young people, of which 28 (1.48%) did not answer and 578 (31.10%) were women. The average age (+/- SD) of the subjects in the group was 21.6 +/- 2.91 years. Six hundred eighty-one (36.65%) were smokers, 479 men (37.42% of all men) and 202 women (34.94% of all women), and 82 (4.4%) were ex-smokers. Fourteen persons surveyed stated that they were nonsmokers but had stopped smoking less than a year earlier. Of the smokers, 300 (44.05%) were at the stage of precontemplation of smoking cessation and 295 (43.31%) were at the contemplation stage. Eighty-six (12.62%) of the smokers stated that they would be willing to stop smoking in the next 30 days (preparation stage). At the time that they completed the survey, 14 subjects were in the action stage. Forty-four percent (43.70%) had previously tried to stop smoking (p < 0.01) and had achieved abstinence for a mean (+/- SD) of 2.52 +/- 2.17 months. We found no significant differences between sexes. The relative distribution of stages of self-change in the smoking behavior of young smokers in this group did not differ from that found in developed countries around Spain. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about adult asthma patients' perspective of their disease burden. This study aimed to obtain a comprehensive picture of patient needs, evaluate their knowledge, source of information, and perception of the severity of their asthma, and compare these variables between severe (SA) and non-severe (NSA) asthma patients., Methods: We conducted an online cross-sectional survey in Spain among asthma patients aged ≥18 years. A bespoke questionnaire was used to collect sociodemographic data, asthma characteristics, treatments, disease burden, patient's perception of disease severity, and asthma information sources. Patients were classified as SA and NSA according to GINA 2020 treatment steps recommendations. To compare populations, 600 participants (200 SA and 400 NSA) were randomly selected to complete the survey., Results: Participants were mostly women, mean age >38 years. SA patients underestimated the severity of their asthma; 52% judged it as mild, and only 2% considered their asthma severe. Overall, 50% of NSA and 96% of SA patients had experienced ≥1 exacerbation the previous year (p < 0.001). Fewer asthma exacerbations (SA) and improved quality of life (QoL) (NSA) were the most frequently expected therapy outcomes. NSA patients believe that asthma impacts their daily life (37%) and worsens QoL (34%) to a lesser degree than SA (67% and 59%, respectively; p < 0.001). Patient-preferred sources of information were specialists (NSA:42%; SA: 38%) and primary care physicians (NSA: 41%; SA: 33%)., Conclusions: Despite the effective therapies currently available, the results of this study still show a significant emotional burden and QoL impairment in patients with severe asthma., (© 2021 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Background: Smoking is considered an epidemic, indeed, one of the most important public health problems worldwide. It is also the most significant preventable cause of death, of a high number of premature deaths, and avoidable chronic diseases. It is considered an enormous economic burden for the world., Objective: To provide an overview of smoking-cessation treatments, including pharmacological and psychological options, and to gather current scientific evidence available on them., Methods: Research included reviewing publications from 2007-2018 in four databases using algorithms related to bupropion, varenicline, nicotine replacement therapy, smoking cessation, psychological treatment, motivational interview, cognitive-behavioral therapy and clinical guidelines for smoking treatment. Meta-analyses or systematic reviews and randomized or quasi-randomized trials were selected. We also included clinical guidelines for smoking treatment from Mexico and other countries., Results: After refining the search, 37 articles met the criteria and were included in the review. The results were grouped by type of intervention., Conclusions: It is necessary to conduct research on combinations of both kinds of treatment with an integral, multidisciplinary vision. Current standard for smoking cessation is a combined psychological and pharmacological treatment., (Copyright: © 2019 SecretarÍa de Salud.)

Objectives: The aim of this study was to perform a bibliometric analysis of EPI-SCAN and IBERPOC studies using the Science Citation Index and Scopus databases, and to determine the overall impact with the impact of smoking on IBERPOC as a secondary objective., Method: A general searching was conducted in Science Citation Index-Expanded through the Web of Science (WoS) (Thomson Reuters) platform and Scopus on 23 March 2015. The search strategy included the terms "iberpoc" OR "episcan" was performed on 15 October 2015., Results: A total of 24 publications were obtained; 13 from IBERPOC study (9 on "COPD" and 4 for "tobacco"), with 11 from the EPI-SCAN (All COPD) study. A total of 841 WoS citations were obtained (445 IBERPOC [99 of tobacco]), and 1,442 from Scopus (963 IBERPOC [144 tobacco]). The theme "tobacco" contributed with 22.24% and 14.95% of total citations in WoS and Scopus, respectively to the IBERPOC study. It was found that Scopus citations were newer, and a similar impact from both WoS studies was detected, although the IBERPOC impact was greater in Scopus. Collaborative networks of institutions and authors of both studies were identified., Conclusions: There is an important productivity and impact of both studies. Scopus citations are newer than those in WoS. The "tobacco" variable added IBERPOC impact and visibility. There was high density, accessibility, and cohesion in collaborative networks of both studies., (Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

This study aimed to gain insight into the impact of lung conditions on smoking behaviour and smoking cessation, and identify recommendations for smoking cessation and professional-patient communications. The study was led by the European Lung Foundation in collaboration with the European Respiratory Society Task Force on "Statement on smoking cessation on COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit". A web-based observational cross-sectional questionnaire was developed from a patient-centered literature review. Topics covered were: cohort characteristics; perspectives on smoking cessation; interactions with healthcare professionals; and recommendations to improve cessation outcomes. The questionnaire was disseminated via existing patient and professional networks and social media channels. The survey was available online for a period of 4 months in 16 languages. The data were analysed as a whole, not by country, with thematic analysis of the open responses. Common characteristics were: male (54%); age 40-55 years (39%); 11-20 cigarettes a day (39%); smokes within 30 min of waking (61%); and has made 1-5 cessation attempts in the previous 12 months (54%). 59% had tried cessation treatments, but, of these, 55% had not found any treatments helpful. Recommendations were: earlier intervention; discussion of the patient's smoking beliefs, behaviours and motivation; giving constructive advice; understanding addiction; informed decision-making; and treatment options. Areas for new and further research have been highlighted through exploring the smoking cessation perspectives and recommendations of people with lung conditions in Europe who smoke., Competing Interests: M. Fletcher was European Lung Foundation chair at the time of the study. S. Masefield and P. Powell are employees of the European Lung Foundation. Further disclosures can be found alongside this article at openres.ersjournals.com

Background: To explore whether exposure to secondhand smoke (SHS) among non-smokers in the European Union (EU) showed any association with sociodemographic factors and/or the extent of national tobacco control policies., Methods: A secondary analysis was performed on data from 26 751 individuals ≥15 years old from 27 EU member states (EU MS), collected during the 2012 Special Eurobarometer survey (wave 77.1). Respondents were asked whether they had been exposed to SHS in eating or drinking establishments during the past 6 months, and/or in their workplace. Data on smoke-free policies were extracted from the European Tobacco Control Status Report and the European Tobacco Control Scale (TCS) in 2013., Results: In total, 29.0% of non-smoking participants reported being exposed to SHS in indoor areas. Males (vs. females) as well as individuals with difficulties to pay bills (vs. those with no difficulties), had significantly greater odds of being exposed to SHS in bars, restaurants and workplaces. For every unit increase of a country's score on the Smoke-free Component of the TCS (indicating greater adherence to smoke-free legislations) the odds ratio of reporting exposure to SHS was 0.82 in bars, 0.85 in restaurants and 0.94 in workplaces., Conclusions: Differences in exposure to SHS clearly exist between and within EU MS, despite the fact that they all have signed the Framework Convention on Tobacco Control, with the burden found to disproportionally affect younger people and individuals with financial difficulties. Moreover, enforcement of smoke-free legislation was inversely associated with SHS exposure, highlighting the importance of enforcing comprehensive smoking bans., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Smoking cessation is the only therapeutic intervention that can prevent COPD smokers from the chronic progression of their disorder. The most important intervention for helping these smokers to quit is a combination of counseling plus pharmacological treatment. The characteristics of the counseling should be different depending if this intervention is offered to smokers with a previous diagnosis of COPD or if the intervention is offered to smokers who have been recently diagnoses with COPD. The counseling of patients who have been recently diagnosed should include: a) explanation of the direct relationship between smoking and COPD, b) encouraging these patients to quit and c) using of spirometry and measurements of CO as a motivational tools. The counseling of patients who have been previously diagnosed should include: a) encouragement to make a serious quit attempt, b) an intervention that increases motivation, self-efficacy and self-esteem, c) and the intervention should also control depression and be directed to weight gain control.

Because stopping smoking is such a pressing necessity for COPD smokers physicians should use smoking cessation treatments aggressively. For optimal efficacy smoking cessation in COPD smokers should combine behavioral and pharmacological treatments. Three types of pharmacological treatments are proven to be safe and effective: Nicotine Replacement Therapy (NRT), Bupropion and Varenicline. Use of NRT, bupropion or varenicline, single or in combination, at standard doses or at high doses, for 8-12 weeks or for more than 6-12 months have proven to help these patients to quit. For optimizing efficacy these medications can also be introduced some weeks before actual quitting. In COPD smoking patients that are not interested in stopping completely or abruptly these medications can be used to aid cessation in a more gradual way. Pharmacotherapy to aid cessation in COPD smokers have proven to be highly cost effective.

Objective: A study is made to determine the prevalence of smoking and its variation over time in a group of Spanish military personnel (MP) under stressful conditions., Methods: A questionnaire specifically designed for this study was administered to the entire MP contingent assigned to Banghis province (Afghanistan) between July and October 2009. A descriptive analysis was made (p < 0.05, 95%CI)., Results: The study sample comprised 254 MP (males 239; mean age 32 years (SD 9)). A total of 39.8% (95%CI; 33.7 - 45.8) were smokers, while 3.1% (95%CI; 1.0 - 5.3%) were former smokers. Regarding smoking habit before and at the end of deployment, one-half (50.5%) of the smokers declared that they smoked the same as before, 20.8% more than before, and 18.8% less than before. In turn, 5.9% of the smokers claimed to have started to smoke in the course of deployment, while 4% of the former smokers declared that they had quit smoking. The MP who quit smoking were younger than those who began to smoke (24 +/- 5 vs 39 +/- 9 years, p = 0.038). Moreover, the heavy smokers (> or = 15 cigarettes/day) reduced tobacco consumption, while the less heavy smokers increased the habit (p < 0.0001)., Conclusions: The prevalence of daily smokers is high among MP. The majority of smokers smoke the same at the end of deployment. Those who quit smoking during the mission are significantly younger than those who begin to smoke. In turn, heavy smokers reduced their habit, while less heavy smokers increased smoking.

Background and Objective: This study estimates smoking-attributable mortality in Spain in 2006., Population and Method: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older., Results: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women., Conclusions: About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high., (Copyright © 2010. Published by Elsevier Espana.)

We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n = 4,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n = 3,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p<0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.

The Consensus on Health Assistance for Smoking Cessation in Spain, is a document reviewing the treatment evidence, as well as policy needs in relation to smoking cessation in Spain. It has been developed by technical representatives of public health administrations, at a national and autonomous level, together with representatives of the scientific societies and professional bodies which are members of the Spanish coalition on smoking prevention National Committee on Tobacco Prevention (CNPT). After approval of a new national tobacco control law 28/2005, several tobacco control policies are being developed, especially by the autonomous governments, including treatment policies. Within this framework, and as part of the requirements of the law, all parties have considered the need to review effectiveness, experimentally validated tobacco dependence treatments and practices. An initial draft written by an expert committee was presented to all parties and discussed at three meetings over a period of a year and a half. The initial draft did review primary and secondary scientific literature from 1987 to 2007 on efficacy and effectiveness of different smoking cessation interventions, including: medical advice and brief smoking cessation interventions; pharmacological aids for treating nicotine dependence; behavioral interventions; specialized intensive treatment; community interventions; and treatment for groups with special needs. Considering the available evidence; current treatment needs; policy gaps; and the criteria of risk, accessibility, efficiency, sustainability and equity; the consensus document recommends the minimal requirements which should be taken into account when developing a policy on smoking cessation in Spain.

Aim: Describe the smoking characteristics and the results of a smoking intervention programme involving 27 cigarette smokers with Thromboangiitis Obliterans (TAO)., Methods: Clinical records of all cigarette smokers with TAO that attended our smoking treatment clinic from 1990 to 2004 were reviewed. Demographic and smoking characteristics, the type of smoking treatment received and its efficacy and safety up to 12 months was abstracted. Treatment consisted of the combination of behavioural and pharmacological treatment. The behavioural treatment was delivered in eight individual visits: one baseline visit and seven follow-up visits. Pharmacological treatment consisted of combinations of nicotine patches and nicotine gum (NRT) and/or bupropion. This is an 'intent to treat' analysis. A descriptive analysis of the variables was performed. Qualitative variable relationships were tested using the chi-square test for independence, or Fisher's Exact Test when expected values were less than five. Statistical significance was accepted at a level of p < 0.05., Results: 27 cigarette smokers (23 male and 4 female), mean (SD) age 36.07 (7.23), mean FTND-score 8.4 (1.4), smoked a mean of 29.6 (7.71) cigarettes daily. They attended our clinic a mean of 45.48 (8.63) months after onset of TAO. Their mean number of attempts to stop was 3.22 (2.75). The continuous abstinence rate decreased from 29% at the end of treatment to 18.5% at 12-month follow up. The seven day point prevalence abstinence rate at the 12th month of follow up was 40.7%. We found that continuous abstinence at 6 and 12 months was more frequent among those with multiple previous stop attempts (p = 0.003 and p = 0.001, respectively). There were no significant differences in abstinence outcomes between groups. Incidence of adverse effects was similar to other smokers seeking treatment. All the smokers who achieved continuous tobacco abstinence had improvement in their disease and none of them underwent amputation, compared to 50% of those who resumed smoking and later required an amputation., Conclusions: Continuous abstinence rates among treated cigarette smokers with TAO are relatively low, but abstinence does improve symptoms and reduce the likelihood of amputation. More aggressive treatment programmes need to be developed for this high risk, highly tobacco dependent population.

This multicenter, community-based, prospective, longitudinal study evaluated the safety of nicotine replacement therapy (NRT), bupropion, and combined therapy of NRT and bupropion for smokers seeking to quit, when these therapies were used under real-world conditions following a smoking cessation program. Participants were smokers aged 18 years or older who attended five smoking cessation clinics. Evaluations were made at 15, 30, 60, and 90 days. We investigated the possible existence of adverse effects as well as the severity of each adverse effect and its influence on the treatment course. The study included 904 smokers: 370 received NRT, 413 received bupropion, and 121 received combined therapy. At 15, 30, 60, and 90 days, adverse effects were reported by 43.8%, 33.1%, 22.3%, and 5.7% of subjects, respectively. Adverse effects were significantly more frequent in subjects receiving combined therapy or bupropion alone than in NRT-treated subjects at the 15-, 30-, and 60-day follow-ups. A total of 83 smokers (9.3%) withdrew from treatment and 116 (12.8%) stopped temporarily because of adverse effects. No differences were found in the percentages of discontinuation among the different treatment options. Adverse effects rarely were severe (n=10). Nevertheless, 41 subjects (4.5%) discontinued drug therapy indefinitely and 55 (6.1%) discontinued it temporarily because of mild adverse effects. Pharmacological therapies for smoking cessation are safe as long as they are appropriately prescribed and supervised by clinicians according to clinical practice guidelines. Adverse effects are primarily mild. Nonetheless, mild adverse effects may be perceived by patients as a serious enough problem to cause them to discontinue treatment.

Background and Objective: The objective of the study was to evaluate the effectiveness of the pharmacological treatment of tobacco dependence according to the criteria established by SEPAR., Patients and Method: Longitudinal, prospective and multicentre study. We included smokers aged more than 18 years who attended 5 smokers clinics and received nicotine replacement therapy (NRT), bupropion or both. The punctual and continuous abstinence was studied at the 15, 30, 60, 90 and 180 days with each one of the proposed treatments. Effective results were defined as the intention to treat., Results: There were 904 smokers, 476 males and 428 females, mean age 42.51 (10.09). Of the 904 individuals who started the treatment, 820, 776, 687, 719 and 679 were present at the follow-up sessions at 15, 30, 60, 90 and 180 days, respectively. The punctual global abstinence at 15 and 180 days was 65.6% and 43.1%, while the continuous one was 57.4% and 38.8% at two and six months, respectively. Significant differences were not observed with regard to the punctual or continuous abstinence among patients treated with NRT, bupropion or both., Conclusions: The pharmacological treatment of tobacco dependence used individually according to the recommendations of the clinical guidelines allows to obtain good results with regard to the momentous and continuous abstinence. The effectiveness of the different first line treatments is similar in all the phases of the therapeutic process.

Between 15% and 20% of smokers develop chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine which characteristics of smoking, particularly the Fagerström Test for Nicotine Dependence (FTND) score, were associated with the risk of developing COPD. Data from the IBERPOC epidemiological study were analyzed. IBERPOC was a multicenter epidemiological study including 4035 individuals aged 40-69 years, 1023 (25%) of whom were active smokers. We analyzed the association between smoking characteristics--such as the cumulative consumption of tobacco, FTND score, and expired-air carbon monoxide levels--and the diagnosis of COPD. Among the smokers, 153 (15%) were diagnosed with COPD. A cumulative tobacco consumption of more than 30 pack-years (OR=4.24, 95% CI=2.83-6.36) and the FTND score (OR=1.11, 95% CI=1.02-1.21, for each point increase) were significantly associated with the diagnosis of COPD in the model obtained by logistic regression analysis with the full sample of smokers. Cumulative consumption of tobacco was associated with the diagnosis of COPD. For each point increase in the FTND score, the probability of a smoker developing COPD increased by 11%.

Objective: In the studies carried out to date, the cost of chronic obstructive pulmonary disease (COPD) may have been overestimated due to the inclusion of previously diagnosed patients seeking medical attention for their symptoms. As a result, the severity of the cases included in these studies may have been greater than in an unselected sample of the general population. The aim of the present study was to estimate the direct cost of COPD on the basis of a representative sample of the overall Spanish population between 40 and 69 years of age (from the IBERPOC study)., Method: The cost was evaluated retrospectively by means of a questionnaire completed by the 363 patients with COPD from the IBERPOC study with questions referring to the previous year. Standardized spirometry was performed on all the patients by a pneumologist in each of the 7 geographical areas in which the study was carried out., Results: Hospitalization accounted for the greatest expenditure (41% of total), followed by drug therapy (37%). The cost was euro;98.39 per patient, and euro;909.50 per previously diagnosed patient. The cost per person of severe COPD was more than 3 times that of moderate COPD and more than 7 times that of mild COPD. The estimated annual cost of COPD in Spain was euro;238.82 million (for 1997)., Conclusion: The present study, which was the first to estimate the cost of COPD in a representative sample of the general population, found the cost to be lower than in studies analyzing samples of patients with previous diagnoses of COPD. The cost distribution is not in line with recommended health care practices, underlining the need to optimize resources used to monitor and treat the disease, with an emphasis on early diagnosis.