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We aim to conduct a pilot cluster randomised controlled trial to assess, in the context of brief general (GP) advice to stop smoking, whether offering full reimbursement of the costs for smoking cessation pharmacotherapy compared with no reimbursement (i.e., current care as usual) increases abstinence from smoking after 12 weeks in smoking patients consulting their GP. A total of 24 GP practices (with a total of 288 patients) from North Rhine-Westphalian General Practice Research Network (NRW-GPRN; www.hafo.nrw) will be randomised 1:1 to an intervention and a control group. In both groups, GPs will receive a training in delivering brief stop-smoking advice according to the ABC method (ask, brief advice, cessation support). Only in the intervention group, GPs’ smoking patients will receive full reimbursement of pharmacotherapy for smoking cessation, such as nicotine replacement therapy. The primary scientific outcome will be patients’ self-reported 7-day non-smoking, biochemically validated with a carbon monoxide measurement in exhaled air (cut-off

Respiratory diseases remain a significant cause of global morbidity and mortality and primary care plays a central role in their prevention, diagnosis and management. An e-Delphi process was employed to identify and prioritise the current respiratory research needs of primary care health professionals worldwide. One hundred and twelve community-based physicians, nurses and other healthcare professionals from 27 high-, middle- and low-income countries suggested 608 initial research questions, reduced after evidence review by 27 academic experts to 176 questions covering diagnosis, management, monitoring, self-management and prognosis of asthma, COPD and other respiratory conditions (including infections, lung cancer, tobacco control, sleep apnoea). Forty-nine questions reached 80% consensus for importance. Cross-cutting themes identified were: a need for more effective training of primary care clinicians; evidence and guidelines specifically relevant to primary care, adaption for local and low-resource settings; empowerment of patients to improve self-management; and the role of the multidisciplinary healthcare team.

Hintergrund und Stand (inter)nationaler Forschung: Regelmäßige körperliche Aktivität ist wirksam in der medizinischen Behandlung der koronaren Herzkrankheit (KHK). Hausärztliche Kurzberatung zur körperlichen Aktivität kann diese effektiv bei Patient:innen steigern. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Die Hausarztpraxis ist ein geeigneter Ort, an dem Therapien und Unterstützung zum Tabakrauchstopp angeboten werden können. Es ist allerdings nicht bekannt, wie motiviert Tabakraucher:innen in Deutschland sind, ihren Konsum zu beenden. Ebenso existieren widersprüchliche Ergebnisse, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

In the context of smoking cessation treatment in primary care, identifying patients at the highest risk of relapse is relevant. We explored data from a primary care trial to assess the validity of two simple urges to smoke questions in predicting long-term relapse and their diagnostic value. Of 295 patients who received behavioural support and varenicline, 180 were abstinent at week 9. In this subgroup, we measured time spent with urges to smoke (TSU) and strength of urges to smoke (SUT; both scales 1 to 6 = highest). We used separate regression models with TSU or SUT as predictor and relapse from week 9-26 or week 9-52 as an outcome. We also calculated the sensitivity (SP), specificity and positive predictive values (PPV) of TSU and SUT in correctly identifying patients who relapsed at follow-up. The adjusted odds ratios (aOR) for predicting relapse from week 9-26 were 1.74 per point increase (95% CI = 1.05-2.89) for TSU and 1.59 (95% CI = 1.11-2.28) for SUT. The aORs for predicting relapse from week 9-52 were 2.41 (95% CI = 1.33-4.37) and 1.71 (95% CI = 1.14-2.56), respectively. Applying a cut-point of ≥3 on TSU resulted in SP = 97.1 and PPV = 70.0 in week 9-26, and SP = 98.8 and PPV = 90.0 in week 9-52. Applying a cut-point of ≥4 on SUT resulted in SP = 99.0 and PPV = 85.7 in week 9-26, and SP = 98.8 and PPV = 85.7 in week 9-52. Both TSU and SUT were valid predictors of long-term relapse in patients under smoking cessation treatment in primary care. These simple questions may be useful to implement in primary care.Trial registration: Dutch Trial Register (NTR3067). ispartof: NPJ PRIMARY CARE RESPIRATORY MEDICINE vol:31 issue:1 ispartof: location:England status: published

Hintergrund: Rauchstoppversuche enden meistens mit einem Rückfall. Im Rahmen der hausärztlichen Versorgung bei der Tabakentwöhnung wäre es sehr hilfreich, Patient*innen mit einem besonders hohen Rückfall-Risiko identifizieren zu können. Fragestellung: Sind zwei [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: In der hausärztlichen Versorgung wird zu selten leitliniengerechte Kurzberatung zur Tabakentwöhnung angeboten. Wir entwickelten ein theoriebasiertes, 3,5-stündiges hausärztliches Training für solche Kurzberatungen nach zwei unterschiedlichen Beratungsmethoden (ABC [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Background Despite treatment, patients with tuberculosis (TB) who smoke have poorer outcomes compared with non-smokers. It is unknown, however, if quitting smoking during the 6 months of TB treatment improves TB outcomes. Methods The TB & Tobacco Trial was a double-blind, placebo-controlled randomised trial of cytisine for smoking cessation in 2472 patients with pulmonary TB in Bangladesh and Pakistan. In a secondary analysis, we investigated the hypothesis that smoking cessation improves health outcomes in patients during the TB treatment course. The outcomes included an eight-point TB clinical score, sputum conversion rates, chest X-ray grades, quality of life (EQ-5D-5L), TB cure plus treatment completion rates and relapse rates. These were compared between those who stopped smoking and those who did not, using regression analysis. Results We analysed the data of 2273 (92%) trial participants. Overall, 25% (577/2273) of participants stopped smoking. Compared with non-quitters, those who quit had better TB cure plus treatment completion rates (91% vs 80%, p

Background Smoking cessation in Tuberculosis (TB) patients is important because it can reduce the high treatment failure and death rates. Cytisine is an effective low-cost treatment for smoking cessation that has not been tested in TB patients. This study aims to assess its effectiveness and safety as a smoking cessation aid in TB patients in Bangladesh and Pakistan.MethodsWe conducted a two-arm, parallel, individually randomised, double-blind, placebo-controlled, multicentre trial. Adult pulmonary TB patients were randomised 1:1 to a 25-day treatment regimen with cytisine plus brief behavioural support or placebo plus brief behavioural support; both medications were identical 1.5 mg hard capsules for oral administration and behavioural support was a 15 minute face-to-face session delivered by health workers. Pre-generated block randomisation lists, stratified by trial sites, were used for allocation. An intention to treat analysis was conducted on the primary outcome: biochemically-verified continuous smoking abstinence at six months post-randomisation. The trial registration number is ISRCTN43811467, International Standard Randomised Clinical Trial Number and it is closed to new participants.FindingsBetween June 2017 and April 2018, we randomised 2,472 patients (1,527 in Bangladesh and 945 in Pakistan). At six months, 32.4% (n=401/1239) were continuously abstinent in the cytisine arm and 29.7% (n=366/1233) in the placebo arm (relative risk (RR) 1.09, 95% confidence interval (CI) 0.97 to 1.23, p=0.114). Serious Adverse Events included 91 deaths (49 in the cytisine arm and 42 in the placebo arm). None of these events (including deaths) were attributed to the study medication. Cytisine was well tolerated.InterpretationOur findings do not support adding cytisine to brief behavioural support when treating tobacco dependence in TB patients. FundingEuropean Union Horizon 2020, grant nr. 680995.

OBJECTIVE To assess the effectiveness of a 3.5h-training for general practitioners (GPs) in two different methods of giving brief stop-smoking advice – 5A (ask, advice, assess, assist, arrange) or ABC (ask, brief advice, cessation support) – during routine consultations with smoking patients. DESIGN Pragmatic 2-arm cluster randomised controlled trial with a pre-post-design for the primary outcome and cluster randomisation for secondary outcomes. SETTING General practices (cluster) in the Rhine-Ruhr Metropolitan Region of the German federal state of North Rhine-Westphalia. The study opened to recruitment in June 2017 and closed in July 2019, with final follow-up in February 2020. PARTICIPANTS General practices with their GPs were randomised (1:1) to receive training in either 5A or ABC. Tobacco smoking patients aged > 18 years, who routinely consulted these GPs six weeks prior or six six following the training were eligible to participate. Non-smokers, those with limited literacy or incapability to provide informed consent, or who did not see their GP in person were ineligible. INTERVENTIONS Two different standardised 3.5h-trainings (ABC or 5A), in small groups of ~8 GPs, in delivering brief stop-smoking advice, moderated by a senior researcher and an experienced GP peer-trainer and including role-plays with professional actors. MAIN OUTCOME MEASURES Primary outcome: patient-reported receipt of GP advice to quit, measured during a face-to-face interview directly following the consultation in the GP practice. Secondary outcomes included patient-reported receipt of GP delivered recommendation/prescription of evidence-based behavioural counselling; nicotine replacement therapy (NRT); varenicline or bupropion; any pharmacotherapy (NRT, varenicline or bupropion); or a combination of behavioural support and pharmacotherapy. A further aim was to compare the effectiveness of the two methods (ABC vs. 5A) against each other regarding all outcomes. All analyses were adjusted for a priori defined potentially relevant confounders and by using imputed patient data for missing data on confounding variables. Main analyses were double-checked using complete cases patient data. RANDOMISATION AND MASKING Two different methods of randomisation were applied, depending on how many GPs were available for the scheduled training dates (six training cycles over the course of two years, with two trainings – 5A and ABC – per cycle): computer-generated block randomisation, or randomisation by virtue of the GPs temporal availability. GPs could not be fully blinded with respect to their training allocation. Patients were blinded to the nature and aim of the study until the end of the data collection. RESULTS 52 GP practices (with 69 GPs) participated in the training and data collection (ABC training: 27 GP practices, 5A training: 25 GP practices). Of 5,406 unique patients who routinely consulted their GP within 5 weeks prior/post training and provided informed consent to participate, 1,937 (35.9%) were current tobacco smokers. Of these, 1,039 were interviewed prior to, and 898 following, the training. The rates of stop-smoking advice delivered by GPs (primary outcome) increased from 13.1% (n=136/1,039) to 33.1% (n=297/898) following the training (adjusted odds ratio (aOR)=3.25, 95% confidence interval (CI)=2.34 to 4.51). Overall, recommendation/prescription rates of cessation treatment were low a priori (

Hintergrund: Das „Assessment of Burden of COPD (ABC) Tool“ wurde in den Niederlanden entwickelt und hilft nachweislich, die krankheitsspezifische Lebensqualität von COPD Patient*innen zu verbessern. Auf den DEGAM Kongressen 2017 und 2018 wurde das ABC Tool in ersten Workshops[zum vollständigen Text gelangen Sie über die oben angegebene URL], 53. Kongress für Allgemeinmedizin und Familienmedizin

Smoking worsens tuberculosis (TB) outcomes. Persons with TB who smoke can benefit from smoking cessation. We report findings of a multi-country qualitative process evaluation assessing barriers and facilitators to implementation of smoking cessation behaviour support in TB clinics in Bangladesh and Pakistan. We conducted semi-structured qualitative interviews at five case study clinics with 35 patients and 8 health workers over a period of 11 months (2017–2018) at different time points during the intervention implementation phase. Interviews were conducted by trained researchers in the native languages, audio-recorded, transcribed into English and analysed using a combined deductive–inductive approach guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. All patients report willingness to quit smoking and recent quit attempts. Individuals’ main motivations to quit are their health and the need to financially provide for a family. Behavioural regulation such as avoiding exposure to cigarettes and social influences from friends, family and colleagues are main themes of the interviews. Most male patients do not feel shy admitting to smoking, for the sole female patient interviewee stigma was an issue. Health workers report structural characteristics such as high workload and limited time per patient as primary barriers to offering behavioural support. Self-efficacy to discuss tobacco use with women varies by health worker. Systemic barriers to implementation such as staff workload and socio-cultural barriers to cessation like gender relations, stigma or social influences should be dealt with creatively to optimize the behaviour support for sustainability and scale-up.

BaselineSurvey_ABCII_German. (PDF 542 kb)

Follow-upSurveyWeek4_ABCII_German. (PDF 486 kb)

Follow-upSurveyWeek4_ABCII_Engl. (PDF 537 kb)

BaselineSurvey_ABCII_Engl. (PDF 560 kb)

Background and aimsSmartphone applications (apps) offer a potentially cost-effective and a wide-reach aid to smoking cessation. In 2012, a content analysis of smoking cessation apps suggested that most apps did not adopt behaviour change techniques (BCTs), which according to previous research had suggested would promote higher success rates in quitting smoking. This study examined whether or not, this situation had changed by 2014 for free smoking cessation apps available in the Apple App Store. It also compared the use of engagement and ease-of-use features between the two time points.Methods137 free apps available in the Apple App Sore in 2014 were coded using an established framework for the presence or absence of evidence-based BCTs, and engagement and ease-of-use features. The results from the 2014 data were compared with a similar exercise conducted on 83 free apps available in 2012.ResultsBCTs supporting identity change, rewarding abstinence and advising on changing routines were less prevalent in 2014 as compared with 2012 (14.6% vs. 42.2%, 18.2% vs. 48.2%, and 17.5% vs. 24.1%, respectively). Advice on coping with cravings and advice on the use of stop-smoking medication were more prevalent in 2014 as compared with 2012 (27.7% vs. 20.5% and 14.6% vs 3.6%, respectively). The use of recognised engagement features was less common in 2014 than in 2012 (45.3% vs. 69.6%) while ease-of-use features remained very high (94.5% vs. 82.6%).ConclusionThere was little evidence of improvement in the use of evidence-based BCTs in free smoking cessation iPhone-based apps between 2012 and 2014.

Hintergrund: Die Behandlung der Tabakabhängigkeit ist von großem Interesse für die öffentliche Gesundheit. Dennoch liegt die Prävalenz des Tabakrauchens in Deutschland weiterhin auf hohem Niveau (28%). Laut Rahmenkonvention der Weltgesundheitsorganisation (WHO) zur Eindämmung[zum vollständigen Text gelangen Sie über die oben angegebene URL], 17. Deutscher Kongress für Versorgungsforschung (DKVF)

Introduction Tuberculosis (TB) remains a significant public health problem in South Asia. Tobacco use increases the risks of TB infection and TB progression. The TB& Tobacco placebo-controlled randomised trial aims to (1) assess the effectiveness of the tobacco cessation medication cytisine versus placebo when combined with behavioural support and (2) implement tobacco cessation medication and behavioural support as part of general TB care in Bangladesh and Pakistan. This paper summarises the process and context evaluation protocol embedded in the effectiveness-implementation hybrid design. Methods and analysis We are conducting a mixed-methods process and context evaluation informed by an intervention logic model that draws on the UK Medical Research Council's Process Evaluation Guidance. Our approach includes quantitative and qualitative data collection on context, recruitment, reach, dose delivered, dose received and fidelity. Quantitative data include patient characteristics, reach of recruitment among eligible patients, routine trial data on dose delivered and dose received, and a COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') questionnaire filled in by participating health workers. Qualitative data include semistructured interviews with TB health workers and patients, and with policy-makers at district and central levels in each country. Interviews will be analysed using the framework approach. The behavioural intervention delivery is audio recorded and assessed using a predefined fidelity coding index based on behavioural change technique taxonomy. Ethics and dissemination The study complies with the guidelines of the Declaration of Helsinki. Ethics approval for the study and process evaluation was granted by the University of Leeds (qualitative components), University of York (trial data and fidelity assessment), Bangladesh Medical Research Council and Bangladesh Drug Administration (trial data and qualitative components) and Pakistan Medical Research Council (trial data and qualitative components). Results of this research will be disseminated through reports to stakeholders and peer-reviewed publications and conference presentations.

Smoking prevalence in Germany remains high at approximately 28%. We assessed public support for tobacco legislation and associations between level of support and smoking and socio-demographic characteristics. Data from 2087 people were collected as part of the German Study on Tobacco Use (“DEBRA”): a nationally representative, face-to-face household survey. Public support was measured on total ban of sale, raising the minimum age for sales, taxation of tobacco industry sales, research into e-cigarettes, and ban of smoking in cars when children are present. Associations were assessed with multivariate logistic regression. Over 50% of the German population support taxing industry profits (57.3%) and assessing e-cigarettes as an aid to quit smoking (55.5%). Over 40% support raising the legal age of sale (43.1%), and 22.9% support a total ban on tobacco sales. A smoking ban in cars when children are present was most popular (71.5%), even among current smokers (67.0%). There is public support for stricter tobacco control measures in Germany. A smoking ban in cars when children are present could be a feasible policy to implement.

Aims To study the effectiveness of intensive counselling by a practice nurse (PN) versus brief advice by a general practitioner (GP), each combined with pharmacotherapy, for 6 months' tobacco abstinence (primary outcome). Secondary outcomes included 12-month abstinence, medication adherence and incremental costs per life-year gained. Design A multi-site (n=10), two-group, parallel, pragmatic randomized controlled trial. Setting A network of primary health-care centres in the Netherlands. Participants A total of 295 adult daily smokers (mean age=48 years; mean cigarettes/day=19). Intervention and comparator Patients were randomized to receive individual counselling by a practice nurse (PN) (n=149) or brief advice by a general practitioner (GP) (146). All patients received 12 weeks of open-label varenicline. Measurements The primary outcome was prolonged biochemically validated abstinence from weeks 9 to 26 after treatment initiation. Secondary outcomes included abstinence from weeks 9 to 52, good dosing adherence (>80%days taken) and incremental costs per life-year gained. Findings Abstinence rates in the PN versus GP groups were 32.2% (n=48) versus 39.0% [n=57; odds ratio (OR)=0.71; 95% confidence interval (CI)=0.44-1.16] from weeks 9 to 26 and 25.5% (n=38) versus 28.8% (n=42; OR=0.84, 95% CI=0.50-1.43) from weeks 9 to 52, respectively. Values of the Bayes factor indicated that the PN and GP were equally effective. Good dosing adherence was significantly lower in the PN (45.5%, n=56/123) than in the GP group (62.0%, n=75/121; OR=0.45, 95% CI=0.26-0.77), and the incremental costs per life-year gained were -(sic) 416.10. Conclusions Among people seeking help to stop smoking from their general practice, one-off brief advice from a general practitioner appears to be as effective as several sessions of behavioural support from a practice nurse when smoking cessation medication is provided.

Emerging models for predicting risk of chronic obstructive pulmonary disease (COPD) require external validation in order to assess their clinical value. We validated a previous model for predicting new onset COPD in a different database. We randomly drew 38,597 case-control pairs (total N = 77,194) of individuals aged >= 35 years and matched for sex, age, and general practice from the United Kingdom Clinical Practice Research Datalink database. We assessed accuracy of the model to discriminate between COPD cases and non-cases by calculating area under the receiver operator characteristic (ROCAUC) for the prediction scores. Analogous to the development model, ever smoking (OR 6.70; 95% CI 6.41-6.99), prior asthma (OR 6.43; 95% CI 5.85-7.07), and higher socioeconomic deprivation (OR 2.90; 95% CI 2.72-3.09 for highest vs. lowest quintile) increased the risk of COPD. The validated prediction scores ranged from 0-5.71 (ROCAUC 0.66; 95% CI 0.65-0.66) for males and 0-5.95 (ROCAUC 0.71; 95% CI 0.70-0.71) for females. We have confirmed that smoking, prior asthma, and socioeconomic deprivation are key risk factors for new onset COPD. Our model seems externally valid at identifying patients at risk of developing COPD. An impact assessment now needs to be undertaken to assess whether this prediction model can be applied in clinical care settings.

Emerging models for predicting risk of chronic obstructive pulmonary disease (COPD) require external validation in order to assess their clinical value. We validated a previous model for predicting new onset COPD in a different database. We randomly drew 38,597 case-control pairs (total N = 77,194) of individuals aged ≥35 years and matched for sex, age, and general practice from the United Kingdom Clinical Practice Research Datalink database. We assessed accuracy of the model to discriminate between COPD cases and non-cases by calculating area under the receiver operator characteristic (ROCAUC) for the prediction scores. Analogous to the development model, ever smoking (OR 6.70; 95%CI 6.41–6.99), prior asthma (OR 6.43; 95%CI 5.85–7.07), and higher socioeconomic deprivation (OR 2.90; 95%CI 2.72–3.09 for highest vs. lowest quintile) increased the risk of COPD. The validated prediction scores ranged from 0–5.71 (ROCAUC 0.66; 95%CI 0.65–0.66) for males and 0–5.95 (ROCAUC 0.71; 95%CI 0.70–0.71) for females. We have confirmed that smoking, prior asthma, and socioeconomic deprivation are key risk factors for new onset COPD. Our model seems externally valid at identifying patients at risk of developing COPD. An impact assessment now needs to be undertaken to assess whether this prediction model can be applied in clinical care settings.

DEBRA - Follow-up survey. (DOCX 38 kb)

DEBRA - Baseline survey. (DOCX 66 kb)

Zielsetzung: Laut klinischen Leitlinien sollten Hausärzte ihren rauchenden Patienten routinemäßig eine Kurzberatung zur Rauchentwöhnung anbieten. Der traditionelle Ansatz zu deren inhaltlicher Gestaltung basiert auf dem "5A" Modell, bei dem der Rauchstatus erfragt (ask),[zum vollständigen Text gelangen Sie über die oben angegebene URL], Gemeinsam informiert entscheiden; 17. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Een tijdschriftredactie kan op drie manieren oordelen over een ingezonden artikel: accepteren, afwijzen (onmiddellijk door de redacteur of na commentaar van de referenten/peer review) of vragen om revisie (gewoonlijk naar aanleiding van het referentencommentaar).

In een wetenschappelijk artikel wordt een verhaal verteld, maar aan wie? welk publiek een artikel leest, wordt grotendeels bepaald door de keuze van het tijdschrift waarin het wordt gepubliceerd.

De vooruitgang van de wetenschap is gebaseerd op het voortbouwen op het werk van anderen. Het is dus van belang eerder werk op de juiste wijze te citeren, om je bronnen aan te geven, om je hypothese te onderbouwen, om te laten zien dat je bekend bent met het desbetreffende vakgebied, om andere onderzoekers de eer te geven die hen toekomt en ook om niet van plagiaat te worden beschuldigd.

Er bestaan uniforme eisen voor artikelen die worden aangeboden aan biomedische tijdschriften (www.icmje.org).

Het auteurschap van een wetenschappelijk artikel – met een belangrijke rol als auteur (eerste, tweede of laatste auteur, corresponderend auteur of eindverantwoordelijke of guarantor) – kan goed zijn voor je carrière. Het is dan ook niet verwonderlijk dat auteurschap een veelbesproken onderwerp is bij vergaderingen en in het koffiehoekje van de afdeling.

Background Varenicline is an effective pharmacotherapy to aid smoking cessation. However, its use is limited by continuing concerns about possible associated risks of serious adverse cardiovascular and neuropsychiatric events. The aim of this study was to investigate whether use of varenicline is associated with such events. Methods In this retrospective cohort study, we used data from patients included in the validated QResearch database, which holds data from 753 National Health Service general practices across England. We identified patients aged 18-100 years (registered for longer than 12 months before data extraction) who received a prescription of nicotine replacement treatment (NRT; reference group), bupropion, or varenicline. We excluded patients if they had used one of the drugs during the 12 months before the start date of the study, had received a prescription of a combination of these drugs during the follow-up period, or were temporary residents. We followed patients up for 6 months to compare incident cardiovascular (ischaemic heart disease, cerebral infarction, heart failure, peripheral vascular disease, and cardiac arrhythmia) and neuropsychiatric (depression and self-harm) events using Cox proportional hazards models, adjusted for potential confounders (primary outcomes). Findings We identified 164 766 patients who received a prescription (106 759 for nicotine replacement treatment; 6557 for bupropion; 51 450 for varenicline) between Jan 1, 2007, and June 30, 2012. Neither bupropion nor varenicline showed an increased risk of any cardiovascular or neuropsychiatric event compared with NRT (all hazard ratios [HRs] less than 1). Varenicline was associated with a significantly reduced risk of ischaemic heart disease (HR 0.80 [95% CI 0.72-0.87]), cerebral infarction (0.62 [0.52-0.73]), heart failure (0.61 [0.45-0.83]), arrhythmia (0.73 [0.60-0.88]), depression (0.66 [0.63-0.69]), and self-harm (0.56 [0.46-0.68]). Interpretation Varenicline does not seem to be associated with an increased risk of documented cardiovascular events, depression, or self-harm when compared with NRT. Adverse events that do not come to attention of general practitioners cannot be excluded. These findings suggest an opportunity for physicians to prescribe varenicline more broadly, even for patients with comorbidities, thereby helping more smokers to quit successfully than do at present. Open Access article published under the terms of CC BY.

BackgroundLittle is known about the effectiveness of mobile apps in aiding smoking cessation or their validity for automated collection of data on smoking cessation outcomes. ObjectiveWe conducted a preliminary evaluation of SF28 (SF28 is the name of the app, short for SmokeFree28)—an app aimed at helping smokers to be smoke-free for 28 days. MethodsData on sociodemographic characteristics, smoking history, number of logins, and abstinence at each login were uploaded to a server from SF28 between August 2012 and August 2013. Users were included if they were aged 16 years or over, smoked cigarettes at the time of registration, had set a quit date, and used the app at least once on or after their quit date. Their characteristics were compared with data from a representative sample of smokers trying to stop smoking in England. The percentage of users recording 28 days of abstinence was compared with a value of 15% estimated for unaided quitting. Correlations were assessed between recorded abstinence for 28 days and well-established abstinence predictors. ResultsA total of 1170 users met the inclusion criteria. Compared with smokers trying to quit in England, they had higher consumption, and were younger, more likely to be female, and had a non-manual rather than manual occupation. In total, 18.9% (95% CI 16.7-21.1) were recorded as being abstinent from smoking for 28 days or longer. The mean number of logins was 8.5 (SD 9.0). The proportion recording abstinence for 28 days or longer was higher in users who were older, in a non-manual occupation, and in those using a smoking cessation medication. ConclusionsThe recorded 28-day abstinence rates from the mobile app, SF28, suggest that it may help some smokers to stop smoking. Further evaluation by means of a randomized trial appears to be warranted.

Interview topic guide. (DOCX 17 kb)

Background It is important to know the comparative effectiveness of varenicline and nicotine replacement therapy (NRT) for smoking cessation when prescribed under routine circumstances and in the general population. Previous estimates relied on cross-sectional data. The objective of the current study was to use longitudinal data to compare the abstinence rates of smokers trying to stop having used varenicline versus NRT on prescription (Rx) when provided with minimal professional support in the general population while adjusting for key potential confounders. Methods Prospective cohort study in 270 adults who participated in a household survey, smoked at baseline, responded to the 6-month follow-up survey, and made at least one quit attempt between the two measurements with either varenicline or NRT Rx in their most recent quit attempt. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including cigarette dependence (measured at baseline). Results Users of varenicline were younger, reported more time spent with urges to smoke at baseline, and were less likely to stop abruptly during their last quit attempt (all p

Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate-to-heavy (10+ CPD) smokers in England. Design Cross-sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6-month follow-up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow-up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9-32.8%). Compared with moderate-to-heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio-economic background. They were more motivated to quit and enjoyed smoking less. During the 6-month follow-up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate-to-heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate-to-heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over-the-counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree.

Background We hypothesized that provision of financial assistance for smokers trying to quit, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. Objectives The primary objective of this review was to assess the impact of reducing the costs of providing or using smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use and/or prescription of smoking cessation treatment and on the number of smokers making a quit attempt. Search methods We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2012. Selection criteria We considered randomised controlled trials (RCTs), controlled trials and interrupted time series studies involving financial benefit interventions to smokers or their healthcare providers or both. Data collection and analysis Two reviewers independently extracted data and assessed the quality of the included studies. Risk ratios (RR) were calculated for individual studies on an intention-to-treat basis and meta-analysis was performed using a random-effects model. We included economic evaluations when a study presented the costs and effects of two or more alternatives. Main results We found eleven trials involving financial interventions directed at smokers and healthcare providers. Full financial interventions directed at smokers had a statistically significant favourable effect on abstinence at six months or greater when compared to no intervention (RR 2.45, 95% CI 1.17 to 5.12, I-2 = 59%, 4 studies). There was also a significant effect of full financial interventions when compared to no interventions on the number of participants making a quit attempt (RR 1.11, 95% CI 1.04 to 1.32, I-2 = 15%) and use of smoking cessation treatment (NRT: RR 1.83, 95% CI 1.55 to 2.15, I-2 = 43%; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I-2 = 71%; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65). There was no evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I-2 = 0%). Comparisons of full coverage with partial coverage, partial coverage with no coverage, and partial coverage with another partial coverage intervention did not detect significant effects. Comparison of full coverage with partial or no coverage resulted in costs per additional quitter ranging from $119 to $6450. Authors' conclusions Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting. The absolute differences are small but the costs per additional quitter are low to moderate. We did not detect an effect on smoking cessation from financial incentives directed at healthcare providers. The methodological qualities of the included studies need to be taken into consideration when interpreting the results.

BACKGROUND: Varenicline is an effective pharmacotherapy to aid smoking cessation. However, its use is limited by continuing concerns about possible associated risks of serious adverse cardiovascular and neuropsychiatric events. The aim of this study was to investigate whether use of varenicline is associated with such events.METHODS: In this retrospective cohort study, we used data from patients included in the validated QResearch database, which holds data from 753 National Health Service general practices across England. We identified patients aged 18-100 years (registered for longer than 12 months before data extraction) who received a prescription of nicotine replacement treatment (NRT; reference group), bupropion, or varenicline. We excluded patients if they had used one of the drugs during the 12 months before the start date of the study, had received a prescription of a combination of these drugs during the follow-up period, or were temporary residents. We followed patients up for 6 months to compare incident cardiovascular (ischaemic heart disease, cerebral infarction, heart failure, peripheral vascular disease, and cardiac arrhythmia) and neuropsychiatric (depression and self-harm) events using Cox proportional hazards models, adjusted for potential confounders (primary outcomes).FINDINGS: We identified 164 766 patients who received a prescription (106 759 for nicotine replacement treatment; 6557 for bupropion; 51 450 for varenicline) between Jan 1, 2007, and June 30, 2012. Neither bupropion nor varenicline showed an increased risk of any cardiovascular or neuropsychiatric event compared with NRT (all hazard ratios [HRs] less than 1. Varenicline was associated with a significantly reduced risk of ischaemic heart disease (HR 0·80 [95%CI 0·72-0·87]), cerebral infarction (0·62 [0·52-0·73]), heart failure (0·61 [0·45-0·83]), arrhythmia (0·73 [0·60-0·88]), depression (0·66 [0·63-0·69]), and self-harm (0·56 [0·46-0·68]).INTERPRETATION: Varenicline does not seem to be associated with an increased risk of documented cardiovascular events, depression, or self-harm when compared with NRT. Adverse events that do not come to attention of general practitioners cannot be excluded. These findings suggest an opportunity for physicians to prescribe varenicline more broadly, even for patients with comorbidities, thereby helping more smokers to quit successfully than do at present.FUNDING: Egton Medical Information Systems, University of Nottingham, Ministry of Innovation, Science and Research of the German Federal State of North Rhine-Westphalia, Cancer Research UK, Medical Research Council, Commonwealth Fund.

A combination of behavioural support and pharmacotherapy is most effective for smoking cessation, but it is not applied sufficiently to effectively help smokers quit. An exploratory study showed that GPs have too little time and have negative feelings about stop-smoking medication and preventive tasks in general. Patients, on the other hand, do not know that they can get smoking cessation assistance in their primary healthcare centre. Also, patients and caregivers were positive about the assistance of the practice nurse in smoking cessation, although their effectiveness had not yet been evaluated. A pragmatic randomised controlled trial showed that intensive counselling by a practice-nurse versus brief advice by a general practitioner, in combination with varenicline, was not more effective. The long-term smoking cessation rate (6-months) was 32.2% for the practice nurse and 39.0% for the GP, which shows both practice nurses and GPs are highly effective in smoking cessation when medication is given. In addition, this research also showed that smokers with COPD experience more and different difficulties in quitting, which indicates that this group of smokers needs specific smoking cessation assistance, potentially from the practice nurse.

In the COPD Care Standard, issued by the Dutch Lung Alliance (LAN) in 2010, the term ‘burden of disease’ was introduced for the first time in order to assess the severity and treatment of COPD. However, what is burden of disease, and how to measure it? This PhD dissertation focuses on the development and evaluation of the COPD burden of disease instrument. Research showed that the burden of disease instrument improves quality of life as well as perceived quality of care. Care providers and patients have confirmed that the instrument has added value. Based on these results, the LAN has decided to implement the burden of disease instrument in COPD care.