Multidimensional smoker profiles and their prediction of smoking following a pharmacobehavioral intervention

The ability to predict the success or failure of smoking cessation efforts will be useful for clinical practice. Stress response is regulated by two primary neuroendocrine systems. Salivary cortisol has been used as a marker for the hypothalamus-pituitary-adrenocortical axis and salivary alpha-amylase as a marker for the sympathetic adrenomedullary system. We studied 62 chronic smokers (34 women and 28 men with an average age of 45.2+/-12.9 years). The levels of salivary cortisol and salivary alpha-amylase were measured during the period of active smoking, and 6 weeks and 24 weeks after quitting. We analyzed the men separately from the women. The men who were unsuccessful in cessation showed significantly higher levels of salivary alpha-amylase over the entire course of the cessation attempt. Before stopping smoking, salivary cortisol levels were higher among the men who were unsuccessful in smoking cessation. After quitting, there were no differences between this group and the men who were successful in cessation. In women we found no differences between groups of successful and unsuccessful ex-smokers during cessation. In conclusions, increased levels of salivary alpha-amylase before and during smoking cessation may predict failure to quit in men. On the other hand, no advantage was found in predicting the failure to quit in women. The results of our study support previously described gender differences in smoking cessation.

/pdf/higher-levels-of-salivary-a-amylase-predict-failure-of-28kl7mzqbx.pdf

Higher Levels of Salivary α-Amylase Predict Failure of Cessation Efforts in Male Smokers

Introduction Higher prevalence of smoking among depressed
patients, as well as the risk of depression in smokers, is well
documented The proportion of patients with a history of
depression among those seeking intensive treatment of tobacco
dependence is also high In contrast, evidence of treatment
success in this subgroup of patients is controversial The aim
of this study was to compare smoking abstinence rates after
tobacco treatment in smokers with and without a history of
depression Methods We reviewed retrospective data from 1,730
smokers seeking treatment in Prague, Czech Republic History of
depression was defined as past diagnosis of depression or
current treatment of depression After a 1-year, self-reported
smoking status was validated by expired-air carbon monoxide We
used logistic regression to analyze associations between
abstinence rates, history of depression, and other factors (eg,
age, sex, tobacco dependence) Results Of 1,730 smokers
treated, 289 (167%) had a history of depression The smoking
abstinence rate at 1 year was 325% for smokers with a history
of depression and 387% for those with no history (P = 048)
Among women, abstinence did not differ between groups (350% vs
357%; P = 86) However, among men, those with a history of
depression had lower rates of abstinence (274% vs 413%; P =
009) After adjustment for baseline covariates, history of
depression was not significantly associated with smoking
abstinence in men or women Conclusion Intensive outpatient
tobacco treatment programs can achieve abstinence rates among
smokers with a history of depression similar to rates among the
general population

/pdf/tobacco-treatment-outcomes-in-patients-with-and-without-a-4q855cm07o.pdf

Tobacco treatment outcomes in patients with and without a history of depression, Czech Republic, 2005-2010.

Objective: Cost-effectiveness analysis of the major tobacco control tools medium long term.
Method: This is a retrospective, descriptive study of the results obtained after analyzing the sample of all patients who attended the Unit Specialized Treatment Smoking during two years. Without drug treatment: the costs and effectiveness of the four options used in our Unit for smoking cessation compared: 1) Bupropion+ NRT, 2) Varenicline, 3) Varenicline and NRT and 4) No pharmacology treatment.
Costs and efficiency: Efficiencies rates for comparison are the result of our study for the 4 options. All costs are expressed in euros, both costs and an effect beyond the first year rate of 3.5% per annum is deducted.
Results: Of the 559 patients, 32.7% received no treatment. 34.5% (n=194) of patients was treated with NRT (gum, patches or in combination with varenicline). Varenicline is the second most frequently used drug with 22.9% and, finally, bupropion (9.8%). The analysis results show that the greater efficacy of varenicline is a better cost/effectiveness (C/E) in the treatment of smoking medium to long term that comes to fully offset the higher cost of treatment compared to the other options. So both varenicline monotherapy as associated with TSN have average costs of € 2.491,21 and € 2.432,22 per patient who quit smoking compared to the other options with Bupropion and TSN 4.136,55 € or drug treatment to 5.783,88 € in a perspective of two years.
Conclusion: The option of giving Varenicline is a better cost/effectiveness (C/E) in the treatment of smoking-half longer than the other options.

Pharmacoeconomic Analysis of the Therapies Used in the Treatment of Smoking in a Specialized Unit

Smoking increases the risk of forming, growing, and rupture of intracranial aneurysms. We retrospectively reviewed patients with intracranial aneurysms treated by neurosurgical or endovascular treatment--154 patients (45 men, 109 women, 15 to 62 years, average 46.3 years, CI +/- 1.72). We found 74% (114/154) of smokers--80% (36/45) men and 71.6% (78/109) women, with the mean value of the Fagerstrom Test of Nicotine Dependence 4.4 (CI +/- 0.40). The average age of smoking initiation was 18.2 years (CI +/- 0.66), the average period of smoking 26.8 years (CI +/- 2.13). The average number of cigarettes consumed daily was 18.2 (CI +/- 1.58). With statistical significance p < 0.05, the athero-index was lower in nonsmokers than smokers: 3.4 (CI +/- 0.56) vs. 4.5 (CI +/- 0.51). HDL cholesterol was higher in non-smokers than smokers: 1.6 mmol/L (CI +/- 0.25) vs. 1.4 (CI +/- 0.10), and triglycerides were higher in smokers than non-smokers: 1.3 mmol/l (CI +/- 0.16) vs. 1.9 (CI +/- 0.35). Forty-two per cent of smokers (48/114) were controlled one year after the treatment; 18.8% of them stopped smoking, 41.7% reduced smoking, and 39.6% continued to smoke as extensively as before. The prevalence of smoking in our sample was higher than in the Czech population (28.2%). Only 18.8% of controlled smokers were able to quit one year after the intervention.

Smokers with intracranial aneurysms who underwent neurosurgical or endovascular treatment have not stopped smoking one year after surgery

This first Czech version of guidelines formulated by the working group of mentioned medical associations is based on current literature and international guidelines. They are aimed mainly on clinical medicine and on incorporation of this treatment into the health care system according to WHO recommendations. They should serve to the treatment of tobacco dependence at any level: during any contact with the smoking patient (short intervention), in specialised centres or for the health care providers or health system itself.

Recommendations for the treatment of tobacco dependence

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Recommendations for the treatment of tobacco dependence