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Prevent Emphysema Now!
Information for Physicians on the Diagnosis and Treatment of COPD
Suggested Treatment
Smoking cessation has been proven to improve lung function and to increase life span. It has also been shown to lessen the risk of heart attack and stroke, and, after years of no smoking, the risk of lung cancer declines. A practical method in smoking cessation is briefly presented below (Table 3) and discussed further on the next page.
The most important stop-smoking intervention is serious counseling about the importance of stopping smoking and the development of a cessation plan. Picking a quit date is key. Nicotine replacement should be started on the quit date. Nicotine replacement products available over-the-counter or by prescription are listed in Table 3.
| Drug and Method of Administration | Unit Dose | Dose Interval |
|---|---|---|
| Nicotine polacrilex (oral) * Fifteen to 30 pieces may be chewed over 24 hours. |
2 - 4 mg | Every 1 - 2 hours* |
| Transdermal nicotine patch | 21, 14, and 7 mg | Over 24 hours |
| 15, 10, and 5 mg | Over 16 hours | |
| 22 and 11 mg | Over 24 hours | |
| Nasal nicotine spray | 0.5 mg/inhalation/nostril hourly or p.r.n. dosingl | 8 - 40 mg/day in |
| Nicotine inhaler | 10 mg/inhaler | Inhale for 20 minutes 6 - 16 times/day |
| Nicotine lozenge | 2 mg | Every 1-2 hours |
| Bupropion sustained-release tablets (Zyban®) | 150 mg | 150 mg for 3 days, then 300 mg/day (Start 2 wks before quit date) |
| Also Useful: | ||
| Clonidine transdermal patch | 0.2 mg | One patch changed weekly for 3 to 10 weeks |
| Nortriptyline tablets | 25, 50, and 75 mg | Maximum dose of 75 to 100 mg per day, treated for 8 to 12 weeks |
The non-nicotine product, bupropion, is at least as effective as nicotine replacement in smoking cessation. When nicotine replacement and bupropion are used together, up to a 35.5% biologically proven quit rate can be achieved at one year, compared to a 15.6% success rate with no pharmacologic interventions. When medication is successful, cessation usually occurs within two weeks. Re-treatment is appropriate up to seven or eight times for those who fail. Start bupropion two weeks before quit date to help insure success in quitting.
The retardation of decline in FEV1 over 30 years has been demonstrated (see Figure 4). Even patients who stopped smoking at age 65 had a survival benefit. Thus, it is never too Iate to stop smoking, but it is far better to stop at a young age and before advanced emphysema develops.
FIGURE 4
The effect of smoking cessation on decrement in
FEV1 (dotted oblique lines), compared with patients
who have never smoked or who are not susceptible to cigarette smoke (upper
solid lines), and also compared with patients who stopped smoking late
and are deteriorating from the harmful effects of cigarette smoke. The
percent FEV1 when the disability most commonly
occurs (approximately 30%), and where death occurs (approximately 10%),
are indicated on the dotted horizontal lines. The percent of predicted
FEV1 at age 25 is on the vertical axis and age
on the horizontal axis.
From: Peto R, Speizer FE, Cochrane AL, Moore F, Fletcher CM, Tinker CM, et al: The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease. Results from 20 years of prospective observation. Am Rev Respir Dis 1983;128:492.