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    COPD and pharmacotherapy for smoking cessation at the VA: Study

    Kathryn WheelerKathryn WheelerSmoking cessation is the most effective intervention for patients with chronic obstructive pulmonary disease (COPD), yet many patients continue to smoke even after hospitalization for an exacerbation, and treatment rates for tobacco abuse after a hospital stay are often low.

    Identifying the differences between patients who receive therapy for tobacco cessation and those who do not could help improve standards for the prescribing of post-discharge tobacco-cessation therapy.

    See also: MTM essentials for COPD management, Part 1

    The study

    Researchers reviewed the electronic medical records in the Veterans Affairs Veterans Integrated Service Network (VISN-20) for a cohort of current smokers admitted to a hospital for a COPD exacerbation. 

    Researchers identified 1,511 current smokers older than 39 years of age and hospitalized between 2005 and 2012 with a primary discharge diagnosis of COPD or an admission diagnosis indicative of a COPD exacerbation. Patients without a documented smoking status or who died during admission were excluded. 

    Pharmacy records supplied information about which patients met the primary outcome, receipt within 48 hours of hospital discharge of medication approved to aid with smoking cessation.  

    Each patient’s medical record was examined for possible predictors of tobacco-cessation therapy use during the index admission and for the previous year. Sensitivity analysis reviewed the use of bupropion during and after hospital admissions, and noted inclusion of COPD diagnosis as a primary discharge diagnosis. These analyses revealed no significant differences in observed effects. 

    See also: MTM for COPD management, Part 2

    The findings

    Overall findings were similar to those of other studies: Use of tobacco-cessation therapy was low.

    Only 17.5% of patients in this study received tobacco-cessation therapy as an inpatient. Of these patients, only 44.7% were dispensed such therapy after discharge from the hospital.

     A nicotine replacement patch was the most commonly prescribed outpatient therapy. 

    Kathryn Wheeler, PharmD, BCPS
    Kathryn Wheeler, PharmD, BCPS, is assistant clinical professor of pharmacy practice, University of Connecticut School of Pharmacy, ...


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