Factores predictores de éxito en el tratamiento del tabaquismo

María Laura Llambí; Elba Esteves; María Laura Blanco; Mary Barros; Carolina Parodi; Beatriz Goja

Authors

María Laura Llambí Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Policlínica de Cesación de Tabaquismo, Integrante. Clínica Médica "A", Ex asistente
Elba Esteves Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Policlínica de Cesación de Tabaquismo, Integrante. Clínica Médica "A", Ex asistente. Universidad de Sevilla, Master en Tabaquismo
María Laura Blanco Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Policlínica de Cesación de Tabaquismo, Integrante. Servicio Social
Mary Barros Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Policlínica de Cesación de Tabaquismo, Integrante. Departamento de Psicología Médica. Ex asistente
Carolina Parodi Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Policlínica de Cesación de Tabaquismo, Integrante. Clínica Médica "A", Ex asistente
Beatriz Goja Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Policlínica de Cesación de Tabaquismo, Coordinadora. Clínica Médica "A", Profesora Agregada

Keywords:

SMOKING CESSATION, SMOKING

Abstract

Introduction: current treatments for tobacco use and dependence attain quitting percentages around 30% for the long term. Identifying predicting factors for success would enable more suitable therapeutic interventions, thus improving results.
Objective: to learn about quit rates in a tobacco dependence program and to identify the treatment’s predicting factors for success.
Method: a descriptive study was conducted and cut off points were analyzed. Variables studied included: age, sex, level of education, living with people who smoke, number of cigarettes per day (cpd), Fagerström test, previous periods of smoking abstinence, tobacco-dependent diseases, history of depression, physical exercise, modality and adherence to treatment, use of drugs. Patients were contacted by phone, a year after they had finished treatment. Abstinence (self-reported) was defined as not having smoked in the last 30 days.
Results: 143 people were contacted: 55.9% of them were women, average age was 46. Quit rate a year after was 35%. Significantly better results (p=0,009 y p=0,039, respectively) were achieved when the cpd was < 20 cpd. The Fagerström test was < 4, and the same was found when there was no history of depression (p=0,043), when people practiced physical exercise (p=0,011), when they adhered to the treatment (p<0,001) and use of drugs (p<0,001).
Multivariate analysis showed that adherence to treatment, use of drugs and the absence of a history of depression increases three to four times the chance for success.
Conclusions: specific drugs, adherence to treatment, and the absence of a history of depression proved to be predicting factors for success of treatment. A wider access to pharmacological treatment is fundamental to increase the abstinence for the long term.

References

(1) Goja B, Esteves E, Barros M, Blanco L, Benia W, Parodi C, et al. Caracterización de la población asistida en la policlínica de tabaquismo del Hospital de Clínicas y resultados del tratamiento. Arch Med Int 2005; 28(4): 83-8.
(2) Dale L, Glover E, Sachs D, Schroeder D, Offord K, Croghan I, et al. Bupropion for smoking cessation: predictors of successful outcome. Chest 2001; 119 (5): 1357-64.
(3) Torrecilla M, Barrueco M, Maderuelo J, Jiménez Ruiz C, Plaza M, Hernández M. ¿Se puede predecir el éxito de la intervención mínima en tabaquismo? Prev Tab 2001; 3(1): 13-9.
(4) Bustamante Navarro R, Lobregad Espuch C, Hidalgo Quiles M, Schwarz Chavarri H, de la Cruz E. Características de los fumadores que acuden a una unidad de tabaquismo en régimen ambulatorio. Prev Tab 2005; 7(1): 11-6.
(5) Vila Roig B, Adell Aparicio C, Bell Panisello C, Tolosa Martínez N, Brau Beltrán J. Características de fumadores que acuden a una consulta de deshabituación tabáquica (2001-2003). Prev Tab 2003; 5 (Supl 1): 51.
(6) Nerín I, Crucelaegui A, Mas A, Guillén D. Perfil de los fumadores que solicitan tratamiento en una Unidad de Tabaquismo. Arch Bronconeumol 2003; 39: 298-302.
(7) López Varela MV, Anido T, Rovira 0, Goja B, Tubino M, Alfonso G, et al. Factores asociados con la abstinencia y eficacia de un programa de cesación de tabaquismo. Rev Med Uruguay 2007; 23(1): 25-33.
(8) Camps X, Frascheri M, Buroni C. Análisis del funcionamiento de un programa de cesación de tabaquismo. Rev Urug Cardiol 2005; 20(1): 16-20.
(9) Royce J, Corbet K, Sorensen G, Ockene J. Gender, social pressure and smoking cessations: the Community Intervention Trial for Smoking Cessation (COMMIT) al baseline. Soc Sci Med 1997; 44(3): 359-70.
(10) Hyland A, Li Q, Bauer J, Giovino G, Steger C, Cummings K. Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res 2004; (Suppl3): S363-9.
(11) Monso E, Campbell J, Tonnesen P, Gustavsson G, Morera J. Sociodemographic predictors of success in smoking intervention. Tob Control 2001; 10(2): 165-69.
(12) Bohadana A, Nilsson F, Rasmussen T, Martinet Y. Gender differences in quit rates following smoking cessation with combination nicotine therapy: influence of baseline smoking behaviour. Nicotine Tob Res 2003; 5(1): 111-6.
(13) García M, Schiaffino A, Twose J, Borrell C, Saltó E, Peris M, et al. Abandono del consumo de tabaco en una cohorte de base poblacional. Arch Bronconeumol 2004; 40: 348-54.
(14) Osler M, Prescot E. Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults. Tob Control 1998; 7: 262-7.
(15) Crucelaegui A, Nerón I, Sobradiel N, Belmonte A, Novella P, Bernal V, et al. Factores predictores de éxito a los seis meses en fumadores tratados en una unidad de tabaquismo. Prev Tab 2004; 6 (Supl. 1): 175-6.
(16) Croghan I, O’Hara M, Schroeder D, Patten C, Croghan G, Hays J, et al. A community-wide smoking cessation program: Quit and Win 1998 in Olmsted county. Prev Med 2001; 33(4): 229-38.
(17) Wetter D, Cofta-Gunn L, Irvin J, Fouladi R, Wright K, Daza P, et al. What accounts for the association of education and smoking cessation? Prev Med 2005; 40(4): 4524-60.
(18) Alonso B, Pérez-Ríos M, Santiago M. Características y factores que condicionaron las recaídas de los participantes en "Deixao E Gaña". Prev Tab 2004; 6 (Supl. 1): 137.
(19) Franquet M, Castella J, Rebull T, Catalán C, Estrada T. Efectividad de un programa de deshabituación tabáquica: variables predictoras. Prev Tab 2004; 6 (supl. 1): 177.
(20) Pirie P, Lando H, Curry S, McBride C, Grothaus L. Tobacco, alcohol, and caffeine use and cessation in early pregnancy. Am J Prev Med 2000; 18(1): 54-61.
(21) Krall E, Garvey A, Garcia R. Smoking relapse after 2 years of abstinence: findings from the VA Normative Aging Study. Nicotine Tob Res 2002; 4(1): 95-100.
(22) Hymowitz N, Jaffe F, Gupta A, Feuerman M. Cigarette smoking among patients with mental retardation and mental illness. Psychiatr Serv 1997; 48(1): 100-2.
(23) Beltrán Garrido J, Sabidó M, Olona N, Masip J, Ortiga B, Rodríguez Pérez E, et al. Papel de los antecedentes psiquiátricos en el hábito tabáquico, en la dependencia y en la respuesta al tratamiento de una cohorte tratada en una unidad de deshabituación hospitalaria. Prev Tab 2004; 6 (Supl. 1): 175.
(24) Lasser K, Boyd J, Woolhandler S, Himmelstein D, Mc Cormick D, Bor D. Smoking and mental illness: a population-based prevalence study. JAMA 2000; 284(20): 2606-10.
(25) Ussher M, West R, Taylor A, McEwen A. Exercise interventions for smoking cessation. Cochrane Database Syst Rev. [base de datos en Internet]. 2007; (4): CD002295. Disponible en: http://cochrane.bvsalud.org/cochrane/main.php? (Consulta: enero 2008).
(26) Stead L, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev. [base de datos en Internet]. 1998; (3): CD001007. Disponible en: http://www.cochrane.org/reviews/en/ab001007.html. (Consulta: enero 2008).
(27) Hughes J, Stead L, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev [base de datos en Internet]. 1997; (3): CD000031. Obtenido de: http://www.cochrane.org/reviews/en/ab000031.html (Consulta: enero 2008).
(28) Sylagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. [base de datos en Internet]. 1996; (3): CD000146. Disponible en: http://www.cochrane.org/reviews/en/ab000146.html (Consulta: enero 2008).