title: Utilization and effectiveness of pharmacotherapy for tobacco use following admission for exacerbation of COPD.
abstract: BACKGROUND
  Patients admitted for chronic obstructive pulmonary disease (COPD) commonly continue to smoke. The utilization and effectiveness of tobacco cessation medications after discharge is largely unknown. We sought to examine whether pharmacologic treatment of tobacco use following admission for COPD was associated with smoking cessation at 6 to 12 months.
  
  
  METHODS
  Multivariable logistic regression analysis of a cohort of 1334 smokers, discharged from hospital with a COPD exacerbation between 2005 and 2012, identified administratively within the Veterans Affairs Veterans Integrated Service Network-20, adjusted for variables chosen a priori. Our primary exposure was treatment with any 1 or combination of smoking cessation medications within 90 days of discharge determined from pharmacy records, with the outcome of smoking cessation at 6 to 12 months after discharge.
  
  
  RESULTS
  Four hundred fifty (33.7%) of the patients were dispensed a smoking cessation medication, with 53.4% receiving a nicotine patch alone. Overall, 19.8% of patients reported quitting smoking at 6 to 12 months. Compared to those not receiving medications, the odds of quitting were not greater among patients dispensed any single or combination of smoking cessation medications within 90 days of discharge (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.74-1.04). Among patients treated with medications compared to nicotine patch alone, varenicline (OR: 2.44, 95% CI: 1.48-4.05) was associated with increased odds of cessation, and short-acting nicotine replacement therapy alone (OR: 0.66, 95% CI: 0.51-0.85) was associated with decreased odds of cessation.
  
  
  CONCLUSIONS
  Treatment was provided to a minority of subjects and was not associated with cessation, with potential differences observed in effectiveness between medications. Systems-based changes may improve delivery of this key intervention.
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.|Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, Washington.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Melzer
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.|Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, Washington.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Feemster
authors.affiliation: Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, Washington.
authors.forename: Margaret P
authors.initials: MP
authors.lastname: Collins
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.|Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, Washington.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016642:Bupropion / Q000008:administration & dosage; D015331:Cohort Studies; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices / Q000639:trends; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends; D000068580:Varenicline / Q000008:administration & dosage
chemical_list: D016642:Bupropion; D000068580:Varenicline
keywords: Tobacco; chronic obstructive; nicotine replacement therapy; pulmonary disease; smoking