title: Smoking cessation for people with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Smoking cessation is the most important treatment for smokers with chronic obstructive pulmonary disease (COPD), but little is known about the effectiveness of different smoking cessation interventions for this particular group of smokers.
  
  
  OBJECTIVE
  To evaluate the effectiveness of behavioural or pharmacological smoking cessation interventions, or both, in smokers with COPD.
  
  
  METHODS
  We searched all records in the Cochrane Airways Group Specialised Register of Trials. In addition to this electronic search, we searched clinical trial registries for planned, ongoing, and unpublished trials. We searched all databases from their inception. We checked the reference lists of all included studies and of other systematic reviews in relevant topic areas. We searched for errata or retractions from eligible trials on PubMed. We conducted our most recent search in March 2016.
  
  
  METHODS
  We included randomised controlled trials assessing the effectiveness of any behavioural or pharmacological treatment, or both, in smokers with COPD reporting at least six months of follow-up abstinence rates.
  
  
  METHODS
  Two review authors independently extracted the data and performed the methodological quality assessment for each study. We resolved any disagreements by consensus.
  
  
  RESULTS
  We included 16 studies (involving 13,123 participants) in this systematic review, two of which were of high quality. These two studies showed that nicotine sublingual tablet and varenicline increased the quit rate over placebo (risk ratio (RR) 2.60 (95% confidence interval (CI) 1.29 to 5.24) and RR 3.34 (95% CI 1.88 to 5.92)). Pooled results of two studies also showed a positive effect of bupropion compared with placebo (RR 2.03 (95% CI 1.26 to 3.28)). When pooling these four studies, we found high-quality evidence for the effectiveness of pharmacotherapy plus high-intensity behavioural treatment compared with placebo plus high-intensity behavioural treatment (RR 2.53 (95% CI 1.83 to 3.50)). Furthermore, we found some evidence that high-intensity behavioural treatment increased abstinence rates when compared with usual care (RR 25.38 (95% CI 8.03 to 80.22)) or low-intensity behavioural treatment (RR 2.18 (95% CI 1.05 to 4.49)). Finally, the results showed effectiveness of various combinations of psychosocial and pharmacological interventions.
  
  
  CONCLUSIONS
  We found high-quality evidence in a meta-analysis including four (1,540 participants) of the 16 included studies that a combination of behavioural treatment and pharmacotherapy is effective in helping smokers with COPD to quit smoking. Furthermore, we conclude that there is no convincing evidence for preferring any particular form of behavioural or pharmacological treatment.
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands.
authors.forename: Eva A M
authors.initials: EA
authors.lastname: van Eerd
authors.forename: Regina M
authors.initials: RM
authors.lastname: van der Meer
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
authors.forename: Daniel
authors.initials: D
authors.lastname: Kotz
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D016642:Bupropion / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009538:Nicotine / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive; D016032:Randomized Controlled Trials as Topic; D016540:Smoking Cessation / Q000379:methods*; D000068580:Varenicline / Q000627:therapeutic use
chemical_list: D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine; D000068580:Varenicline