Introduction Smoking is a significant cause of respiratory disease and risk factor for chronic obstructive pulmonary disease (COPD) and asthma admissions. 70% of smokers admitted to hospital want to quit and quit smoking interventions during acute admission are NICE recommended.¹ Many patients with respiratory disease are highly nicotine-dependent and varenicline is an effective treatment^1,2 but is not routinely initiated during admission.

Method We retrospectively reviewed the notes of all patients prescribed varenicline during in-patient stay on the respiratory ward over 18 months (August 2012–January 2014). Baseline data included demographics, disease details (diagnosis, spirometry) and smoking history (tobacco/cannabis use, pack/joint-years). The primary outcomes were carbon monoxide (CO) validated quit rates at 4-weeks and self-reported quit rates at 6-months and 1-year.

All patients were seen on the ward by a smoking cessation advisor and after discharge as per NICE guidance.¹ Nicotine withdrawal during varenicline initiation was treated with standard combination nicotine replacement therapy.¹

Results 44 patients (17M:27F) were prescribed varenicline during admission. Mean (range) age was 61 (23–81) years with median (range) 50 (8–180) pack-years. 8/44 (18%) also smoked cannabis. 29 (66%) had COPD, 7 (16%) asthma, and 8 (18%) had both. Mean (SD) FEV₁ was 1.18 (0.52)L (n = 40) with FEV₁%predicted 47 (21)% (n = 26). 7 patients (16%) died; all from smoking-related diseases, within 18 months of admission with mean (range) age at death 71 (61–78) years. 2 were lost to follow-up. CO-validated 4-week quit rate was 48% (21/44). Self-reported 6-month and 1-year quit rates were 41% (18/44) and 20% (9/44) respectively. Only 4/44 (9%) stopped varenicline early due to side-effects (nausea/headache).

Conclusion Varenicline was safe and well-tolerated when initiated in hospital. The 4-week 48% quit rate for these ‘sick’ smokers was almost as high as the 52% national target for ‘well’ smokers. Self-reported 6-month quit rates were almost as good as the best published rates with intensive support in COPD (41% cf 49%).² Varenicline should be used as a treatment for smokers admitted with respiratory disease.¹

References

1. NICE PH guidance 48. Smoking cessation in secondary care. 2013

2. Jiménez Ruiz et al. Nicotine and Tobacco Research. 2012;14(9):1035-1039