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Zyban Helps Ill Hardcore Smokers Quit

A slight boost for those with lung disease

THURSDAY, May 17, 2001 (HealthDayNews) -- The drug Zyban can help hardcore smokers quit, even people who still smoked while suffering chronic lung disease caused by their habit, says a new study.

Zyban, or bupropion, is an antidepressant that reduces smokers' cravings for nicotine. Earlier studies have shown that the drug is nearly twice as effective as other cessation therapies, such as the nicotine patch, though rates of long-term abstinence are only about 15 percent to 20 percent.

The latest work suggests the drug also is effective in people with a long history of smoking who have a more stubborn addiction to nicotine than casual tobacco users. The study was funded by GlaxoSmithKline which makes the drug.

"Patients who continue to smoke despite the fact that they have a smoking-related disease have a harder time quitting," says lead study author Dr. Donald Tashkin, a lung specialist at the University of California at Los Angeles. Findings appears in the May 19 issue of The Lancet.

"We know that these people are at particularly high risk for developing serious disability down the road" as the decline in their lung function accelerates, he says. "So it's really important to get these people to stop smoking."

Tashkin and his colleagues at 11 medical centers compared sustained-release Zyban to a placebo in 404 heavy smokers with mild or moderate emphysema or chronic bronchitis, which fall under the umbrella term chronic obstructive pulmonary disease (COPD).

Half the subjects, who smoked an average of 1.5 packs of cigarettes a day before the 12-week study, received 300 milligrams a day of the drug while half took a dummy pill. All were given behavioral counseling to help them quit.

Nearly 30 percent of the Zyban group abstained from smoking for four to seven weeks, compared with 16 percent of those who received the placebo, the researchers say.

However, abstinence rates in each group waned as the study progressed. By the twelfth week, 18 percent of subjects on Zyban were smoke-free, compared with 10 percent of the others. After another six months, only 16 percent in the Zyban group and 9 percent of those on counseling alone, remained off tobacco.

Subjects who took the antidepressant reported fewer and weaker cravings for nicotine than the others. Seven people on Zyban dropped out of the study because of bad reactions to the drug.

"The results are not fantastic, but nevertheless they are substantial and useful," Tashkin says.

"It's nice to see that there's a tool that can be used to help people with COPD stop smoking," says Dr. Norman Edelman, a spokesman for the American Lung Association and dean of the State University of New York School of Medicine.

On the other hand, Edelman says, "you really want to know how many [smokers] are still off cigarettes at six months or a year. There's recidivism, so that the difference between the treated and control group tends to be less" over time.

What To Do

Between 10 percent and 15 percent of smokers, and 10 million to 15 million Americans overall, have COPD. The condition kills nearly 100,000 Americans year. In less than 20 years, experts predict that COPD will be one of the top five health burdens worldwide.

Although emphysema and chronic airway inflammation can take 20 years to cause breathing symptoms, even teen smokers show early signs of smoldering lung damage, Tashkin says. Once COPD sets in, it can't be reversed. However, quitting smoking will lead to immediate improvements in lung function and is the only "treatment" proven to slow the progression of the disease.

For a review of smoking cessation resources on the Web, try About.com.

COPD-Support and the National Emphysema Foundation have more about the disorders.

Read other HealthScout articles about smoking cessation.

SOURCES: Interviews with Donald Tashkin, M.D., professor of medicine, University of California at Los Angeles School of Medicine, and Norman Edelman, M.D., consultant for scientific affairs, American Lung Association, and dean, School of Medicine, State University of New York, Stony Brook; May 19, 2001 The Lancet
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