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Biomedical subjects

P Tønnesen

Publications and source records attributed to P Tønnesen.

At least 19 recordsLinked to original sources
PubMed2004

Essential communication skills in individual smoking cessation.

When dealing with smokers it is important to realize that nicotine addiction plays a major role. Minimal clinic smoking cessation advice by a physician is a powerful motivation to quit and even short intervention (<3 minutes) is effective especially when repeated. There is a dose-response relationship between the number and duration of sessions and quit rate. The optimum programme contains 4-5 sessions of 10-15 minutes duration during the first six weeks after quit day. It is essential that smokers select a target quit day and stop smoking completely on that day as even a few cigarettes per day in the first weeks are strongly related to relapse. Administration of nicotine replacement products or bupropion may double success rates. The communication with smokers should be emphatic and adjusted to the level of change. Barriers to successful smoking cessation and structured interventions are described. The use of the five As to motivated smokers and the five Rs to smokers not ready to quit is recommended. Telephone and written material may supplement clinic visits in the follow-up period.

Antidepressive Agents, Second-Generation↗
PubMed2003

A multicentre, randomized, double-blind, placebo-controlled, 1-year study of bupropion SR for smoking cessation.

BACKGROUND: Bupropion sustained release (bupropion SR) has been shown to increase smoking cessation success rates in the US studies. OBJECTIVE: To determine whether bupropion SR, in combination with counselling, is effective for smoking cessation in a multi-country study. METHODS: This randomized, double-blind, placebo-controlled trial enrolled 707 smokers. A total of 527 received bupropion SR 300 mg daily for 7 weeks and 180 received placebo. A total of 11 clinic visits and 10 telephone contacts were scheduled, during the course of 1 year. Seven-week and 12-month abstinence rates were the study outcomes. RESULTS: Both continuous and weekly point prevalence smoking abstinence rates were significantly higher in the bupropion SR group compared with placebo. The continuous abstinence rate from weeks 4 to 7 was 46% in the bupropion SR group compared with 23% in the placebo group [odds ratio (OR) = 2.82; 95% confidence interval (CI) 1.89-4.28; P < 0.001). At month 12, the continuous abstinence rates were 21% for the bupropion SR group and 11% for the placebo group (OR = 2.19; 95% CI 1.29-3.86, P = 0.002). For most nicotine-withdrawal symptoms small changes were measured. Adverse events were higher for the bupropion SR group compared with placebo (insomnia 24% vs. 15%; dry mouth 13% vs. 5%). CONCLUSION: Bupropion SR in combination with counselling increased the abstinence rate compared with placebo, and was well tolerated.

Adult↗
PubMed2001

[Compliance of patients with chronic obstructive lung disease receiving oxygen therapy at home].

Twenty-nine patients with severe chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT) were prospectively studied for compliance with therapy. Seven patients (24%) used oxygen < 16 hours/day and their mean 24-hour pulse oximetry showed mild hypoxaemia. In addition, we found that eight patients (28%) were smokers. We suggest that the follow-up of these patients should focus on the daily duration of the use of oxygen and cessation of smoking to optimise the effect of this therapy.

Adult↗
PubMed2001

Sociodemographic predictors of success in smoking intervention.

AIM: To examine the role of sociodemographic factors as predictors of sustained smoking cessation for the population who volunteer to participate in intervention programmes. METHOD: Data for the 3575 smokers who participated in the CEASE (collaborative European anti-smoking evaluation) trial, a European multicentred study that used transdermal nicotine patches as an adjunct to smoking cessation in the chest clinic, were analysed. The effects of age, sex, smoking habit, socioeconomic status (housing conditions, education, and employment), disease, smoking habits of relatives, and baseline markers of tobacco use on sustained smoking cessation (self-reported abstinence and expired carbon monoxide < 10 parts per million) were assessed using logistic regression modelling (odds ratio (OR), 95% confidence interval (CI)). RESULTS: 477/3575 smokers were sustained abstainers one year after the intervention (overall success rate 13.3%). In the univariable logistic regression models an effect of active treatment on smoking cessation was observed (OR 1.50, 95% CI 1.15 to 1.96), and additional effects on outcome were found for age (OR 1.02, 95% CI 1.01 to 1.03), sex (men v women: OR 1.38, 95% CI 1.14 to 1.68), housing conditions (OR 1.43, 95% CI 1.25 to 1.65), current respiratory (OR 0.79, 95% CI 0.67 to 0.92) or cardiac disease (OR 0.46, 95% CI 0.28 to 0.75), and markers of tobacco use (cigarettes per day: OR 0.79, 95% CI 0.69 to 0.90; expired carbon monoxide: OR 0.98, 95% CI 0.97 to 0.99). Education and employment did not have a significant effect on the outcome. The effect of the variables associated with success in smoking cessation persisted after adjustment for covariates. CONCLUSION: Age, sex, and housing conditions have a major effect on smoking cessation in European smokers participating in smoking cessation programmes.

Administration, Cutaneous↗
PubMed2000

Smoking cessation with four nicotine replacement regimes in a lung clinic.

Smoking cessation is a key intervention for prevention of several lung diseases. The aim of the present study was to compare the effect of smoking cessation with nicotine replacement in a lung clinic in a low resource set-up suitable for implementation in other lung clinics. This was an open, randomized trial with 4 different nicotine replacement regimes combined with minimal behavioural support in daily routine. A total of 446 smokers (>9 cigarettes x day(-1)) were allocated to a nurse-conducted smoking cessation programme with 4 treatment arms: a 5-mg nicotine patch ("placebo"), a 15-mg nicotine patch, nicotine inhaler, and a 15-mg nicotine patch plus nicotine inhaler. Recommended use of the nicotine products were 3 months with the possibility of continuing use up to 9 months on an individual basis. Individual follow-up studies were scheduled after 2 and 6 weeks, 3, 6, 9 and 12 months. The 12-month point prevalence was 6% (5-mg patch (placebo)), 16% (15-mg patch) (p<0.05), 9% (inhaler) and 11% (15-mg patch plus inhaler), respectively. To conclude, the set-up investigated in this study which included minimal behavioural support with nicotine patches should be evaluated in other lung clinics, as it doubled success rate when compared to a placebo with a 1-yr point prevalence of 16% and also the resources used are limited.

Adult↗
PubMed2000

Adequacy of oxygenation in a group of Danish patients with COPD on long-term oxygen therapy.

The aim of this study was to assess the adequacy of oxygenation in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT) in Copenhagen county. Twenty-six patients were enrolled and assessed prospectively by 24-h pulse oximetry. Patients comprised seven males and 19 females with a mean age of 69 +/- 5 yrs, arterial oxygen tension of 6.5 +/- 0.6 kPa, forced vital capacity of 1.47 L, forced expiratory volume in one second of 0.5 +/- 0.2 L (22 +/- 9% of predicted) and St. George's Respiratory Questionnaire total score of 61 +/- 14. The mean 24-h arterial oxygen saturation measured by pulse oximetry (Sp,O2) was within normal limits (94 +/- 1%), but mild hypoxaemia with a mean Sp,O2 of 89 +/- 4% and a total of 12 +/- 15 desaturation episodes per patient were observed, mostly during daily activities. Multiple regression analysis revealed no significant predictors for patient oxygenation. In summary, 24-h pulse oximetry showed adequate oxygenation in this group of COPD patients on LTOT, though mild hypoxaemia was present during some daily activities.

Aged↗
PubMed1999

Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Collaborative European Anti-Smoking Evaluation. European Respiratory Society.

The Collaborative European Anti-Smoking Evaluation (CEASE) was a European multicentre, randomized, double-blind placebo controlled smoking cessation study. The objectives were to determine whether higher dosage and longer duration of nicotine patch therapy would increase the success rate. Thirty-six chest clinics enrolled a total of 3,575 smokers. Subjects were allocated to one of five treatment arms: placebo and either standard or higher dose nicotine patches (15 mg and 25 mg daily) each given for 8 or 22 weeks with adjunctive moderately intensive support. The 12 month sustained success rates were: 25 mg patch for 22 weeks (L-25), 15.4%; 25 mg patch for 8 weeks (S-25), 15.9%; 15 mg patch for 22 weeks (L-15), 13.7%; 15 mg patch for 8 weeks (S-15), 11.7%; and placebo (P-0) 9.9% (placebo versus 15 mg, p<0.05; 25 mg versus 15 mg, p<0.03; 25 mg versus placebo, p<0.001, Chi-squared test). There was no significant difference in success rate between the two active treatment durations. Of the first week abstainers (n=1,698), 25.1% achieved success at 12 months as opposed to first week smokers, 2.7% of 1,877 subjects (p< 0.001). In summary, a higher than standard dose of nicotine patch was associated with an increase in the long-term success in smoking cessation but continuation of treatment beyond 8-12 weeks did not increase the success rates.

Administration, Cutaneous↗
PubMed1999

Smoking cessation: nicotine replacement, gums and patches.

This is an overview of smoking cessation with a clinical approach. The different nicotine replacement products approximately double the long-term success rate with a dose-response effect, but with an equal efficacy of the different administration forms, so there is no long-term effect of a combination of two products, and they have only mild side-effects. The success rate will increase with the level of adjunctive behavioural support. Total smoking abstinence during the first week after quit-day is a very strong predictor of long-term success. Bupropion, an antidepressant drug, seems to be a promising drug in smoking cessation and is at least equally efficacious as nicotine products. All health care workers in pulmonary units have an obligation to deliver up-to-date smoking cessation services to their smoking patients.

Administration, Cutaneous↗
PubMed1998

Randomized controlled smoking cessation study: transient increase in plasma high density lipoprotein but no change in lipoprotein oxidation resistance.

Low plasma levels of high density lipoprotein (HDL) and high levels of low density lipoprotein (LDL) as well as smoking are known risk factors in coronary heart disease. It has been suggested that oxidative modification renders LDL atherogenic. We investigated the influence of smoking cessation on plasma lipid and lipoprotein levels and on the ability of lipoproteins to resist oxidation in vitro (lag time). A total of 182 healthy smokers who smoked more than 15 cigarettes per day were randomized to stop smoking (smoking cessation group, n = 100) or to continue smoking for 4 weeks (control group, n = 82). The smoking cessation group was followed up after 26 weeks. After 4 weeks, the HDL level had increased from mean +/- SD 1.36 +/- 0.34 to 1.48 +/- 0.40 mmol l-1 (p < 0.001) in 62 successful quitters, while levels were unchanged in the control group (72 subjects in per-protocol analysis). However, after 26 weeks there was no change in HDL (1.34 +/- 0.36 vs. 1.36 +/- 0.35 mmol l-1) in 29 subjects from the smoking cessation group who fulfilled the study. Plasma levels of very low density lipoprotein (VLDL), LDL, total cholesterol, triglycerides and oxidation resistance of VLDL + LDL did not show significant changes any time during the study for either group. Thus, plasma levels of lipids and lipoproteins as well as oxidation resistance of lipoproteins seem unaffected by smoking cessation for 26 weeks.

Adult↗
PubMed1998

Effect of smoking cessation on oxidative DNA modification estimated by 8-oxo-7,8-dihydro-2'-deoxyguanosine excretion.

BACKGROUND: Reactive oxygen species from, e.g. tobacco smoke are suggested to be involved in carcinogenesis by oxidative modification of DNA. The urinary excretion rate of the oxidized nucleoside 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) has been validated as a biomarker of the rate of oxidative DNA modification with mechanistic relation to carcinogenesis. In cross-sectional studies, the urinary excretion rate of 8-oxodG has been shown to be elevated in smokers compared with non-smokers. PURPOSE: In this randomised, controlled smoking cessation study, we investigated whether cigarette smoking per se causes oxidative DNA modification. METHODS: Of the 182 healthy smokers included, 100 were randomized to quit smoking after baseline samples had been taken, and 82 were randomized to continue usual smoking. Before the start of the study and after 4 weeks, the subjects collected 24-h urine samples that were analysed for 8-oxodG content by high-pressure liquid chromatography with electrochemical detection. The subjects randomized to smoking cessation were followed up after 26 weeks. RESULTS: Four weeks of smoking cessation resulted in a 21% decrease in 8-oxodG excretion rate (from mean +/- SD, 30.5 +/- 13.9 to 24.1 +/- 10.5 nmol/24 h, P < 0.001) in 58 quitters included in per-protocol data analysis. Sixty-five continued smokers included in per-protocol analysis showed a 9% decrease in 8-oxodG excretion rate (from 31.6 +/- 13.2 to 28.7 +/- 12.6 nmol/24 h, P = 0.026). After 4 weeks, the 8-oxodG excretion rate was 16% (95% confidence interval 4 to 28%) higher in the continued smokers than in the quitters (P = 0.0085, ANCOVA), demonstrating the effect of smoking per se. A 23% (P < 0.005) decrease in 8-oxodG excretion rate was sustained for 26 weeks in 27 quitters who completed the study. CONCLUSION: Smoking cessation significantly reduces the urinary excretion rate of 8-oxodG, giving direct and controlled evidence that cigarette smoking causes an increased rate of oxidative DNA modification. This could represent a mechanism by which tobacco smoke is carcinogenic.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed1996

The effect of ephedrine plus caffeine on smoking cessation and postcessation weight gain.

OBJECTIVES: To evaluate the efficacy of a combination of ephedrine and caffeine on smoking cessation rates, postcessation weight gain, and withdrawal symptoms and to examine changes in glycosylated hemoglobin (HbA1c) after smoking cessation. METHODS: This randomized double-blind placebo-controlled study with a 1-year follow-up period was carried out at the Department of Pulmonary Medicine in Denmark. Study subjects were 225 heavy smokers who wanted to quit smoking without gaining weight. Two-thirds of the subjects were randomized to receive 20 mg ephedrine plus 200 mg caffeine three times a day; one-third of the subjects received placebo treatment. The dosage was gradually decreased from week 12 to discontinuation at week 39. Group support and control were performed at entry and after 1, 3, 6, 12, 26, 39, and 52 weeks. Main outcome measures were (1) self-reported abstinence with validation by carbon monoxide in expired air and serum cotinine and (2) weight gain. RESULTS: The success rates after 1 year were 17% in the group treated with ephedrine plus caffeine and 16% in the group treated with placebo; the success rates were not significantly different at any time. The success rates for the four counseling physicians varied between 7% and 27% after 1 year (p < 0.05). The weight gain was significantly lower in the ephedrine plus caffeine-treated group during the first 12 weeks, but weight gains were similar after 1 year. No differences in the smoking withdrawal symptoms could be observed between the treatment groups. HbA1c was lower 6 weeks and 1 year after smoking cessation (p < 0.05). CONCLUSIONS: We found an effect of this combination of ephedrine and caffeine on weight gain during the first 12 weeks, but we found no effect on the success rates or craving for cigarettes.

Adult↗
PubMed1996

Recycling of hard-core smokers with nicotine nasal spray.

The primary aim of this smoking cessation study was to evaluate the effect of long-term treatment with nicotine nasal spray in a group of hard-core smokers. A further aim was to compare the effect of ad libitum with fixed dosage of nasal nicotine spray. Eighty nine smokers, failures from two earlier studies with nicotine patches, were enrolled in an open smoking cessation study with nicotine nasal sprays, to be used ad libitum (n=45) or on a fixed schedule of 1 mg x h-1 during the day (n= 44). Carbon monoxide-verified continuous abstinence from smoking beyond Week 2, was 39% at 3 weeks, 12% at 3 months, 10% at 6 months and 6% after 1 yr, with no significant difference in success rate between ad libitum and fixed dosing. Mean daily nicotine dose was 15-16 mg during the first 3 months (range 2-65 mg). Tolerance to local irritating side-effects of nicotine developed during the first weeks of use. Although short-term outcome was promising, the long-term success rate in this group of hardcore smokers was low. Other recycling set-ups are warranted, which might include more aggressive nicotine dosing.

Administration, Intranasal↗
PubMed1996

Nurse-conducted smoking cessation with minimal intervention in a lung clinic: a randomized controlled study.

This study aimed to evaluate the effect of a motivational, minimal intervention approach to smoking cessation in an open, randomized design conducted by nurses as routine work in a lung clinic. Subjects who smoked less than 10 cigarettes x day(-1), and subjects who smoked > or = 10 cigarettes x day(-1) and who had refused to participate in a smoking cessation trial with nicotine replacement therapy, were randomly allocated to a motivational approach to smoking cessation or to a control group. The motivational approach consisted of a nurse-conducted 5 min consultation concerning reasons to quit smoking, brochures about smoking cessation and advice about how to quit. After 4-6 weeks, subjects in the motivational group received a letter encouraging them to quit smoking. After 1 year, all subjects were contacted by phone and smoking status reported. Subjects claiming to be abstinent attended the clinic for carbon monoxide verification. A total of 507 subjects were enrolled, 254 in the motivational group and 253 in the control group. The mean age of the motivational group was 51 yrs, 50% were males and they smoked a mean of 13 cigarettes x day(-1). The mean age of the control group was 53 yrs, 61% were males and they smoked a mean of 12 cigarettes x day(-1). At the 1 year follow-up, the success rate for point prevalence (no smoking at 1 year and during the preceding month) was 8, 7% in the motivational group versus 3.6% in the control group (p=0.025). The 12 months sustained success rate (no smoking at all during the year) was 3.1 versus 1.2% (p=0.22). The point prevalence for light smokers (<10 cigarettes x day(-1)) was 13.9% in the motivational group versus 6.3% in control group (p=0.12), and for heavy smokers (10 or more cigarettes x day(-1)) 5.2% versus 1.9% (p=0.20). In conclusion, the effect of this nurse-conducted, minimal intervention, motivational approach seems promising as the quit rate at 1 year follow-up had doubled.

Adult↗