Tabakentwöhnung – wirksam und kosteneffektiv

Was ist neu?

Tabakentwöhnung in der Klinik – OPS 9–501 Tabakentwöhnung Im Krankenhaus kann durch Gespräche, pharmakologische Hilfen und vor allem eine Weiterbetreuung in ambulanten Strukturen eine effektive Entwöhnung organisiert werden. Medizinische Fachgesellschaften bemühen sich um eine adäquate Finanzierung im DRG-System.

Pharmakologische Unterstützung Eine pharmakologische Unterstützung auch mit Vareniclin ist effektiv und sicher.

Goldstandard: Gespräche plus Pharmakotherapie Gespräche plus Pharmakotherapie sind wirksamer als jede Therapie für sich allein.

Tabakentwöhnung bei manifesten Erkrankungen Für die wesentlichen tabakassoziierten Erkrankungen wie die koronare Herzerkrankung oder die chronisch-obstruktive Lungenerkrankung sind positive Effekte auf Morbidität und Mortalität durch hochwertige Metaanalysen abgesichert.

Schwere Verläufe von COVID-19 bei Rauchern Rauchen ist ein erheblicher Risikofaktor für eine Coronavirus-Infektion und einen schweren Krankheitsverlauf.

E-Zigarette zur Tabakentwöhnung? Die Daten zu toxischen Langzeitfolgen wie zur langfristigen Effektivität der E-Zigaretten in der Tabakentwöhnung sind noch unklar. Dual use ist häufig. Die E-Zigarette kann daher weiterhin nicht zur Tabakentwöhnung empfohlen werden.

Abstract

In hospital, effective smoking cessation can be organized through counselling, pharmacological aids and, above all, continuous care in outpatient structures following discharge. Pharmacological treatment has proven to be effective and safe with nicotine replacement therapy as well as varenicline. Counselling plus pharmacotherapy is more effective in combination than either therapy is on its own. To better implement structures medical societies in Germany are seeking adequate funding e. g. in the DRG system for hospitalised patients.

There are obvious and relevant benefits in smoking cessation. Not only for the main tobacco-related diseases such as coronary heart disease or chronic obstructive pulmonary disease (COPD), positive effects of quitting on morbidity and mortality have been confirmed by high-quality meta-analyses. Furthermore, quality of life is increasing following cessation. Presently, smoking is found to be a significant risk factor for severe disease and mortality following coronavirus infection.

Do e-cigarettes offer an alternative in smoking cessation? No. Animal and human data are suggesting toxic effects especially following longer use. The long-term effectiveness of e-cigarettes in tobacco cessation is still uncertain and epidemiologic data clearly point toward ineffectiveness. Furthermore, dual use with potentiation of the toxic effects is common. Therefore, e-cigarettes cannot be recommended for tobacco cessation.

Schlüsselwörter

Tabakentwöhnung - Krankenhaus - Pharmakotherapie - E-Zigaretten - COVID-19

Key words

smoking cessation - hospitalised patients - pharmacotherapy - E-cigarettes - COVID-19

Publication History

Article published online:
01 June 2021

• Literatur

• 1 Kotz D, Batra A, Kastaun S. Smoking Cessation Attempts and Common Strategies Employed. Dtsch Arztebl Int 2020; 117: 7-13
• 2 Reid RD, Mullen KA, Slovinec D'Angelo ME. et al Smoking cessation for hospitalized smokers: an evaluation of the „Ottawa Model“. Nicotine Tob Res 2010; 12: 11-18
• 3 Mullen KA, Manuel DG, Hawken SJ. et al Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes. Tob Control 2017; 26: 293-299
• 4 Andreas S, Jany B, Hering T. et al OPS 9-501 Multimodale stationäre Behandlung zur Tabakentwöhnung. Pneumologie 2018; 72: 103-105
• 5 Rigotti NA, Clair C, Munafò MR. et al Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev 2012; 5: Cd001837
• 6 Lindson N, Chepkin SC, Ye W. et al Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2019; 4: CD013308
• 7 Kotz D, Viechtbauer W, Simpson C. et al Cardiovascular and neuropsychiatric risks of varenicline: a retrospective cohort study. Lancet Respir Med 2015; 3: 761-768
• 8 van den Brand FA, Nagelhout GE, Reda AA. et al Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev 2017; 9: CD004305
• 9 Wang MP, Suen YN, Li WH. et al Intervention with brief cessation advice plus active referral for proactively recruited community smokers: A pragmatic cluster randomized clinical trial. JAMA Intern Med 2017; 177: 1790-1797
• 10 Jiménez-Ruiz CA, Andreas S, Lewis KE. et al Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J 2015; 46: 61-79
• 11 Alqahtani JS, Oyelade T, Aldhahir AM. et al Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A rapid systematic review and meta-analysis. PLoS One 2020; 15: e0233147
• 12 Bozier J, Chivers EK, Chapman DG. et al The evolving landscape of e-Cigarettes: A systematic review of recent evidence. Chest 2020; 157: 1362-1390
• 13 Wills T, Soneji S, Choi K. et al E-cigarette use and respiratory disorder: An integrative review of converging evidence from epidemiological and laboratory studies. Eur Respir J 2021; 57: 1901815
• 14 Hartmann-Boyce J, McRobbie H, Lindson N. et al Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2020; 10: CD010216
• 15 Pierce JP, Benmarhnia T, Chen R. et al Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16. PLoS One 2020; 15: e0237938