Therapieën voor stoppen met roken (antidepressiva, nicotinevervanging en counseling) en implicaties voor de behandeling van patiënten met chronische obstructieve longziekte

Only a small percentage of smokers who state they want to stop smoking in the next half year, succeed in doing so. This is not only due to the addictive nature of smoking cigarettes, but also because of psychological and social factors. Approximately 80% of the people who have used nicotine-replacement therapy return to smoking after some time. Therefore, the interest in non-nicotine pharmacotherapy has increased considerably in recent years. The antidepressants bupropion and nortriptyline are, compared to a placebo, particularly effective smoking cessation aids (relative risk (RR)_{nortriptyline}: 2.7; 95% CI: 1.3-5.3; RR_bupropion: 1.5; 95% CI: 1.1-2.6). A combined strategy of nicotine-replacement therapy with counselling or antidepressants (bupropion or nortriptyline) with counselling, in which the physiological as well as the psychological aspects of smoking cessation are treated, seems to be the most effective. Although smoking cessation is seen as the single most important way of preventing a further deterioration of the lung function at all stages of chronic obstructive pulmonary disease (COPD), little research has been conducted amongst COPD patients. Especially the use of the antidepressants bupropion or nortriptyline seems particularly interesting for the treatment of patients with COPD. This is not only because smoking cigarettes is the major risk factor for the development of the disease, but also because COPD patients have a higher than normal prevalence of depression. Furthermore, an association has been found between smoking cigarettes and depression, and the presence of depression or depressive symptoms appears to be an important cause of relapse.