Normal Limits

"Chance is the very guide of life"

"In practical medicine the facts are far too few for them to enter into the calculus of probabilities... in applied medicine we are always concerned with the individual" -- S. D. Poisson

October 27, 2005

Arch Int Med - Efficacy of Bupropion and Nortriptyline for Smoking Cessation Among People at Risk for or With COPD (Wagena et al 2005)

Bupropion SR is known to be effective in helping smokers quit. Smoking cessation is particular important for patients suffering from COPD, since this is the only things that is known to slow the progression of the disease. This RCT studied the effectiveness of bupropion SR for smoking cessation in patiens with COPD or at risk for it. This is a well-crafted study that enrolled 255 patients, with an impressive less than 5% lost to follow-up at 26 weeks.

Some interesting findings:
- Amongst patients with stages I, II, and III COPD, 27% (12 of 44) of those on bupripion SR vs 8% (4 of 48) of those on placebo remained abstinent from week 4 to week 26 (chi-square p-value 0.02). NNT = 5.3 patients with COPD. (Note that COPD stratification was initially done using the European Respiratory Society definition, but presented with according to the GOLD guideline)
- Amongst depressed patients, 35% (8 of 23) of those on bupropion SR vs 11% (2 of 19) of those on placebo remained abstinent from week 4 to week 26 (Fisher's exact test p-value 0.08... this can be seen as statistically significant because of the exactness and discreteness of Fisher's test). NNT = 4.1 patients at risk for COPD or with COPD who have depression. (Depression was defined as Beck Depression Inventory score <= 15, which is associated with having clinical depression)

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