LAUSR

Background Tobacco dependence is a significant cause of morbidity and mortality in patients with respiratory disease for which there is evidence-based treatment. This includes behaviour change support (BCS), nicotine replacement therapy (NRT) and varenicline. We have previously reported a 41% 6-month quit rate for a cohort of smokers admitted with respiratory disease treated with varenicline.1 Aim The aim of this study was to evaluate 5-year outcomes for a cohort of respiratory ward inpatients started on varenicline, with BCS and NRT, during hospital admission. Methods We retrospectively reviewed the electronic records (Hospital/General Practice access) for 44 respiratory inpatients1 prescribed varenicline August 2012 to January 2014 for demographics, diagnoses, spirometry, smoking history, admissions and death. Patients not seen recently had telephone follow-up; death certificates were reviewed for hospital deaths. Primary outcomes were death, current smoking status (clinician/patient reported) and admissions/bed-days since index admission. Results Data was available for 39/44 patients (89%); table 1 shows patient characteristics and outcomes. Eighteen (46%) patients died within 5 years of index admission with mean age at death 67 years; 16/18 (89%) patients who died had COPD and 78% (14/18) remained tobacco dependent. Cause of death for 3/4 (75%) patients, where certificate available, was a smoking-related cause. Six of 21 (29%) patients alive at 5 years were ex-smokers. Over 5 years from index admission ex-smokers had a lower but non-significant number of admissions and bed-days compared to smokers; mean admissions 2.0 v 3.1 and bed-days 16 v 25.Abstract S1 Table 1 Patients characteristics and 5-year outcomes for respiratory inpatients treated with varenicline (with behaviour change support and nicotine replacement therapy) during index admission August 2012–January 2014 Diedn= 18 Alive Current smoker n= 15 Alive Ex-smoker n= 6 Age mean (range) years 67 (42–82) 59 (29–80) 71 (49–88) COPD n (%) 16 (89%) 7 (47%) 5 (83%) Asthma n (%) 2 (11%) 11 (73%) 3 (50%) Asthma and COPD n (%) 2 (11%) 6 (40%) 2 (33%) FEV1 mean (SD) L 0.94 (0.55) n=15 1.63 (0.80) n=13 1.27 (0.47) n=6 FVC mean (SD) L 1.99 (1.68) n=3 2.51 (1.05) n=10 2.35 (0.43) n=5 Charlson comorbidity index mean (range) 5.1 (2–10) 3.3 (0–7) 5 (2–8) Pack-years at index admission median (range) 63 (20–140) 35 (8–100) 72 (20–120) Cannabis/smoked drugs at index admission n (%) 2 (11%) 3 (20%) 0 (0%) Further admissions over 5 years or until death mean (range) n 2.8 (0–11) 3.1 (0–13) 2.0 (0–6) Bed-days over 5 years or until death mean (range) n 41 (0–234) 25 (0–116) 16 (0–42) Conclusions This group of patients who were tobacco dependent and admitted with respiratory disease had a very high 5-year mortality at almost 50% and mean age of death was only 67 years. Quit rate at 5 years in those still alive was 29%; down from 41% at 6-months.1 Over 5 years continuing smokers had an average of three further admissions and 25 days in hospital. Yet nationally fewer than one in two inpatients are offered treatment for tobacco dependence. This study highlights the importance of clinical teams treating tobacco dependence as a relapsing-remitting long-term condition at every contact point. Reference Ainley, et al. Thorax 2014;69(Suppl 2):A199.