Action to Stop Smoking in Suspected Tuberculosis (ASSIST) in Pakistan: A Cluster Randomized, Controlled Trial
Publication: Annals of Internal Medicine
Volume 158, Number 9
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Abstract
Background:
Tobacco use is responsible for a large proportion of the total disease burden from tuberculosis. Pakistan is one of the 10 high-burden countries for both tuberculosis and tobacco use.
Objective:
To assess the effectiveness of a behavioral support intervention and bupropion in achieving 6-month continuous abstinence in adult smokers with suspected pulmonary tuberculosis.
Design:
Cluster randomized, controlled trial. (Current Controlled Trials: ISRCTN08829879)
Setting:
Health centers in the Jhang and Sargodha districts in Pakistan.
Patients:
1955 adult smokers with suspected tuberculosis.
Intervention:
Health centers were randomly assigned to provide 2 brief behavioral support sessions (BSS), BSS plus 7 weeks of bupropion therapy (BSS+), or usual care.
Measurements:
The primary end point was continuous abstinence at 6 months after the quit date and was determined by carbon monoxide levels in patients. Secondary end points were point abstinence at 1 and 6 months.
Results:
Both treatments led to statistically significant relative risks (RRs) for abstinence compared with usual care (RR for BSS+, 8.2 [95% CI, 3.7 to 18.2]; RR for BSS, 7.4 [CI, 3.4 to 16.4]). Equivalence between the treatments could not be established. In the BSS+ group, 275 of 606 patients (45.4% [CI, 41.4% to 49.4%]) achieved continuous abstinence compared with 254 of 620 (41.0% [CI, 37.1% to 45.0%]) in the BSS group and 52 of 615 (8.5% [CI, 6.4% to 10.9%]) in the usual care group. There was substantial heterogeneity of program effects across clusters.
Limitations:
Imbalances in the urban and rural proportions and smoking habits among treatment groups, and inability to confirm adherence to bupropion treatment and validate longer-term abstinence or the effect of smoking cessation on tuberculosis outcomes.
Conclusion:
Behavioral support alone or in combination with bupropion is effective in promoting cessation in smokers with suspected tuberculosis.
Primary Funding Source:
International Development Research Centre.
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Supplemental Material
Supplement 1. Tobacco Cessasion Desk Guide: Five Steps to Quit
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Information & Authors
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Published In
Annals of Internal Medicine
Volume 158 • Number 9 • 7 May 2013
Pages: 667 - 675
History
Published online: 7 May 2013
Published in issue: 7 May 2013
Keywords
Copyright
© 2013 American College of Physicians.
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Action to Stop Smoking in Suspected Tuberculosis (ASSIST) in Pakistan: A Cluster Randomized, Controlled Trial. Ann Intern Med.2013;158:667-675. [Epub 7 May 2013]. doi:10.7326/0003-4819-158-9-201305070-00006
Action to Stop Smoking in Suspected Tuberculosis (ASSIST) in Pakistan: A Cluster Randomized, Controlled Trial. Ann Intern Med.2013;158:667-675. [Epub 7 May 2013]. doi:10.7326/0003-4819-158-9-201305070-00006
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