Smoking cessation prescriptions increase when patients have asthma
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Key takeaways:
- The study used the Smoking Status tool in an EHR system to identify smokers.
- Patients identified as nonsmokers also received nicotine and varenicline.
- EHR data can provide feedback about the success of cessation programs.
BOSTON — Smokers with asthma were more likely to be prescribed a smoking cessation treatment than smokers who did not have asthma, according to a poster at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
“Nicotine is a very addictive substance, so, of course, we would love for no one to be smoking. But we understand it is a really hard habit to break, and we’re grateful to be able to assist people with these medications,” Shira Yellin, MD, resident, department of medicine, Icahn School of Medicine at Mount Sinai, told Healio.
“They have worse control of their asthma. They have more hospitalizations for their asthma. They might need more medication for their asthma — just overall, increased health care utilization,” she continued. “Both from an individual standpoint and a public health standpoint, it really is an issue that we want to address.”
Yellin worked with Edward Anselm, MD, assistant clinical professor of medicine at Icahn School of Medicine at Mount Sinai, to collect data on adults in Epic from May 2023 through April 2024 using the electronic health record system’s Slicer Dicer self-service query tool.
Based on the tool’s Smoking Status function, Yellin and Anselm categorized patients as smokers (n = 35,999), nonsmokers (n = 247,943) or unknown (n = 20,244). They also identified patients with asthma based on ICD codes.
Specifically, 11.8% of the patients with asthma and 8.18% of those who did not have asthma were smokers based on results from the Smoking Status tool. Smoking cessation prescriptions included nicotine replacement therapy, varenicline and bupropion.
“There are some patients who are not interested in medication, but because the medication is so effective and is really recommended for anyone who is smoking, we’re using it as a proxy, in this case, for overall smoking cessation counseling,” Yellin said.
Among patients with asthma, nicotine was prescribed for 3,793 smokers, 1,149 nonsmokers and 96 patients with unknown status. Also, 1,088 smokers, 389 nonsmokers and 25 patients with unknown status were prescribed varenicline. Bupropion prescriptions were given to 1,649 smokers, 8,298 nonsmokers and 219 patients with unknown status.
Among patients who did not have asthma, 10,727 smokers, 3,355 nonsmokers and 743 patients of unknown status were prescribed nicotine. Similarly, 3,188 smokers, 1,354 nonsmokers and 131 patients of unknown status received varenicline. Bupropion prescriptions were given to 7,641 smokers, 53,066 nonsmokers and 3,425 patients with unknown status.
“Within asthmatic smokers, rates of prescriptions of any of those three medications was 18.1%, and rates of prescriptions for non-asthmatic smokers was 8.4%,” Yellin said.
“It’s great that the rates were high in asthmatic smokers, but obviously there is still a lot of room to grow in both groups,” Yellin added.
Although Yellin and Anselm called varenicline the most effective medication for smoking cessation, they noted that it was prescribed the least often among patients with and without asthma alike.
The researchers also attributed the high rates of bupropion prescriptions to its indications outside of smoking. But the numbers of patients identified as nonsmokers who received nicotine and varenicline, which do not have any indications outside of smoking cessation, led them to suggest that the Smoking Status tool may not be a reliable indicator.
“There are a lot of nonsmokers who are getting these medications that don’t have other uses,” Yellin said. “That leads us to believe that they really are smokers.”
Further, Yellen and Anselm noted that 36.3% of smokers who saw a doctor in the previous year received medication for smoking cessation, based on National Health Interview Survey Data, which provides the best benchmark data for comparison, they added.
However, the study did not explore why patients with asthma received more smoking cessation prescriptions than those who did not have asthma.
“We would be hypothesizing, but I think that it’s very likely that when a provider sees an asthmatic patient and they know how bad smoking is for that asthmatic condition, they’re very aggressive in trying to get those patients,” Yellin said.
Yelin also said that there is a lot of room for their EHR system to improve documentation of smoking status to make it clear to physicians when their patient needs to discuss smoking cessation.
But despite the numbers of patients who were considered nonsmokers and who received prescriptions for drugs that only treat smoking cessation, Yellin and Anselm concluded that EHRs still can be helpful in assessing the performance of tobacco cessation interventions.
For more information:
Shira Yellin, MD, can be reached at shpyellin@gmail.com.