| Summary: | Introduction
Cigarette smoking is the most important risk factor for Crohn’s disease
(CD). The effectiveness of smoking cessation programs (SCPs) in patients with
CD is still poorly understood.
Methods
This was a retrospective, observational, single-centre, cohort study of
136 active smokers with mean age 55 years (SD=11), 58% males, including 27
(19.8%) patients with CD who entered the multidisciplinary SCP of the Luigi
Sacco University Hospital of Milan from January 2017 through January 2019. A
pulmonologist was responsible for the clinical and pharmacological management,
while a psychiatrist and a psychologist conducted the counselling and assessed
the motivation to quit, anxiety and depression using the Brief Psychiatric Rating
Scale (BPRS) and the nicotine dependence with the Fagerström test. Patients
were defined as quitters after 12 months.
Results
Demographic and clinical characteristics, and Fagerström score, did not
differ in patients with and without CD. At baseline, patients with CD had a
higher BPRS (median: 27, IQR: 22–32; vs 25 and 22–28.5; p=0.03), and a lower
motivation to quit score (median: 10, IQR: 9–13; vs 14 and 12–15; p<0.001). After
12 months, the quitting rate of smokers with CD was significantly lower (14.8%
vs 36.7%; p<0.022) and the chance of quitting was negatively associated with the
baseline BPRS (r=-0.256; p<0.003). Varenicline and nicotine replacement therapy
tended to be less effective in patients with CD.
Conclusions
The lower efficacy of SCPs in patients with CD might be secondary to
a higher prevalence of anxiety and depression. Psychological issue recognition
and support should be enhanced to increase SCP effectiveness in CD.
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