Covid-19 and the role of smoking: the protocol of the multicentric prospective study COSMO-IT (COvid19 and SMOking in ITaly).

The emergency caused by Covid-19 pandemic raised interest in studying lifestyles and comorbidities as important determinants of poor Covid-19 prognosis. Data on tobacco smoking, alcohol consumption and obesity are still limited, while no data are available on the role of e-cigarettes and heated tobacco products (HTP). To clarify the role of tobacco smoking and other lifestyle habits on COVID-19 severity and progression, we designed a longitudinal observational study titled COvid19 and SMOking in ITaly (COSMO-IT). About 30 Italian hospitals in North, Centre and South of Italy joined the study. Its main aims are: 1) to quantify the role of tobacco smoking and smoking cessation on the severity and progression of COVID-19 in hospitalized patients; 2) to compare smoking prevalence and severity of the disease in relation to smoking in hospitalized COVID-19 patients versus patients treated at home; 3) to quantify the association between other lifestyle factors, such as e-cigarette and HTP use, alcohol and obesity and the risk of unfavourable COVID-19 outcomes. Socio-demographic, lifestyle and medical history information will be gathered for around 3000 hospitalized and 700-1000 home-isolated, laboratory-confirmed, COVID-19 patients. Given the current absence of a vaccine against SARS-COV-2 and the lack of a specific treatment for -COVID-19, prevention strategies are of extreme importance. This project, designed to highly contribute to the international scientific debate on the role of avoidable lifestyle habits on COVID-19 severity, will provide valuable epidemiological data in order to support important recommendations to prevent COVID-19 incidence, progression and mortality

Use of varenicline in smokeless tobacco cessation influences sleep quality and dream recall frequency but not dream affect

Objective: Varenicline (VCL) treatment has become popular as a part of smoking-cessation therapies, even though its possible implications in neuropsychiatric adverse events include abnormal sleep and nightmares. Our study is the first aimed at prospectively investigating changes in sleep and dream measures across such treatment by using a one week sleep diary and collecting dream recall (DR). Methods: Thirty-eight smokers participated in two different effective smoking-cessation programs: 25 subjects received VCL, 13 subjects received nicotine replacement therapy (NRT). Participants were requested to fill out a sleep diary and audio-record dreams for one week, both at baseline assessment (T0) and after two weeks from the beginning of treatment (T1). Differences in sleep and dream measures were tested using mixed Analysis of Covariance with time (T0 vs T1) as a within-subject factor and group (VCL vs NRT) as a between-subject factor, considering age as a covariant. Results: Sleep measures showed a significant increase in the number of awakenings in the VCL group at T1 compared to T0. The VCL group reported an increase in DR rate at T1. These sleep and dream measures were intercorrelated, but only at T1 and during VCL treatment. Conclusions: The correlations between DR rate and sleep fragmentation measures underlined that VCL cannot be considered as a direct cause of abnormal dreams. Comparisons between groups cast some doubts on the actual existence of abnormal dreams, at least as compared to the NRT group. Our results are consistent with the 'activation models', showing that numerous DRs in the VCL group may be related to lighter slee

The 40-day cytisine treatment for smoking cessation: the Italian experience

Introduction In Eastern Europe, cytisine has been used a lot in smoking cessation while in Italy, it has only recently been introduced, however using a longer treatment schedule consisting of 40 days instead of 25 and a different posology. This work gathered the retrospective observational data collected by some Italian smoking cessation centers that used the 40 day cytisine treatment (40-DCT) and focused on short-term results and possible adverse events. Material and Methods In Italy, cytisine (1.5 mg per tablet) was prescribed as galenical formulation because is not licensed with a specific brand. The dosing regimen was: induction (2 to 6 tablets/ day for the first 7 days), maintenance (6 tablets/day for 7 days), and gradual reduction for 26 days. The 40-DCT was integrated with a behavioral support (5-7 meetings/patient). Demographic and clinical variables of patients were collected at the beginning and at the end of treatment. Results A total of 162 patients (43.2% male) were treated with the 40-DCT, their mean-age was 51.1 years. They smoked 22.6 cigarettes/day and had a mean respiratory CO of 22 ppm at start. The quitting rate at end of treatment was 61%, while 26.0% dropped- out. Among those who continued to smoke (13%), about half of them (6%) halved the number of cigarettes. Nobody interrupted the treatment and only few patients had minor side effects. Conclusions The 40-DCT was effective in tobacco addiction treatment and well tolerated. The vegetal origin and the low cost of cytisine may increase its acceptability and help smokers to quit