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Aiding reduction of smoking with nicotine replacement medications: Hope for the recalcitrant smoker?
Abstract
To assess the effect of the various nicotine replacement therapies (NRT) on smoking reduction.
During an initial sampling week, the subjects familiarised themselves with nicotine gum, patch, nasal spray, vaporiser (vapour inhaler) and sublingual tablet. A crossover design was used during the next four study weeks; during two of these weeks the subjects could select one nicotine replacement product of their choice to use, whereas during the other two they were randomly assigned a product to use.
143 men and women smoking an average of 22.6 (SD 7.0) cigarettes per day and exhibiting a Fagerström Tolerance Questionnaire (FTQ) score of 7.0 (SD 1.9).
Subjects were asked to use as much NRT as they wished, yet to smoke enough to feel comfortable.
Self-reported cigarette consumption, exhaled carbon monoxide (CO), withdrawal symptom score, cotinine plasma levels and motivation to quit were monitored over a period of five weeks.
Self-reported smoking declined steadily over the five weeks, from 22.6 (SD 7.0) to 10.4 (SD 1.0) (P<0.001) cigarettes daily (54% decrease), with the biggest drop (37%) during the first product-sampling week. Smoking reduction was greater on average during the weeks when the subjects could choose their nicotine product than when products were assigned. CO readings decreased from 22.7 (SD 8.5) to 14.8 (SD 8.4) ppm (P<0.001) confirming a reduction in smoking (35% decrease), although cotinine levels remained steady, suggesting that subjects were titrating nicotine to their original levels. Withdrawal scores decreased over time (32% decrease, P<0.001), showing that there was no discomfort associated with the smoking reduction, and motivation to quit was enhanced by the treatment in most subjects (93%).
NRT for aiding smoking reduction appeared to be safe, was associated with a clinically significant reduction in smoke exposure over a five-week follow up, and increased motivation to stop smoking. A smoking reduction procedure may help the very recalcitrant smoker gain confidence and increase the control over his/her smoking behaviour. More controlled research is needed to follow up these promising results.
... Apart from smoking cessation, smoking reduction is also a favorable outcome because NRT manages craving symptoms better. [20] This can help smokers to reduce frequency although unable or unwilling to quit. Smoking reduction could be a first step toward cessation as this encourages subsequent quit attempts. ...
Background’: India is ranked second in the world in terms of tobacco use and tops the list of eight high‑burden countries that account for two‑thirds of the new tuberculosis (TB) cases globally. As tobacco smoking among TB patients is associated with unsuccessful TB treatment outcomes, effective smoking cessation interventions for TB patients is essential to combat this double pandemic.
Aim: The study determined the effectiveness of nicotine replacement therapy (NRT) on smoking reduction and cessation among pulmonary TB patients. Settings and Design: The study included 300 pulmonary TB patients undergoing antitubercular treatment in government health care centers of Dakshina Kannada district in southern India. Materials and Methods: The participants in this two‑armed, single‑blinded, placebo‑controlled, block‑randomized trial were divided equally (n = 150) for experimental arm (brief advice + NRT) and control arm (brief advice + placebo). The total duration of treatment and follow‑up was 6 months. Unadjusted relative risk (URR) and adjusted relative risk (ARR) were calculated for treatment outcomes at 95% confidence interval (CI). Generalized linear regression analysis was performed upon variables with P value less than 0.2.
Results: After 6 months of intervention including follow up, there was a significant reduction in self‑reported smoking (ARR = 1.08, 95% CI 1.01–1.17, P = 0.03) in the experimental arm compared with the control arm. Biochemically verified smoking abstinence was not significantly different between the two arms (ARR = 1.01, 95% CI 0.72–1.38, P = 0.97). Conclusion: The study showed statistically significant effectiveness of NRT for self‑reported smoking reduction
... Use of carbonated or acidic drinks should be contraindicated before 15 mins or during the use of lozenges. Minimum duration for use of this product is 3 months [10] . ...
Background:
Nicotine replacement therapy (NRT) aims to replace nicotine from cigarettes. This helps to reduce cravings and withdrawal symptoms, and ease the transition from cigarette smoking to complete abstinence. Although there is high-certainty evidence that NRT is effective for achieving long-term smoking abstinence, it is unclear whether different forms, doses, durations of treatment or timing of use impacts its effects.
Objectives:
To determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long-term smoking cessation.
Search methods:
We searched the Cochrane Tobacco Addiction Group trials register for papers mentioning NRT in the title, abstract or keywords, most recently in April 2022.
Selection criteria:
We included randomised trials in people motivated to quit, comparing one type of NRT use with another. We excluded studies that did not assess cessation as an outcome, with follow-up of fewer than six months, and with additional intervention components not matched between arms. Separate reviews cover studies comparing NRT to control, or to other pharmacotherapies.
Data collection and analysis:
We followed standard Cochrane methods. We measured smoking abstinence after at least six months, using the most rigorous definition available. We extracted data on cardiac adverse events (AEs), serious adverse events (SAEs) and study withdrawals due to treatment. MAIN RESULTS: We identified 68 completed studies with 43,327 participants, five of which are new to this update. Most completed studies recruited adults either from the community or from healthcare clinics. We judged 28 of the 68 studies to be at high risk of bias. Restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results for any comparisons apart from the preloading comparison, which tested the effect of using NRT prior to quit day whilst still smoking. There is high-certainty evidence that combination NRT (fast-acting form plus patch) results in higher long-term quit rates than single form (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.17 to 1.37; I2 = 12%; 16 studies, 12,169 participants). Moderate-certainty evidence, limited by imprecision, indicates that 42/44 mg patches are as effective as 21/22 mg (24-hour) patches (RR 1.09, 95% CI 0.93 to 1.29; I2 = 38%; 5 studies, 1655 participants), and that 21 mg patches are more effective than 14 mg (24-hour) patches (RR 1.48, 95% CI 1.06 to 2.08; 1 study, 537 participants). Moderate-certainty evidence, again limited by imprecision, also suggests a benefit of 25 mg over 15 mg (16-hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41; I2 = 0%; 3 studies, 3446 participants). Nine studies tested the effect of using NRT prior to quit day (preloading) in comparison to using it from quit day onward. There was moderate-certainty evidence, limited by risk of bias, of a favourable effect of preloading on abstinence (RR 1.25, 95% CI 1.08 to 1.44; I2 = 0%; 9 studies, 4395 participants). High-certainty evidence from eight studies suggests that using either a form of fast-acting NRT or a nicotine patch results in similar long-term quit rates (RR 0.90, 95% CI 0.77 to 1.05; I2 = 0%; 8 studies, 3319 participants). We found no clear evidence of an effect of duration of nicotine patch use (low-certainty evidence); duration of combination NRT use (low- and very low-certainty evidence); or fast-acting NRT type (very low-certainty evidence). Cardiac AEs, SAEs and withdrawals due to treatment were all measured variably and infrequently across studies, resulting in low- or very low-certainty evidence for all comparisons. Most comparisons found no clear evidence of an effect on these outcomes, and rates were low overall. More withdrawals due to treatment were reported in people using nasal spray compared to patches in one study (RR 3.47, 95% CI 1.15 to 10.46; 1 study, 922 participants; very low-certainty evidence) and in people using 42/44 mg patches in comparison to 21/22 mg patches across two studies (RR 4.99, 95% CI 1.60 to 15.50; I2 = 0%; 2 studies, 544 participants; low-certainty evidence).
Authors' conclusions:
There is high-certainty evidence that using combination NRT versus single-form NRT and 4 mg versus 2 mg nicotine gum can result in an increase in the chances of successfully stopping smoking. Due to imprecision, evidence was of moderate certainty for patch dose comparisons. There is some indication that the lower-dose nicotine patches and gum may be less effective than higher-dose products. Using a fast-acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches. There is moderate-certainty evidence that using NRT before quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding. Evidence for the comparative safety and tolerability of different types of NRT use is limited. New studies should ensure that AEs, SAEs and withdrawals due to treatment are reported.
Sevgili okuyucularımız, Bu kitabı bilim gibi uzun bir yol kat etmekte olan ve temel tıp alanında çalışan değerli arkadaşlarımızın katkıları ile yayımladık. Bir işe başlamak onun başarılması için oldukça önemli bir aşamadır, bu nedenle hayatta hiçbir şeyi ertelememek gerektiğini unutmayalım. Sağlık bilimlerinde temel ve klinik bilimleri birbirinden keskin çizgilerle ayırmak mümkün değildir. Ayrıca disiplinler arası araştırmalar ve çalışmalar daha kıymetlidir. Bu nedenle kitabımızın içeriği her ne kadar temel tıp bilimleri ağırlıklı olsa da klinikle entegre olan konular da yer almaktadır. Diyabetin erkek infertilitesi ile ilişkisi, lipit yapıları ile ilgili araştırmalarının geçmişi ve şimdiki durumunun gözden geçirilmesi ile birlikte lipidomik araştırma tekniklerinin incelenmesi, kalsiyum iyonu ve pompalarının kas kasılma ve gevşemesindeki kritik işlevlerinin belirlenmesi, regülatör B hücrelerinin fonksiyonlarının araştırılması, tıp tarihinde dört humor olarak bilinen sarı ve kara safra, balgam ve kan kavramlarının incelenmesi, çinko eksikliğinin tiroid bozukluğuyla ilişkisinin araştırılması, doku biyokimyasının gözden geçirilmesi, hematopoetik kök hücre nakli ve böbrek konusunun değerlendirilmesi, halk sağlığı açısından sigara bağımlılığı ve mücadele yöntemlerinin küresel düzeyde karşılaştırmalı bir analizi, kanserde glikoliz üzerine uzun kodlamayan RNA’ların etkileri, insanlarda kromozom ayrılması bozukluklarının genetik mekanizmaları, merkezi sinir sisteminde bulunan bazal nükleusların tarihçesi ve terminolojisinin oluşumu ve kanser gelişiminde sirtuin ailesinin rolü gibi bölümleri kapsamaktadır. İnsanlık için bilimsel platformlarda özveri ile çalışan bilim insanlarına ışık tutması dileği ile kitabımıza destek veren yazar kadromuz ve yayın ekibimize teşekkür ederim. Prof. Dr. HÜLYA ÇİÇEK
21. yy’da dünyadaki ülkelerin toplumları üzerinde çeşitli hastalıklar ortaya çıkmıştır. Ortaya çıkan bu hastalıklar içerisinde en büyük paylardan biri de kötü alışkanlıkların getirdiği hastalıklar olarak karşımıza çıkmaktadır. İnsanların tütün ve tütün ürünlerine olan bağımlılıkları da bu alışkanlıklar arasında yer almaktadır. Tütün ve tütün ürünleri içerisinde toplumlarda en çok kullanılan ve ilk akla gelen sigaradır. Sigaranın insanlar üzerindeki olumsuz etkileri, sebep olduğu hastalıklar uzmanlar tarafından desteklenmektedir. Ancak tüm bunlara rağmen sigara bağımlılığı oranları istenilen seviyelere düşmemiştir. Bağımlılık seyrinin böyle devam etmesi de küresel bağlamda büyük bir sorun oluşturmuş ve devletlerin sağlık sistemleri üzerinde de büyük baskı oluşturmuştur. Sağlık alanındaki kıt kaynakların doğru şekilde kullanılması devletler adına çok önemlidir. Tütün ve tütün ürünlerine bağlı olarak gelişen ağır rahatsızlıklar ve ölümlerin önüne geçebilmek adına yerel ve ulusal bağlamda birtakım adımlar atılmıştır. Bu kapsamda Dünya Sağlık Örgütü, 2003 yılında “Tütün Kontrol Çerçeve Sözleşmesi“ni, 2008 yılında ise “MPOWER“ paket programını tasarlayarak bir adım atmıştır. Bu uygulamayla birlikte dünyadaki ülkelerin çoğunda tütün kontrolünde gözle görülür ilerlemeler olmuştur. Bu ilerlemenin sürdürülebilir olması için paketin uygulama alanları genişletilmelidir. Aksi takdirde tütün ve tütün ürünlerinin olumsuz etkilerinin önüne geçmek zorlaşacaktır
Cigarette smoking is associated with pulmonary and cardiovascular disease and confers increased postoperative morbidity and mortality. Smoking cessation in the weeks before surgery can mitigate these risks, and surgeons should screen patients for smoking before a scheduled operation so that appropriate smoking cessation education and resources can be given. Interventions that combine nicotine replacement therapy, pharmacotherapy, and counseling are effective to achieve durable smoking cessation. When trying to stop smoking in the preoperative period, surgical patients experience much higher than average cessation rates compared with the general population, indicating that the time around surgery is ripe for motivating and sustaining behavior change. This chapter summarizes the impact of smoking on postoperative outcomes in abdominal and colorectal surgery, the benefits of smoking cessation, and the impact of interventions aimed to reduce smoking before surgery.
There is a significant research-to-practice gap with respect to reaching underserved populations with evidence-based tobacco cessation treatments. Increasing enrollment in evidence-based treatments is necessary to reduce tobacco use and tobacco-related health inequities. The purpose of the current study was to evaluate whether Motivation And Problem Solving (MAPS), a flexible, holistic counseling/navigation approach delivered via phone, and proactive provision of Nicotine Replacement Therapy (NRT) would improve Quitline enrollment among a sample of low SES smokers who were not motivated to quit. In a 3×2 factorial design, cigarette smokers (N = 603) were randomized to one of six treatment conditions (Standard Treatment, MAPS-6, or MAPS-12 by NRT or no NRT). Results indicated that both MAPS-6 and MAPS-12 increased Quitline enrollment compared to Standard Treatment (ps < .03). There were no differences between MAPS conditions. NRT did not increase Quitline enrollment. MAPS is an effective intervention with the potential to be disseminated and implemented in healthcare and community settings to increase the reach of evidence-based interventions for tobacco cessation.
Approximately one in six American adults is a current smoker, and smoking accounts for one-third of all cancer deaths. In general, patients with cancer have a higher dependence on nicotine and are more likely to be smokers or ex-smokers. Several instruments measure nicotine dependence among cigarette smokers. However, the evaluation and final recommendation are clinical, and the treatment plan must be individualized. Nonpharmacologic treatments include behavioral counseling, quitlines, and self-help material, but yield relatively low quit rates if used alone. Pharmacologic treatments approved by the US Food and Drug Administration include nicotine replacement therapies, bupropion, and varenicline. Patients with cancer who use tobacco should be treated according to evidence-based treatment guidelines, with particular attention to tailoring education about their disease-tobacco link, pharmacotherapy, comorbid medical and psychiatric disorders, and family and household tobacco use. Health care providers have limited time and expertise to address smoking among patients with cancer, and patients may have comorbid substance use or dependence or other emotional and mental disorders that undermine their ability to quit smoking. Systems-level challenges and tailored treatment approaches are needed to identify all tobacco users, lower the rate of persistent tobacco use, and reduce recidivism among patients with cancer.
This essay speculates about the possibility of a normalised future of addiction, where dependence on substances is no longer attached to a disease category or disordered identity. It draws on critical sociological literature addressing expectation and the moral economy of anticipation, as well as adopting a utopian perspective inspired by feminist and queer theory. It questions dominant discourses of technologised innovation in the addiction field, and instead sees openings towards a better future in the spaces and practices of harm reduction.
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