Aiding reduction of smoking with nicotine replacement medications: hope for the recalcitrant smoker?

Fagerström, Karl; Tejding, R; Westin, Åke; Lunell, Erik

doi:10.1136/tc.6.4.311

Cited by 123 publications

(88 citation statements)

References 11 publications

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“…This "harm reduction" finding could have important clinical implications for most smokers who are unable or unwilling to quit (2,27). We also found a significant reduction in the mean number of cigarettes within the control group.…”

Section: Smoking Cessation In Diabetic Patientssupporting

confidence: 58%

Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings.

et al. 2000

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Abbreviations: CHD, coronary heart disease; FTND, Fagerström Test for Nicotine Dependence; NRT, nicotine replacement therapy.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Intervention Study for Smoking Cessation in Diabetic PatientsA randomized controlled trial in both clinical and primary care settingsOBJECTIVE -To evaluate the effectiveness of a nurse-managed smoking cessation intervention in diabetic patients. RESEARCH DESIGN AND METHODS -This randomized controlled clinical trialinvolved 280 diabetic smokers (age range 17-84 years) who were randomized either into control (n = 133) or intervention (n = 147) groups at 12 primary care centers and 2 hospitals located in Navarre, Spain. The intervention consisted of a 40-min nurse visit that included counseling, education, and contracting information (a negotiated cessation date). The followup consisted of telephone calls, letters, and visits. The control group received the usual care for diabetic smokers. Baseline and 6-month follow-up measurements included smoking status (self-reported cessation was verified by urine cotinine concentrations), mean number of cigarettes smoked per day, and stage of change.RESULTS -At the 6-month follow-up, the smoking cessation incidence was 17.0% in the intervention group compared with 2.3% in the usual care group, which was a 14.7% difference (95% CI 8.2-21.3%). Among participants who continued smoking, a significant reduction was evident in the average cigarette consumption at the 6-month follow-up. The mean number of cigarettes per day decreased from 20.0 at baseline to 15.5 at 6 months for the experimental group versus from 19.7 to 18.1 for the control group (P Ͻ 0.01).CONCLUSIONS -A structured intervention managed by a single nurse was shown to be effective in changing the smoking behavior of diabetic patients.

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Section: Smoking Cessation In Diabetic Patientssupporting

confidence: 58%

Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings.

et al. 2000

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“…increased puff volume and/or number of puffs per cigarette) in an unconscious attempt at self-titration of nicotine, apparently driven by a physiological need to maintain nicotine levels [9][10][11]. Similar compensatory smoking behaviour has been observed in smokers who switch from high-to lownicotine/tar cigarettes [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 77%

Smoking reduction and the rate of decline in FEV1: results from the Lung Health Study

Simmons

Connett²,

Nides

et al. 2005

European Respiratory Journal

100

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Previous findings from the Lung Health Study have shown that smoking cessation and sustained abstinence substantially reduce the rate of decline in forced expiratory volume (FEV1) among smokers with early chronic obstructive pulmonary disease (COPD) when compared with continuing smoking. Intermittent quitters demonstrated rates of FEV1 decline intermediate between those of sustained quitters and continuing smokers.In this study, data from 1,980 participants were analysed from 10 centres of the Lung Health Study in the USA and Canada. All participants were smokers with mild-to-moderate COPD who were unable to quit smoking at any time during the 1st yr of the study.No linear relationship was found between reduction in cigarettes per day and changes in FEV1 during the 1st yr of the study. However, examination of the data revealed that this relationship was nonlinear. Further analysis found that smokers who reduced their cigarettes per day to very low amounts had smaller declines in FEV1 than those who did not. Reduction in cigarettes per day was associated with only minimal changes in the presence of chronic respiratory symptoms.In conclusion, compensatory changes in smoking behaviour may account for the limited and unpredictable impact of smoking reduction on lung function decline and symptom prevalence when compared with smoking cessation.KEYWORDS: Forced expiratory volume in one second, smoking cessation, smoking reduction S ustained smoking cessation substantially reduces the smoking-related accelerated rate of decline in forced expiratory volume in one second (FEV1) and decreases the frequency of chronic respiratory symptoms among smokers with early chronic obstructive pulmonary disease (COPD) when compared with continuing smokers [1][2][3]. Intermittent quitting is associated with rates of FEV1 decline intermediate between those observed in sustained quitters and continuing smokers [4]. Conversely, it is not known whether partial reduction in the number of cigarettes smoked per day among continuing smokers is associated with improvement in the subsequent course of lung function decline when compared with that observed when daily consumption remains unchanged. For smokers with COPD who find it difficult to quit smoking entirely this is an important issue, since they may assume that smoking reduction is an effective alternative strategy for slowing disease progression. In the only previous long-term prospective study of smoking reduction (from o15 to ,15 cigarettes?day -1 ) on the rate of FEV1 decline, smokers ,55 yrs showed a significant reduction in FEV1 decline, although older smokers did not [5]. In that study, only two measurements of lung function were performed at an interval of 5 yrs and details of changes in the smoking rate, including the timing of changes in smoking amount relative to the measurement of lung function, were not reported.The present analysis examines the relationship between smoking reduction and change in FEV1 in a subset of the participants in the Lung Health Study, a large...

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“…The amount of reduction and the increase with NRT did not appear to differ between (a) published versus unpublished studies, (b) participants who could have been using NRT at the follow-up versus not, (c) types of NRT or (d) smokers who were assigned to a particular type of NRT versus were allowed to choose the type of NRT. However, within one study, participants had greater reduction when allowed to choose their NRT than when randomly assigned a NRT (Fagerstrom et al 1997).…”

Section: Aim 3: To What Extent Can Smokers Substantially Reduce and Mmentioning

confidence: 99%

The feasibility of smoking reduction: an update

2005

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Aim To update conclusions of a previous review of smoking reduction on the extent to which (1) smokers spontaneously reduce their smoking, (2) smokers who try to quit and fail return to smoking less, (3) smokers can substantially reduce and maintain reductions via pharmacological and behavioral treatments and (4) smokers compensate when they reduce.Method Qualitative systematic review. Data sources Systematic computer searches and other methods. Study selectionPublished and unpublished studies of smokers not trying to stop smoking. We located 13-26 studies for each of the four aims. Data extractionThe first author entered data with confirmation by second author.Data synthesis Due to the heterogeneity of methods and necessity of extensive recalculation, a metaanalysis was not feasible.Results Few daily smokers spontaneously reduce. Among those who try to stop smoking and relapse, some return to reduced smoking but whether they maintain this reduction is unclear. Nicotine replacement (and perhaps behavior therapies) can induce smokers not interested in quitting to make significant reductions in their smoking and maintain these over time. Some compensatory smoking occurs with reduction but significant declines in smoke exposure still occur. ConclusionsThese results indicate that reduction is feasible when aided by treatment. Whether reduction should be promoted will depend on the effect of reduction on health outcomes and future cessation.

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Aiding reduction of smoking with nicotine replacement medications: hope for the recalcitrant smoker?

Cited by 123 publications

References 11 publications

Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings.

Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings.

Smoking reduction and the rate of decline in FEV1: results from the Lung Health Study

The feasibility of smoking reduction: an update

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