Harm Reduction – A Treatment Approach for Resistant Smokers with Tobacco-Related Symptoms

Abstract

Smokers with chronic obstructive pulmonary disease (COPD) appear to represent a hard-core group, and this presents a dilemma for chest physicians. A reduction in cigarette smoking benefits health, and nicotine replacement therapy (NRT) can aid smoking reduction. Hence we studied the efficacy of nicotine gum in helping hard-core smokers with severe COPD to quit. Seventeen smokers with severe COPD (FEV₁ 38–47% of predicted normal) who smoked >30 cigarettes/day but were unable to quit were encouraged to reduce their smoking as much as possible by using 4-mg nicotine gum. Five gradually reduced their daily tobacco consumption and, 18 months after starting NRT, were smoking an average of 6 cigarettes/day while still using nicotine gum. Compared to baseline, their respiratory symptoms had improved, and both FEV₁ and FVC had increased. There was no improvement in pulmonary function in the group of smokers who did not reduce their cigarette consumption. No adverse events relating to nicotine occurred among the patients who used NRT to reduce their smoking. We propose that this reduction approach should be considered for patients with respiratory disease who are unable or unwilling to stop smoking.

The feasibility of smoking reduction: an update

“…Nicotine replacement therapy (NRT) trials-We located 19 trials that tested NRT for reduction in smokers not currently trying to quit whose data could be aggregated (Table 3) (Rennard et al 1990(Rennard et al ,1994Fager-strom et al 1997;Bolliger et al 2000;Hurt et al 2000;Fagerstrom, Hughes & Callas 2002;Jimenez-Ruiz et al 2002;Kralikova, Kozak & Rasmussen 2002;Rennard et al 2002;Stein et al 2002;Carpenter, Hughes & Keely 2003;Haustein et al 2003;Landfeldt et al 2003;Wennike et al 2003;Carpenter et al 2004;Etter, Laszlo & Perneger 2004;Hecht et al 2004;Joseph et al 2004;Kotlyar et al 2004). None of the trials stated that those in the reduction group were instructed not to quit and many trials stated explicitly that those in the reduction group were encouraged to quit at any point during reduction.…”

“…Since that review, several reviews of reduced smoking have appeared (Kozlowski et al 2001;Zellweger 2001;Fager-strom 2002;Jimenez-Ruiz et al 2002;Tonnesen, in press). However, these reviews were brief and did not include more recent reduction studies.…”

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

“…In a study conducted by JIMENEZ-RUIZ et al [18] five out of 12 severe COPD patients demonstrated improvement in respiratory symptoms and pulmonary function after reducing smoking from .30 cigarettes?day -1 to an average of 6 cigarettes?day -1 , with the aid of nicotine replacement therapy. An association has also been demonstrated between nicotine gum use and smoking reduction in both the Lung Health Study [19] and a report by WENNIKE et al [20].…”

“…Compensatory changes in smoking behaviour following smoking reduction can be attenuated by nicotine replacement therapy or pharmacological aids that reduce nicotine craving, such as bupropion [17,18]. In a study conducted by JIMENEZ-RUIZ et al [18] five out of 12 severe COPD patients demonstrated improvement in respiratory symptoms and pulmonary function after reducing smoking from .30 cigarettes?day -1 to an average of 6 cigarettes?day -1 , with the aid of nicotine replacement therapy.…”

“…Improvements in chronic respiratory symptoms have been associated with smoking cessation in Lung Health Study participants [2] and with reduction in smoking amount to very low levels in patients with severe COPD [18]. Whereas smoking cessation in heavy smokers (o15 cigarettes?day -1 ) participating in three prospective Danish population studies was associated with a significant reduction in the risk of hospitalisation for COPD when compared with continuing heavy smoking, reduction in smoking by o50% without quitting was not [22].…”