Smoking Cessation—Part III: Pharmacotherapy of Smoking Cessation

Abstract

T obacco dependence is a chronic condition with efficient and cost-effective treatment available. All tobacco users should be offered one of the first-line agents for smoking cessation, except in special circumstances (Fiore, Bailey, & Cohen, 2000). Misconceptions and fears of using medications, for smoking cessation have greatly contributed to the under-utilization of these products. This is the third column in a three-part series on smoking cessation. This column addresses the various pharmacological agents used for smoking cessation. The first article in the series, which appeared in the February issue (Vol. 53, No.2, pp. 63-64), was a review of the epidemiology of smoking, the adverse effects of smoking, and an approach to identify individuals ready to quit. Part II appeared in the May issue (Vol. 53, No.5, pp. 194-197) and focused on smoking cessation couseling and behavioral therapies. Quitting smoking is very difficult. Only approximately 7% of clients who quit without any treatment, or

Effects of Tobacco Smoke Exposure in Childhood on Atopic Diseases

“…This effect facilitates allergen penetration across the epithelium and augments histamine release from subepithelial sensitized basophils [24]. Further, tobacco smoke exposure increases secretion of the proallergic cytokine, thymic stromal lymphopoietin (TSLP) in lung tissue [25–27]. TSLP is a cytokine that influences development of Th2 cells through upregulation of OX40 ligand in dendritic cells and is now considered to be critical in development of atopic responses [28].…”

“…Studies have shown that NRTs increase the odds of long-term cessation by 1.5- to 2-fold. NRTs are specifically designed to relieve some of the nicotine withdrawal symptoms and have also been found to serve as good adjuvants to the nicotine-free medications, including bupropion and varenicline [27, 50–54]. Bupropion is a heterocyclic antidepressant that has been specifically marketed for smoking cessation.…”

State of the Art Reviews: Smoking Cessation

“…By providing nicotine throughout the night, the 24-hour patch reduces cravings for the fi rst cigarette in the morning. 30 Some patients experience vivid dreams or insomnia when the patch is worn for 24 hours. Wearing the patch for 16 hours and removing it at night may alleviate both issues.…”

“…The FDA has not yet approved an NRT combination treatment, but existing studies on combination treatments do show some advantages over single or no medications at all. 30,[46][47][48][49] Combination therapy for smoking cessation usually includes combining a passive NRT, such as the patch, with an acute NRT, such as the gum (as mentioned earlier). Adding nicotine gum to the patch has been shown to improve quit rates from 23% to 34% at 12 weeks and from 15% to 28% at 24 weeks.…”