Nicotine Replacement May Help Smokers Quit Gradually
FRIDAY April 3, 2009 -- For smokers who want to cut down on the number of cigarettes they smoke, using nicotine replacement therapy not only helps them smoke less but makes it twice as likely that they will quit altogether, British researchers report.
Although using nicotine replacement therapy -- such as gum, inhalers, patches and lozenges -- as a way to reduce smoking is approved in Britain and other countries, it remains unapproved and controversial in the United States. Some think it sends the wrong message -- that cutting down on smoking is OK. Others think that because tobacco companies make other nicotine delivery devices, this approach is merely a boon to the tobacco industry.
"We looked at papers that took people who said, 'I don't want to stop smoking, but I am prepared to reduce my smoking,' " said lead researcher Dr. Paul Aveyard, from the School of Health and Population Sciences at the University of Birmingham. They were given either a nicotine replacement product or a placebo, "and twice as many in the active treatment groups quit smoking compared with the placebo side," he said.
The results are similar to studies on the use of nicotine replacement therapy among people who said they wanted to quit.
In addition, Aveyard said, there were no serious adverse effects from the use of nicotine replacement while people continued to smoke.
The findings were published online April 3 in BMJ.
For the study, Aveyard's team reviewed seven studies that compared the use of nicotine gum or inhalators with placebos to see which was more effective in gradually getting smokers to quit. The studies included a total of 2,767 people.
Over six to 18 months, 6.75 percent of those using nicotine replacement stopped smoking for six months -- double the proportion of those using placebos. The researchers said it meant that 3 percent of smokers quit who otherwise would not have.
Participants in the studies who used nicotine replacement also received regular behavioral support and monitoring, and the researchers said that this support may have been as important as the nicotine replacement itself.
Aveyard said that use of nicotine replacement would allow treatment of many more smokers than the small number who say they want to quit. "It potentially opens the door to treat almost all smokers with treatments that were formally reserved for people who are wanting to quit right now," he said.
Because most nicotine replacement drugs are available over-the-counter but are not approved in the United States for smoking reduction, Aveyard suggests that people who want to try this approach should first consult with their doctor.
Dr. Norman H. Edelman, chief medical officer of the American Lung Association, predicted that the topic is going to be widely discussed in the United States.
"In Britain, they are a little bit ahead of us," Edelman said. "Right now, the FDA approval for nicotine replacement therapy is as an aid to cessation. The next issue is whether we should use nicotine therapy to reduce smoking without worrying about whether people quit or not."
The American Lung Association says that it should be used to help people quit smoking, but the group has "not adopted the idea of using nicotine replacement therapy for risk reduction," Edelman said.
And whether the Food and Drug Administration will approve its use to cut down on smoking is unclear, he said.
"It's a hot potato topic," Edelman said. "Cigarette companies are manufacturing nicotine delivery devices of all kinds, and there is a tendency to be negative about that. Nobody feels kindly disposed to letting tobacco companies make nicotine delivery devices."
And using nicotine replacement to reduce smoking sends the message that you can benefit by just smoking less, and "the American Lung Association is very opposed to that," Edelman said. "We do not support risk reduction by just smoking fewer cigarettes."
In a related article in the Journal of Thoracic Oncology, researchers reported that programs to help people quit smoking are cost-effective even for people with lung cancer.
A research team led by Dr. Christopher Slatore, from the University of Washington in Seattle, found that a smoking cessation program started before lung resection surgery was cost-effective both one and five years after surgery. They based their analysis on length of survival and improvement in the person's quality of life.
Although the results of the study apply only to people eligible for resection, all lung cancer patients should take part in smoking cessation programs, the researchers concluded.
The American Lung Association has more on quitting smoking.
Posted: April 2009