Precessation treatment with nicotine patch significantly increases abstinence rates relative to conventional treatment.
ABSTRACT Previous studies have reported that smoking abstinence rates are increased when nicotine skin patch treatment is initiated prior to the target quit smoking date, as compared with conventional treatment beginning on the quit date. We hypothesized that smoking in the presence of continuous levels of nicotine would attenuate the reinforcing effects of cigarette smoking and lead to a decline in dependence on inhaled nicotine, thus facilitating cessation.
This study involved four groups of smokers (n = 100 per group) who received either nicotine patch (21 mg/24 hr) or placebo patch treatment for 2 weeks before the quit smoking date, and during this period, smoked their usual brands of cigarettes or switched to low-tar and nicotine cigarettes: a 2 (nicotine patch) x 2 (cigarette type) factorial design. From the quit date on, all groups received standard nicotine patch treatment, consisting of 6 weeks of 21 mg/24 hr, 2 weeks of 14 mg/24 hr, and 2 weeks of 7 mg/24 hr. Abstinence was defined as self-report of no smoking from the quit date on, confirmed by expired-air carbon monoxide.
Continuous abstinence rates were approximately doubled by precessation nicotine patch treatment. The treatment mainly benefited smokers with lower levels of dependence, based on Fagerström Test for Nicotine Dependence score. All treatments were well tolerated.
In view of these findings and similar results from previous studies, current labeling of the nicotine patch, which recommends using nicotine replacement therapy only after the quit date, should be reexamined.
Article: Randomized trial of the effectiveness of combined behavioral/pharmacological smoking cessation treatment in Syrian primary care clinics.[show abstract] [hide abstract]
ABSTRACT: AIM: Effectiveness of nicotine replacement therapy (NRT) for smoking cessation has not been evaluated in low income countries, such as Syria, where it is expensive and not widely available. We evaluated whether nicotine patch boosts smoking cessation rates when used in conjunction with behavioral support in primary care clinics in Aleppo, Syria. DESIGN: Two arm, parallel group, randomized, placebo controlled, double-blinded multi-site trial. SETTING: Four primary care clinics in Aleppo, Syria. PARTICIPANTS: 269 adult primary care patients received behavioral cessation counseling from a trained primary care physician and were randomized to receive 6 weeks of treatment with nicotine vs. placebo patch. MEASUREMENTS: Primary endpoints were prolonged abstinence (no smoking after a 2 week grace period) at end of treatment and 6 and 12 months post-quit day, assessed by self-report and exhaled carbon monoxide levels of <10 ppm. FINDINGS: Treatment adherence was excellent and nicotine patch produced expected reductions in urges to smoke and withdrawal symptoms, but no treatment effect was observed. The proportion of patients in the nicotine and placebo groups with prolonged abstinence was 21.6% and 20.0%, respectively, at end of treatment, 13.4% and 14.1% at 6 months, and 12.7% and 11.9% at 12 months. CONCLUSIONS: Nicotine patches may not be effective in helping smokers in low income countries to stop when given as an adjunct to behavioural support.Addiction 08/2012; · 4.31 Impact Factor
Article: Smoking as a Chronic Disease[show abstract] [hide abstract]
ABSTRACT: Despite remaining the leading cause of preventable death in the United States, tobacco smoking does not garner the attention it deserves in the medical and public health communities. Smoking is often referred to merely as a “bad habit” that simply requires adequate willpower to conquer effectively. Fortunately, recent attitudes regarding smoking, as illustrated by the latest US Public Health Service Clinical Practice Guidelines, call for a “chronic disease model” for treating tobacco dependence. This article underscores the importance of viewing smoking as a chronic disease by illustrating the effects on morbidity and mortality, discussing the relapsing nature of addiction, outlining the need for continuum of care for different “severities” of illness, and describing the latest research regarding effective treatment components. Tobacco dependence treatments are safe, effective, and cost-saving, and their use should be encouraged and covered by health insurance analogous to other chronic conditions. KeywordsSmoking cessation-Tobacco dependence-Nicotine replacement-Cessation pharmacotherapy-Chronic disease model-Cardiovascular risk factorCurrent Cardiovascular Risk Reports 04/2012; 4(6):413-420.