Smoking cessation
Etiology of smoking
Tobacco smoking as self-medication
Treatment
Counseling
Recording smoking status as a vital sign increases the frequency of brief advice to patients by physicians.[1]
Demonstration of damage to lungs
In general, informing patients of their lung function as measured by spirometry does not increase smoking cession according to a systematic review by the U.S. Preventive Services Task Force (USPSTF).[2] However, in a more recent randomized controlled trial, patients in the group who were informed of their 'lung age' were more likely to stop smoking.[3] However, in this trial, "People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group".[3]
Medications
| Study | Subjects | Intervention | Comparison | Outcome | Results | |
|---|---|---|---|---|---|---|
| Intervention group | Comparison group | |||||
| Steinberg[4] 2009 |
Community volunteers with predefined medical illnesses | Triple therapy of nicotine patch, nicotine oral inhaler, and bupropion ad libitum | Nicotine patch alone | Abstinence at 26 weeks by 7 days exhaled carbon monoxide testing | 35% | 19% |
| Jorenby[5] 1999 |
Community volunteers without medical illness | Double therapy with bupropion and nicotine patch | Nicotine patch alone | Abstinence at 52 weeks by single exhaled carbon monoxide testing | Combo 36% Bupropion 30% |
16% |
Combining multiple medications may improve outcomes.[4]
| Eisenberg[6] (odds ratio) |
Cochrane[7] (relative risk ratio) | |
|---|---|---|
| Bupropion | 2.07 | 1.17 |
| Varenicline | 2.41 | 1.18 |
| Nicotine replacement | cell | cell |
- Varenicline, 2.55
- Bupropion, 2.12
Nicotine replacement
A systematic reviews of selected medications including nicotine replacement found that the odds ratios for quitting with nicotine are:[6]
- Spray, 2.37
- Inhaler, 2.18
- Patch, 1.88
- Gum, 1.65
Rimonabant
Rimonabant, a selective type 1 cannabinoid (CB1) receptor antagonist, improves smoking cessation and moderate weight gain associated with smoking cessation according to a meta-analysis of randomized controlled trials by the Cochrane Collaboration.[8] However, "there is current concern (August 2007) over rates of depression and suicidal thoughts in people taking rimonabant for weight control."[8]
Atomoxetine
Addiction is reinforced by the fear of experiencing the adverse effects associated with the cessation of the drug. Smoking withdrawal causes cognitive deficits analogous to attention deficit hyperactivity disorder, an observation which prompted researchers to test the hypothesis that drugs that ameliorate ADHD facilitate smoking cessation. In confirmation of this hypothesis, it was shown that atomoxetine, a norepinephrine reuptake inhibitor that is approved by the FDA to treat the symptoms of ADHD, dose-dependently reversed congnitive deficits in an animal model of nicotine withdrawal.[9] Atomoxetine is not indicated at this time as a medication to treat the ADHD-like symptoms of smoking cessation.
Incentives
Financial incentives may help.[10]
References
- ↑ Rothemich SF, Woolf SH, Johnson RE, et al (2008). "Effect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study". Ann Fam Med 6 (1): 60-8. DOI:10.1370/afm.750. PMID 18195316. Research Blogging.
- ↑ Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB (2008). "Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force". Ann. Intern. Med.. PMID 18316746. [e]
- ↑ 3.0 3.1 Parkes G, Greenhalgh T, Griffin M, Dent R (2008). "Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial". BMJ. DOI:10.1136/bmj.39503.582396.25. PMID 18326503. Research Blogging.
- ↑ 4.0 4.1 4.2 Steinberg MB, Greenhaus S, Schmelzer AC, et al (April 2009). "Triple-combination pharmacotherapy for medically ill smokers: a randomized trial". Ann. Intern. Med. 150 (7): 447–54. PMID 19349630. [e]
- ↑ 5.0 5.1 Jorenby DE, Leischow SJ, Nides MA, et al (March 1999). "A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation". N. Engl. J. Med. 340 (9): 685–91. PMID 10053177. [e]
- ↑ 6.0 6.1 Eisenberg MJ, Filion KB, Yavin D, et al (July 2008). "Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials". CMAJ 179 (2): 135–44. DOI:10.1503/cmaj.070256. PMID 18625984. PMC 2443223. Research Blogging.
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedpmid19160228 - ↑ 8.0 8.1 Cahill K, Ussher M (2007). "Cannabinoid type 1 receptor antagonists (rimonabant) for smoking cessation". Cochrane Database Syst Rev (4): CD005353. DOI:10.1002/14651858.CD005353.pub3. PMID 17943852. Research Blogging.
- ↑ Davis JA, Gould TJ (September 2007). "Atomoxetine reverses nicotine withdrawal-associated deficits in contextual fear conditioning". Neuropsychopharmacology 32 (9): 2011–9. DOI:10.1038/sj.npp.1301315. PMID 17228337. Research Blogging.
- ↑ Volpp KG, Troxel AB, Pauly MV, et al (February 2009). "A randomized, controlled trial of financial incentives for smoking cessation". N. Engl. J. Med. 360 (7): 699–709. DOI:10.1056/NEJMsa0806819. PMID 19213683. Research Blogging.