Smoking Cessation
Guidelines
Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. The following website offers the latest comprehensive AHRQ guidelines. The “Abstract” and “Executive Summary” links on the left margin provide succinct summaries that integrate the use of pharmacologic and non-pharmacologic approaches to smoking cessation.
Guideline at NCBI Bookshelf
Non-pharmacologic interventions
Parkes G, Greenhalgh T, Griffin M, et al. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ 2008; 336:598-600. This RCT (n=561) evaluated the effect of telling smokers their lung age based on spirometry accompanied by graphic displays. Independently verified quit rates at 12 months in the intervention and control groups were 13.6% and 6.4% (p = .005), respectively.
PMID: 18326503
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Volpp KG, Troxel AB, Pauly MV, et al. A randomized controlled trial of financial incentives for smoking cessation. N Engl J Med 2009; 360:699-709. Study randomized 878 employees of a single company to receiving info on smoking cessation programs vs the program info plus up to $750 dollars in financial incentives for completing a cessation program and 6 months of abstinence. Nearly 15% of individuals in the financial incentive program had quit for 6 months compared to 5% in the information only group.
PMID: 19213683
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Pharmacologic interventions
Transdermal Nicotine Study Group. Transdermal nicotine for smoking cessation. Six-month results from two multicenter controlled clinical trials. JAMA 1991; 266:3133-8. This study assessed rates of continuous smoking abstinence among patients who had successfully quit after a 6-week trial of transdermal nicotine replacement. 26% of patients that had been randomized 21 mg patches were not smoking at 6 months compared to 12% in the placebo group.
PMID: 1956099
Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340:685-91. This trial randomized nearly 900 patients to bupropion, a nicotine patch, bupropion plus a patch, or placebo. 12 month cessation rates were 30.3% for bupropion, 16.4% for the patch, 15.6% for placebo, and 35.5% with combined bupropion and patch. 12% of patients did not tolerate bupropion.
PMID: 10053177
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Gonzales D, Rennard SI, Nides M, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized, controlled trial. JAMA 2006; 296:47-55. This, along with another simultaneously published study by Jorenby DE et al in the same issue, randomized over 1000 patients to 12 weeks of varenicline (Chantix), bupropion, or placebo. Continuous abstinence for weeks 9 through 52 were 21.9% for varenicline, 16.1% for bupropion, and 8.4% for placebo (p = .057 for varenicline vs bupropion).
PMID: 16820546
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Long-term effects of smoking cessation interventions
Anthonisen NR, Skeans MA, Wise RA, et al. The effects of a smoking cessation on 14.5 year mortality. Ann Intern Med 2005; 142:233-9. This article is noteworthy for showing smoking cessation reduces mortality even when the intervention is successful in only a minority of patients. The study compared a 10-week intervention that combined counseling and nicotine gum with usual care among smokers with obstructive lung disease. Quit rates at 5 years were 21.7% and 5.4% in the intervention and usual care groups, respectively. At 14.5 years, the hazard ratio for all-cause mortality in the usual care group vs. the intervention group was 1.18 (95% CI 1.02 to 1.37).
PMID: 15710956
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