Nicotine replacement therapy … - Carlos A ... - Entretiens du Carla

Conclusion 7
Oral form or Patches for reducing
tobacco consumption
To be effective, reduction in
consumption has to be supported by NRT.
Oral forms are to be selected as a priority
in accordance with the smoker’s
preferences. Patches and oral forms may
also be combined.
One should be aware of a high(er) level
of nicotinemia when NRT is used for
reducing smoking when the smoker at the
same time is not reducing the amount of
cigarettes as planned.
The experts indicate that oral tobacco
products used in certain countries such as
snus, to reduce the consumption of
cigarettes carry the risk of causing somatic
pathologies and addiction, and therefore
must be the subject of further studies
before public authorities can authorize
their sale. See Conclusion 14.
Conclusion 8
Reduction and pregnancy
As much of the harm that smoking causes
in pregnancy is dose dependant (e.g.
reduced birth weight), pregnant women
should try to quit when they are pregnant
and if they cannot stop smoking, they should
reduce their smoking as much as possible. If,
using only behavioural methods, women are
not able to stop smoking then they could
consider using nicotine replacement therapy
(NRT) to help them stop (see Conclusion 12).
Much of the toxicity from tobacco use
during pregnancy may be caused by the
products of combustion* (see note in the
margin) that are given off when tobacco is
burned (e.g. carbon monoxide or polycyclic
aromatic hydrocarbons) and so NRT may be
safer than continued smoking.
11
However, the impact on women’s total
nicotine exposure (i.e. from both NRT and
continued smoking), of using NRT for
smoking reduction in pregnancy remains
unknown. Research is needed to determine
whether or not using NRT to help reduce
(and not quit) smoking in pregnancy also
reduces the delivery of toxins and is less
harmful to the fetus than continued
maternal smoking.
Conclusion 9
Reduction in a patient with heart
disease
Many studies have confirmed the perfect
safety of NRT in association with a reduction
in tobacco consumption for patients with
heart diseases (including coronary patients).
Also, even it is important to emphasize
the necessity of total abstinence for smokers
with heart disease to minimize health risks
from tobacco, reduction should eventually
be promoted as a first step to achieving
cessation in smokers unwilling or perceiving
themselves unable to quit. Nevertheless, we
don't know the real benefits of this strategy
on health outcomes, especially in coronary
patients.
These recommendations confirm the high
tolerance of NRT and their usefulness as
excellent tools to help stop and reduce
tobacco use. They also stress the importance
of supporting smokers and highlight the key
role of the physician or another health
worker or tobaccologist who must adjust the
choice of therapy in order to meet the
smoker’s needs and possibilities.
Le Carla.
Conclusions
* It is not
definite that
carbon monoxyde
is the
primary cause
of harm from
smoking in
pregnancy.