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

• Other studies have demonstrated the
value of reducing consumption in patients
with COPD ("Lung Health Study") to
enable them to maintain abstinence by
consuming 2-mg gum with 5 years of
follow-up (14% of ex-smokers out of 3,923
patients consumed 10 pieces of gum a
day) or to produce long-term smoking
reduction (5% of residual smokers
consumed 7 pieces of gum a day) (20). In
both cases perfect coronary tolerance was
observed, while reduced breath CO levels
correlated with the decrease in the
number of cigarettes consumed. During
the follow-up of this study it was observed
that repeated quit attempts reduced loss
of lung function, as assessed by FEV1 (21).
An NRT-assisted smoking reduction
strategy in patients with asthma produced
slight clinical improvement but above all
increased motivation to quit smoking [22].
In subjects smoking more than 40
cigarettes a day and agreeing to take part
in a reduction strategy with the assistance
of 2-mg strength gum (10/day) for 9 weeks
and to undergo endoscopic investigations
(23) it was shown that smoking reduction
could be obtained in 13 of the 15
volunteers, that is was accompanied by a
44% reduction in mean exhaled CO levels
and that improvements in endoscopic
measures of bronchoalveolar inflammation
(biochemical and cellular) were rapidly
shown.
Fleur Van Bladeren.
Many studies stress its
safety
The observations from the "Lung
Health Study" cited above (20) and those
from the study by Mahmarian et al. (24)
where smokers with coronary artery
disease were given high doses of nicotine
replacement therapy showed that
ischemia is not exacerbated by NRT (the
degree of ischemia correlated with toxic
carbon monoxide intake). Finally, NRTsupported
smoking reduction is associated
with improvements in indicators of
hemodynamic, metabolic and biometric
risk which, combined with the
improvement in quality of life indicators
(25), suggest that this technique is safe.
Although studies need to be developed
in order to identify all the biomarkers of
harm and their impact on health (26-27)
NRT is currently the effective therapy to
help smoking cessation in smoking
reduction strategies that has been best
evaluated and that presents the highest
benefit/risk profile (28-29).
Question on
hold and future
perspectives
Is smoking reduction
using OTC NRT
conceivable?
One study (30) conducted in 223
smokers receiving treatment with 21-mg
patches for 42 days simply with the
support of a self-help manual found a 6month
quit rate of 12% and a quit
attempt rate of 22% (identical rates to those
observed after 6 weeks). Of those smoking
after 6 months, mean daily consumption had
decreased from 28 to 18 cigarettes.
Therefore, smoking reduction supported by
OTC NRT would be possible…
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