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

However it takes little account of the
undeniable long-term toxicity of smoking,
even if it is reduced, since fluctuations
have been demonstrated in the behavior
of smokers over the period of smoking
reduction (31), similar to the variation in
the decision to quit in pregnant women.
Any factors that promote support from a
healthcare professional during smoking
reduction therapy (validation of the
reduction, developing the motivation to
quit (33) then help quitting through a
combination of NRT and cognitive
behavior therapy with the greatest chance
of success (34).
Figure 4 Design of the smoking reduction study.
Weeks 2-3 comprise phase 1 of the study and
weeks 4-5 comprise phase 2. Numbers indicate
completion of each week. In : Fagerström KO,
Tejding R, Westin Ake, Lunell E. Aiding reduction of
smoking with nicotine replacement medications :
hope for recal-citrant smoker? Tobacco control
1997; 6: 311-16.
Figure 5 Effect of choice of medication compared
with random allocation to medication on reduction
of cigarettes per day, exhaled carbon monoxide
(CO), and total withdrawal sympton score.In
:Fagerström KO, Tejding R, Westin Ake, Lunell E. Aiding
reduction of smoking with nicotine replacement
medications: hope for recalcitrant smoker ? Tobacco
control 1997; 6: 311-16.
53
Is NRT-assisted smoking
reduction conceivable in
pregnant women?
Many practitioners already give NRT to
pregnant women in France, even though
it against the recommendations. Although
a toxic effect of nicotine on the fetus
cannot be excluded, carbon monoxide is
mostly responsible for the hypoxia that
has consequences for fetal development
and pregnancy outcome (35).
The results of one study to evaluate the
effect of nicotine patches on the
frequency of smoking cessation, birth
weight and preterm delivery found no
particular toxicity in women who
continued to smoke (36). It seems
probable that in the presence of a stable
nicotine intake, any smoking reduction
that reduces carbon monoxide intake is
much less toxic than continuing with the
same level of cigarette consumption, and
a few studies with a low level of evidence
seem to support this.
Studies need to be conducted to
demonstrate definitively the value and
non-toxicity of this concept in pregnant
women, although they may confront
methodological and ethical problems.
Smoking reduction
supported by NRT in
hard-core smokers
Several epidemiological surveys have
attempted to evaluate the prevalence of
the "hard-core" phenomenon in tobacco
consumers (37-40). According to these
studies, it lies between 5% and 16%.
Hard-core smokers constitute a group
of smokers who are relatively unconvinced
of the toxicity of smoking and of the
dependence it induces, even though they
exhibit high dependence and are high
consumers, and they are also relatively
unreceptive to messages about prevention
and to restrictions on consumption. Their
Reducing cigarettes consumption - Jean Perriot