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Immediate reduction more effective than a gradual approach for smoking cessation
Clinical Question
Is a strategy of immediate reduction more or less effective than a gradual reduction to successfully decrease cigarette smoking?
Bottom line
This study found that an immediate reduction versus a gradual reduction of nicotine content resulted in the greatest overall decrease in biomarkers of smoke exposure over 20 weeks. It is uncertain from this study whether there was a difference in long-term smoking cessation rates. A previous study, which was more clinically useful (Lindson-Hawley N, et al. Ann Intern Med 2016;164(9):585-592), reported validated abstinence rates as higher in the abrupt cessation group than in the gradual reduction group at 6 months (22% vs 15.5%; number needed to treat = 22.2; 95% CI 11.9 - 71.7). 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
These investigators identified adults who were smoking at least 5 cigarettes per day with no specific intention to quit within 30 days. Consenting and eligible participants were enrolled and randomly received assignment (concealed allocation) to 1 of 3 groups: (1) immediate nicotine reduction, (2) gradual nicotine reduction, or (3) usual nicotine content. Unlabeled cigarettes with varying doses of nicotine (immediate group: 0.4 mg; gradual group: 15.5, 11.7, 5.2, 2.4, and 0.4 mg; control group: 15 to 18 mg) were distributed by the investigators. Individuals masked to treatment group assignment assessed all study outcomes. Primary end points included measurements of 3 biomarkers of smoke toxicant exposure: breath carbon monoxide (CO), urine 3-HMPA, and urine PheT levels. Complete follow-up occurred at 20 weeks for 68% of participants in the immediate reduction group, 81% in the gradual reduction group, and 86% in the control group. Using intention-to-treat analysis, significantly less exposure to nicotine was documented by all 3 biomarkers in the immediate reduction versus gradual reduction group and in the immediate reduction versus control group, but not between the gradual reduction and control group. In addition, the mean number of cigarette-free days among all participants was significantly higher in the immediate versus gradual reduction and control groups, with again no significant difference between the gradual reduction group and the control group. There was, however, no significant difference in the percentage of individuals with at least one cigarette-free days among any of the 3 groups.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
I’m not sure it is relevant to discuss with my patients the results from a study of people being given low-dose nic smokes. My patients don’t have access to such. But it is interesting.
I always thought gradual reduction is the way for smoking cessation. This article tells us different story. It tells immediate reduction is more effective. I think we can use the both ways. One way is effective for specific patient population and other way is effective for another group of patients.
I want to make an analogy of smoking to other addictions . You don’t give heroin addict bits of heroin to make him stop using gradually. Smoking is powerful addiction, it s hard to stop and one has to be strongly motivated to stop completely.
I do advise my patients to stop smoking I have seen more success that they stop immediately and they call it cold turkey but most start again 2-3 months after their surgical procedure stress of is common excuse and they believe they are not addicted and they can stop any time.
Also I have seen patient who has been on addictive narcotic like oxycodone after surgery and recovery few of them are able to stop narcotic suddenly.
looks like some people are neither addicted or dependent they use addictive chemical for purpose and they are able to stop anytime.
It would be useful to translate this information into numbers of cigarettes per day. Is it is presented in nicotine dose per cigarette And this is not useful in clinical practice.
Excellent
Good poem