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Extended Nicotine Treatment for Long-Term Smokers FREE

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The summary below is from the full report titled “Effectiveness of Extended-Duration Trans-dermal Nicotine Therapy. A Randomized Trial.” It is in the 2 February 2010 issue of Annals of Internal Medicine (volume 152, pages 144-151). The authors are R.A. Schnoll, F. Patterson, E.P. Wileyto, D.F. Heitjan, A.E. Shields, D.A. Asch, and C. Lerman.

Ann Intern Med. 2010;152(3):I-38. doi:10.7326/0003-4819-152-3-201002020-00002
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What is the problem and what is known about it so far?

Cigarette smoking can be a chronic problem. Many smokers want to quit but find it difficult. Quitting may require several repeated attempts. Cessation aids include counseling and various medication treatments. A common medication treatment is nicotine replacement therapy. Several forms of nicotine replacement therapy exist. One is a patch placed on the skin that provides up to 24 hours of nicotine at a slower, less intense pace than cigarettes. Some guidelines on quitting smoking recommend that patients use the patches daily for 8 weeks when they are trying to quit. Several studies show, however, that many persons who are able to stop smoking with treatment begin smoking again within 6 to 12 months. More information is needed about whether the use of nicotine patches for a longer period (>8 weeks) increases long-term quit rates.

Why did the researchers do this particular study?

To compare long-term rates of tobacco abstinence among long-term smokers who received nicotine patches for either 8 or 24 weeks.

Who was studied?

568 smokers who wanted to quit smoking. All had smoked 10 or more cigarettes daily and had been smoking for at least 1 year.

How was the study done?

Researchers at an academic medical center recruited “healthy” adult smokers aged 18 to 65 years who wanted to quit. They offered all eligible participants 8 behavioral counseling sessions. In addition, the smokers were randomly assigned to receive nicotine patches (21 mg daily) for either 8 or 24 weeks. Smokers assigned to 8-week therapy received placebo patches from weeks 16 to 24 to help ensure that no one knew who was receiving which therapy. The researchers asked participants about smoking habits throughout the study and took breath samples that measured carbon monoxide levels at 24 and 52 weeks. At those points, they compared numbers of persons in each group who said they had not been smoking during the previous week and who had negative breath test results (carbon monoxide level <10 ppm).

What did the researchers find?

Tobacco abstinence rates were statistically significantly higher in the extended-therapy group than the standard-therapy group at 24 weeks. However, similar numbers of participants in both groups (about 14%) were abstinent at 52 weeks. Reported side effects, such as nausea, skin redness, and sleep problems, were mostly similar between groups. No serious life-threatening adverse events were attributed to extended therapy.

What were the limitations of the study?

Participants were volunteers seeking treatment. No participant had comorbid conditions, such as diabetes, known serious heart disease, or alcohol dependence. Several participants in both groups stopped using the patches within the first few weeks of the study. Some participants did not provide complete abstinence data at follow-up.

What are the implications of the study?

Some smokers may avoid smoking for a longer period by using nicotine patches for 6 months rather than for 2 months. Many persons resume smoking once they stop nicotine treatment. Therefore, long-term patch use should be considered.





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