A Review of Smoking Cessation Interventions

Ashish Maseeh, MD, and Gagandeep Kwatra, MD

Introduction

Every 8 seconds, a person dies of a tobacco-related disease, and almost as quickly another victim is recruited.^[1] Cigarette smoking is a major preventable cause of morbidity and is expected to cause up to 450 million deaths in the next 50 years.^[2] While the association of smoking with cardiovascular diseases, cancer, respiratory diseases, and gastric ulceration has been documented extensively,^[3] it may also accelerate early menopause through its antiestrogen effect.^[4]

Smoking cessation may be defined as validated sustained abstinence from cigarettes and/or other tobacco products for at least 6 months, but preferably for a year.^[5] Regardless of age at the time of quitting, cessation decreases the risk of as well as delays the progression of smoking-related diseases while increasing life expectancy.^[6] Another important consideration is the cost-effectiveness of smoking cessation support, which is far superior to that of many other potentially life-saving interventions, and there is a distinct economic advantage in encouraging patients to quit.^[7]

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Cite this: A Review of Smoking Cessation Interventions - Medscape - Jun 07, 2005.

Comparison of the Different Preparations Available for Nicotine Replacement Therapy
Drug	Dosage	Duration	Side Effects	Precautions	Advantages	Disadvantages	Efficacy
Nicotine gum 2 mg (<25 cig/day) 4 mg (≥25 cig/day)	1 piece/hour up to a maximum of 24 pieces/day	8 12 weeks	Irritation in mouth, mouth ulcers, sore jaw, dyspepsia, nausea, hiccups, (?) breathing difficulties	Contraindicated if gastric ulcers. Avoid in pregnancy and lactation	User controls dose, substitute ritual*, rapid absorption, available OTC	Complex chewing technique, difficulty for denture users, cannot eat/drink, acute withdrawal on abrupt discontinuation	≈ 1.5 to 2 times that of placebo
Nicotine patch 7, 14, 21 mg (24 hours) 15 mg (16 hours)	Worn for 16 24 hours, depending upon the patch	21 mg/day X 4 weeks then 14 mg/day X 2 weeks then 7 mg/day X 2 weeks (total 8 weeks) or 15 mg/16 hours/day X 8 weeks	Local skin reaction/irritation, insomnia, (?) cardiovascular side effects	Avoid in pregnancy/lactation. Caution advised if coexistent cardiovascular disease	Steady plasma levels, simple to use (? therefore better compliance), can be used by patients of PUD/those with denture, OTC, low habituation, (?) improved cognitive decrements, discreet	Slow release preparation, no control over dose (therefore not useful for acute craving), effects wane over time therefore high relapse rate	As above
Nasal spray 1 dose = 1 spray (0.5 mg) in each nostril	1 to 2 doses/hour (up to 40 mg/day)	3 to 6 months	Nasal irritation, sneezing, watering of eyes **	Cautious use in patients with perennial rhinitis, rhinosinusitis, recurrent epistaxis, recent MI or worsening angina. Avoid in pregnancy and lactation	Fastest delivery & highest levels of nicotine among all products, user controls dose	Embarrassing, high incidence of local side effect may decrease compliance	As above
Nicotine inhaler 4 mg/cartridge (also 1 mg of menthol/ cartridge)	6 to 16 cartridges/day	3 to 6 months	Irritation in mouth and throat, cough	Avoid in pregnancy and lactation, Cautious use in patients with recent MI or worsening angina	User controls dose, substitute ritual, rapid delivery of nicotine compared to patch	Embarrassing, compliance less than patch, frequent puffing required	As above
Nicotine lozenges 2 and 4 mg	9 to 20 per day	12 weeks	Dyspepsia, irritation in mouth	Avoid in pregnancy/lactation. Caution advised if coexistent cardiovascular disease	Easy to use, no complex techniques for administration, user controls dose, discreet	Acute withdrawal on abrupt discontinuation cannot eat/drink, safety in geriatric patients and PUD unclear

*See text for smoking ritual.
**Incidence of adverse effects proportional to the amount of product use.
? Possibility exists/isolated report that needs further investigation.
OTC = over the counter; PUD = peptic ulcer disease; MI = myocardial infarction.

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A Review of Smoking Cessation Interventions

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