Learn more about nicotine dependency and cessation by reading the following selected publications.
Goldstein MG, DePue JD, et al. A Population-Based Survey of Physician Smoking Cessation Counseling Practices Preventive Medicine 1998, Pages 720-729. A survey of primary care physicians focusing on national guidelines for smoking cessation counseling showed a majority Ask (67%) and Advise (74%) patients about smoking, but few Assist (35%) or Arrange follow-up (8%).
Anthonisen NR, Connett JE, et al. Effects of Smoking Intervention and the Use of an Inhaled Anticholinergic Bronchodilator on the Rate of Decline of FEV1 JAMA 1994, Pages 1497—1505. An aggressive smoking intervention program significantly reduces the age-related decline in FEV1 in middle-aged smokers with mild airways obstruction. Use of inhaled anticholinergic bronchodilator results in a relatively small improvement in FEV1 that appears to be reversed after drug is discontinued.
Tonstad S, Davies S, et al. Psychiatric Adverse Events in Randomized, Double-Blind, Placebo-Controlled Clinical Trials of Varenicline. Drug Safety 2010, Pages 289—301. The incidence of psychiatric disorders was 10.7% in subjects treated with varenicline and 9.7% in subjects treated with placebo, RR of 1.02 (95% CI 0.86, 1.22). There were no cases of suicidal ideation or behavior in varenicline-treated subjects in the ten placebo-controlled studies analyzed.
Benowitz NL, Zevin S, Jacob P. Suppression of nicotine intake during ad libitum cigarette smoking by high-dose transdermal nicotine. J. Pharmacol. Exp. Ther. 1998, Pages 958-962 . Transdermal nicotine suppressed nicotine intake from cigarette smoking by 3%, 10% and 40% on average in the 21, 42 and 63 mg/day conditions. The number of cigarettes smoked per day declined from an average of 17.2 to 12.7 and the intake of nicotine per cigarette declined from 2.5 to 1.6.
Meine TJ, Patel MR, et al. Safety and Effectiveness of Transdermal Nicotine Patch in Smokers Admitted With Acute Coronary Syndromes Am J Cardiol 2005;95:976–978 An analysis of smokers admitted with acute coronary syndrome who received transdermal nicotine therapy and those who did not was performed. Propensity analysis was used to match patients. Transdermal nicotine therapy appears safe and does not have an effect on the mortality of patients with acute coronary syndromes.
Zapawa L, Hughes J, et al. Cautions and warnings on the US OTC label for nicotine replacement: What’s a doctor to do? Addictive Behaviors 2011; 36: 327–332. Every clinician who has ever treated a smoker has faced significant and often confusing contradiction between the usage instructions on the label and their own clinical judgment. Though not a report of primary research, this paper is a “must read” for every clinician interested in treating tobacco. The authors are recognized experts in the field, and have collated the available evidence related to the most common clinical questions regarding nicotine replacement. This is exactly the paper you need to read in order to help guide your approach to the long-term care of your smokers (and potentially even to justify your decisions to insurers).
Hajek P, McRobbie HJ, et al. Use of varenicline for 4 weeks before quitting smoking. Decrease in ad lib smoking and increase in smoking cessation rates. Arch Intern Med. 2011;171:770-777. Since its introduction, varenicline has been marketed under the instruction to begin abstinence at the conclusion of a 7-day dose escalation period. This is in contrast to the observation that many patients who use varenicline find it difficult to abstain so soon after initiation. In this study, 100 smokers were randomly assigned to receive active varenicline for either 1 or 4 weeks before quitting. The 12-week abstinence rates were higher for the 4-week group (47.2% vs 20.8%), with the effect particularly strong among subjects who reduced cotinine levels prior to quit day (66.7% vs 22.6%).