MedicalResearch.com Interview with:
Dr Nicola Lindson PhD CPsychol
Cochrane Tobacco Addiction Group (TAG) Managing Editor & Senior Researcher
Nuffield Department of Primary Care Health Sciences,
University of Oxford
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: People have been using nicotine replacement therapy, otherwise known as NRT, to quit smoking for more than 20 years. NRT is available in a range of forms: skin patches, chewing gum, nasal and oral sprays, inhalators, and lozenges. We have good evidence that it is safe and that it helps more people to quit than trying to stop smoking using no medication.
We carried out a systematic review to try and find out what the best ways are to use NRT to maximise a person’s chances of quitting successfully. We did this by looking at studies that compared at least two different types of NRT use, such as higher versus lower doses, or longer versus shorter use.
The takeaway message from the review is that using more nicotine (in the form of nicotine replacement therapy, ) to aid quitting can help more people to stop smoking in the long-term. There is high quality evidence that using two forms of nicotine replacement at the same time – a patch as well as a faster-acting form such as gum – increases chances of quitting, and evidence also suggests that starting to use nicotine replacement before the day you give up cigarettes can help more people quit than beginning use on the day you stop.
There is no evidence that using more nicotine replacement is harmful when used as directed.
MedicalResearch.com: What should readers take away from your report?
Response: Some people are not sure about using nicotine replacement therapy, or increasing the amount they use, as they are worried it may be harmful or that they will become addicted. In fact we know that nicotine replacement therapy, is safe when used as directed, and people who smoke are already used to and can tolerate high levels of nicotine. Cigarettes – not nicotine – are the killer and so the important thing is quitting cigarettes. NRT is not addictive in the same way that cigarettes are due to the different way it delivers nicotine. Therefore, most people find it very easy to stop using NRT after using it to stop smoking.
Quitting smoking is hard, but important, as even people who’ve smoked for many years can improve their health by quitting. It is important that we do all we can to increase the chances of stopping. In the UK most people who use NRT buy it over the counter and last year only 12% of those people used two forms of NRT at the same time. Our evidence shows that if people trying to quit stick on a nicotine patch, as well as using another form, such as gum, nasal spray or lozenges, every time they have a craving to smoke, they are more likely to quit and improve their health.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Many of the types of nicotine replacement therapy, use we wanted to investigate, for example length of use and patch dose did not have much evidence available looking into their effects. As a result we concluded that more high-quality studies are needed to compare higher versus lower patch doses, different durations of nicotine replacement therapy, use, different types of fast-acting NRT (such as gum, lozenge, nasal spray). Well-conducted studies examining the use of fast-acting NRT or combination NRT (patch plus a fast acting form) use before quitting, whilst still smoking, would also add to the existing evidence. Finally, the studies in the review were carried out in people who smoked between 15 and 40 cigarettes per day. Studies in people smoking fewer than 15 cigarettes a day or more than 40 cigarettes a day would also add to the existing evidence base.
MedicalResearch.com: Is there anything else you would like to add?
Response: This systematic review was a Cochrane Review carried out by authors from the Cochrane Tobacco Addiction Group. Cochrane is a global non-profit organisation that reviews evidence on healthcare interventions and summarises the findings. This helps people to make important decisions using unbiased information without having to first read every study out there.
Cochrane Database of Systematic Reviews
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