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Smoking reduction

Smoking reduction. Philip Tønnesen, M.D., Department of Pulmonary Medicine Copenhagen, Denmark. Tobacco control. Prevention Smoking cessation Smoking reduction. Nicotine replacement. 17 % of NRT is used for other than smoking cessation! i.e.

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Smoking reduction

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  1. Smoking reduction Philip Tønnesen, M.D., Department of Pulmonary Medicine Copenhagen, Denmark P Tonnesen.2009

  2. Tobacco control Prevention Smoking cessation Smoking reduction P Tonnesen.2009

  3. Nicotine replacement • 17 % of NRT is used for other than smoking cessation! i.e. • 60 % use NRT < 2 weeks • 40 % no instruction (GP or pharmacit) • Temporary abstinence: during work, travel • Smoking reduction P Tonnesen.2009

  4. Smokers in the Netherlands 100% New smokers to reach with Reduction to Stop Happy smokers 34% 80% Wants to reduce 16% Smokers 60% Reduces now 17% Unhappy (ambivalent) smokers66% 40% Wants to stop 29% 20% Stops today 4% 0% P Tonnesen.2009

  5. Smoking Reduction Rationale • Aimed for smokers low in motivation to quit / unable to quit • Induction of permanent change in smoking habit • Compensation not 100% • Will not interfere with smoking cessation P Tonnesen.2009

  6. Smoking Reduction • Cigarettes  + NRT use Definition: “arbitrary” Cigarettes/day < 50 % of entry numbers plus any decrease in CO (1 ppm or >) P Tonnesen.2009

  7. Cessation-induction Ready to reduce smoking NRT increases reduction Self-efficacy increased Intentionto quit increased Increasedprobabilityof a quit attempt Reducingprior to quittingdecreases relapse NRT prior to quittingdecreases relapse Increasedabstinence P Tonnesen.2009

  8. Clinical Studies P Tonnesen.2009

  9. Gum and Inhalator Increase the Likelihood of Successful Sustained Reduction (2 Inhaler, 4 Gum studies) % * * p<0.001 * * * Sustained Smoking Reduction From Week 6 (at least 50% reduction, verified by a lowered CO) P Tonnesen.2009

  10. Gum and Inhalator Increase the Likelihood of Successful Cessation (2 Inhaler, 4 Gum studies) % * p<0.001 * * * * Point Prevalence Cessation Rates (complete cessation, verified by a CO < 10 ppm) P Tonnesen.2009

  11. Smoking reductionWennike, Tønnesen et al. Addiction 2003 • 411 smokers • 24 cigarettes/day • Motivation to reduce on 10-cm VAS: 9 • Motivation to quit on 10-cm VAS: 5 • Nicotine gum for up to 12 months P Tonnesen.2009

  12. Smoking reductionWennike, Tønnesen et al. Addiction 2003 Reduction (sustained): Active Placebo 4-months 14 % 5 % (p<0.002) 1-year 8.8 % 1.5 % (p<0.001) 2-years 6.3 % 0.5 % (p<0.001) P Tonnesen.2009

  13. Smoking reductionWennike, Tønnesen et al, Addiction 2003 Cessation (point): Active Placebo 4 months 6.3 % 0.5 % (p<0.001) 1-year 11.2 % 3.9 % (p<0.005) 2-years 9.3 % 3.4% (p<0.01) P Tonnesen.2009

  14. Motivation to quit P Tonnesen.2009

  15. Smoking cessation/reduction in COPD (Tønnesen et al.In press) • 370 COPD patients • Age :62 years • FEV1: 1.57 (56 % predicted) • Cigarettes/day: 20 • FTND: 6.4 • High – low support, NRT – placebo 12 weeks P Tonnesen.2009

  16. Smoking reduction in COPD NRT versus placebo: 6 months reduction rate: 21 % vs 15 % 12 months reduction rate: 12 % vs 13 % P Tonnesen.2009

  17. Smoking cessation in COPD NRT versus placebo: 6 months quit rate: 23 % vs 10 % 12 months quit rate: 17 % vs 10 % (OR 2.0) P Tonnesen.2009

  18. Reduction to quit with NRT OTC • 3297 smokers in US • 2-mg, 4-mg nicotine gum or placebo • The first 8 weeks gardually reduce number of CPD and increase number of pieces of gum • Abstinent 24 hours use gum as FDA recom • Shiffman et al. Am J Prev Med 2009 P Tonnesen.2009

  19. Reduction to quit with NRT OTC • Results: Odds ratio for quitting vs. placebo • 1 Month 6 Months • 2-mg gum 2.01 1.80 • 4-mg gum 4.66 5.90 • Reducers more likely to quit • Shiffman et al. 2009 P Tonnesen.2009

  20. Adverse events • A review of 11 studies of NRT used for smoking reduction found no unexpected adverse events, while side effects that may possibly be related to nicotine overdose (such as nausea and vomiting) were evenly distributed between active and placebo treatment groups (Fagerström & Hughes 2002) • No increase in cardiovascular events (Murray et al 1996) in concurrent use of NRT and smoking for up to five years P Tonnesen.2009

  21. Adverse events cont • Use of nicotine 4 mg gum and smoking every hour (in order to attain unusually high plasma nicotine levels) revealed no evidence of adverse cardiac effects, even during exercise tests (Stahl et al 2001). • The total nicotine intake remains broadly stable when smokers use NRT to reduce their cigarette smoking (Benowitz et al 1998) P Tonnesen.2009

  22. Conclusion : Smoking reduction • Reduction possible long-term • Reduction leads to cessation • NRT increase ”success rates” • Motivation to quit not decreased, but actually increased (55-80%) • Recruitment of new segment of smokers • Effect on health ? (if < 6 cig/day ?) P Tonnesen.2009

  23. NRT and smoking reduction • Fast acting NRT: gum or inhaler, sublingual, loozenge (nasal spray) (mouth spray) 2. Use for 2-3 months: If reduced to less than 50 % then continue with NRT P Tonnesen.2009

  24. Treatment of most smokers is possible Motivated to quit Motivated to reduce Smoking cessation Smoking Reduction Agressive smoking cessation with NRT: Combinations of 2 NRT’s; bupropionSR; varenicline; Recycling NRT for 3-(18) months P Tonnesen.2009

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