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Intensive Efforts Could Improve Smoking-Cessation Rate

Both outreach programs and the intense cessation programs affect the proportion of smokers who succeed in quitting.

Most patients who smoke don’t receive counseling or pharmacotherapy, and even when such treatments are provided, they have only modest efficacy. In two studies, researchers evaluated whether more-intensive smoking-cessation efforts can improve outcomes.

In one study, 127 adult smokers in New Jersey who had medical illnesses (e.g., cardiovascular disease, diabetes, chronic pulmonary disease) were assigned randomly to transdermal nicotine alone or to combination therapy (transdermal nicotine, nicotine inhaler, and bupropion). At 26 weeks, more people assigned to combination therapy than to transdermal patches alone were abstinent (35% vs. 19%).

In another study, 750 smokers who visited Kansas primary care practices were offered free treatment every 6 months for 2 years, regardless of their readiness to quit (70% were in precontemplation or contemplation stages). Randomization was to transdermal nicotine or bupropion alone, either pharmacotherapy plus two counseling phone calls, or pharmacotherapy plus six phone calls. The counseling groups also received educational newsletters with smoking-cessation tips and progress reports for their physicians. Most patients (77%) requested at least one course of treatment. Abstinence during any 6-month treatment period was more common in the intensively counseled group than in the less-intensively counseled group and was more common in the counseled groups than in the noncounseled group (odds ratio, 1.4 for both comparisons). However, at 24 months (the primary study endpoint), no significant differences were found in abstinence rates (23%–28%), or in receipt of counseling or pharmacotherapy.

Comment: In the first study, researchers demonstrated the efficacy of more-intensive pharmacotherapy for smoking. The second study also suggested a benefit for more-intensive treatment; however, to me, the more important point is that most smokers requested smoking-cessation treatment, despite not being ready to quit, and a relatively high proportion (approximately one quarter) were abstinent at 2 years. Together, these findings suggest that more-intensive treatments, along with greater efforts to reach people who might benefit, hold promise for improving treatment of nicotine-dependent patients.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine May 7, 2009

Citation(s):

Steinberg MB et al. Triple-combination pharmacotherapy for medically ill smokers: A randomized trial. Ann Intern Med 2009 Apr 7; 150:447.

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• Medline abstract (Free)

Ellerbeck EF et al. Effect of varying levels of disease management on smoking cessation: A randomized trial. Ann Intern Med 2009 Apr 7; 150:437.

• Original article (Subscription may be required)
• Medline abstract (Free)