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(New page: {{subpages}} ==Etiology of smoking== '''Tobacco smoking as self-medication''' ==Treatment== ===Counseling=== Recording smoking status as a vital sign increases the frequency of brief advi...)
 
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==Etiology of smoking==
'''Tobacco smoking as self-medication'''
 
==Treatment==
===Counseling===
Recording smoking status as a vital sign increases the frequency of brief advice to patients by physicians.<ref name="pmid18195316">{{cite journal |author=Rothemich SF, Woolf SH, Johnson RE, ''et al'' |title=Effect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study |journal=Ann Fam Med |volume=6 |issue=1 |pages=60-8 |year=2008 |pmid=18195316 |doi=10.1370/afm.750 |url=http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=18195316 |issn=}}</ref>
 
[[Motivational interviewing]] may help smoking cessation.<ref name="pmid20091612">{{cite journal| author=Lai DT, Cahill K, Qin Y, Tang JL| title=Motivational interviewing for smoking cessation. | journal=Cochrane Database Syst Rev | year= 2010 | volume=  | issue= 1 | pages= CD006936 | pmid=20091612
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20091612 | doi=10.1002/14651858.CD006936.pub2 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
 
====Demonstration of damage to lungs====
In general, informing patients of their lung function as measured by spirometry does not increase smoking cession according to a [[systematic review]] by the [[US Preventive Services Task Force| U.S. Preventive Services Task Force]]  (USPSTF).<ref name="pmid18316746">{{cite journal |author=Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB |title=Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume= |issue= |pages= |year=2008 |pmid=18316746 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=18316746 |issn=}}</ref> However, in a more recent [[randomized controlled trial]], patients in the group who were informed of their 'lung age' were more likely to stop smoking.<ref name="pmid18326503">{{cite journal |author=Parkes G, Greenhalgh T, Griffin M, Dent R |title=Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial |journal=BMJ |volume= |issue= |pages= |year=2008 |pmid=18326503 |doi=10.1136/bmj.39503.582396.25 |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18326503 |issn=}}</ref> However, in this trial, "People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group".<ref name="pmid18326503"/>
 
===Medications===
====Bupropion====
[[Bupropion]] is both an [[adrenergic uptake inhibitor]] and a [[dopamine uptake inhibitor]] and can help smoking cessation<ref name="pmid9337378">{{cite journal| author=Hurt RD, Sachs DP, Glover ED, Offord KP, Johnston JA, Dale LC et al.| title=A comparison of sustained-release bupropion and placebo for smoking cessation. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 17 | pages= 1195-202 | pmid=9337378
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9337378 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>, including adding to the effective of nicotine replacement.<ref name="pmid10053177">{{cite journal| author=Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR et al.| title=A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. | journal=N Engl J Med | year= 1999 | volume= 340 | issue= 9 | pages= 685-91 | pmid=10053177
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10053177 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
 
====Varenicline====
[[Varenicline]], a partial agonist at the α<sub>4</sub>β<sub>2</sub> nicotinic [[acetylcholine receptor]], may be more effective than bupropion<ref name="pmid16820547">{{cite journal| author=Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE et al.| title=Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. | journal=JAMA | year= 2006 | volume= 296 | issue= 1 | pages= 56-63 | pmid=16820547
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16820547 | doi=10.1001/jama.296.1.56 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid16820546">{{cite journal| author=Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB et al.| title=Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. | journal=JAMA | year= 2006 | volume= 296 | issue= 1 | pages= 47-55 | pmid=16820546
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16820546 | doi=10.1001/jama.296.1.47 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>; however, bupropion is a [[generic drug]]. [[Varenicline]] is probably better than the nicotine patch; however, the only study was not blinded and was industry sponsored.<ref name="pmid18263663">{{cite journal| author=Aubin HJ, Bobak A, Britton JR, Oncken C, Billing CB, Gong J et al.| title=Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. | journal=Thorax | year= 2008 | volume= 63 | issue= 8 | pages= 717-24 | pmid=18263663
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18263663 | doi=10.1136/thx.2007.090647 | pmc=PMC2569194 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
 
The [[Food and Drug Administration]] of the [[United States]] has issued an advisory for varenicline and psychiatric disease.<ref>Anonymous (2009). [http://www.fda.gov/drugs/drugsafety/publichealthadvisories/ucm051136 Important Information on Chantix (varenicline)] Food and Drug Administration</ref>
 
{| class="wikitable"
|+ Selected medications for abstinence<ref name="pmid18625984">{{cite journal |author=Eisenberg MJ, Filion KB, Yavin D, ''et al.'' |title=Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials |journal=CMAJ |volume=179 |issue=2 |pages=135–44 |year=2008 |month=July |pmid=18625984 |pmc=2443223 |doi=10.1503/cmaj.070256 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=18625984 |issn=}}</ref><ref name="pmid19160228">{{cite journal |author=Hajek P, Stead LF, West R, Jarvis M, Lancaster T |title=Relapse prevention interventions for smoking cessation |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD003999 |year=2009 |pmid=19160228 |doi=10.1002/14651858.CD003999.pub3 |url=http://dx.doi.org/10.1002/14651858.CD003999.pub3 |issn=}}</ref>
! &nbsp;!! Eisenberg<ref name="pmid18625984"/><br/>([[odds ratio]])!!Cochrane<ref name="pmid19160228"/><br/>([[relative risk ratio]])
|-
| Bupropion|| 2.07|| 1.17
|-
| Varenicline|| 2.41|| 1.18
|}
 
====Nicotine replacement====
A [[systematic review]]s of selected [[medication]]s including nicotine replacement found that the [[odds ratio]]s for quitting with nicotine are:<ref name="pmid18625984">{{cite journal |author=Eisenberg MJ, Filion KB, Yavin D, ''et al'' |title=Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials |journal=CMAJ |volume=179 |issue=2 |pages=135–44 |year=2008 |month=July |pmid=18625984 |pmc=2443223 |doi=10.1503/cmaj.070256 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=18625984 |issn=}}</ref>
* Spray, 2.37
* Inhaler, 2.18
* Patch, 1.88
* Gum, 1.65
 
====Rimonabant====
Rimonabant, a selective type 1 cannabinoid (CB1) receptor antagonist, improves smoking cessation and moderate weight gain associated with smoking cessation according to a [[meta-analysis]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]].<ref name="pmid17943852">{{cite journal |author=Cahill K, Ussher M |title=Cannabinoid type 1 receptor antagonists (rimonabant) for smoking cessation |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD005353 |year=2007 |pmid=17943852 |doi=10.1002/14651858.CD005353.pub3}}</ref> However, "there is current concern (August 2007) over rates of depression and suicidal thoughts in people taking rimonabant for weight control."<ref name="pmid17943852"/>
 
====Atomoxetine====
Addiction is reinforced by the fear of experiencing the adverse effects associated with the cessation of the drug. Smoking withdrawal causes cognitive deficits analogous to [[attention deficit hyperactivity disorder]], an observation which prompted researchers to test the hypothesis that drugs that ameliorate ADHD facilitate smoking cessation. In confirmation of this hypothesis, it was shown that [[atomoxetine]], a [[norepinephrine reuptake inhibitor]] that is approved by the FDA to treat the symptoms of ADHD, dose-dependently reversed congnitive deficits in an animal model of nicotine withdrawal.<ref name="pmid17228337">{{cite journal |author=Davis JA, Gould TJ |title=Atomoxetine reverses nicotine withdrawal-associated deficits in contextual fear conditioning |journal=Neuropsychopharmacology |volume=32 |issue=9 |pages=2011–9 |year=2007 |month=September |pmid=17228337 |doi=10.1038/sj.npp.1301315 |url=}}</ref> Atomoxetine is not indicated at this time as a medication to treat the ADHD-like symptoms of smoking cessation.
 
====Combinations of medications====
{| class="wikitable"
|+ Selected trials of combination smoking cessation interventions<ref name="pmid19349630">{{cite journal |author=Steinberg MB, Greenhaus S, Schmelzer AC, ''et al'' |title=Triple-combination pharmacotherapy for medically ill smokers: a randomized trial |journal=Ann. Intern. Med. |volume=150 |issue=7 |pages=447–54 |year=2009 |month=April |pmid=19349630 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=19349630 |issn=}}</ref><ref name="pmid10053177">{{cite journal |author=Jorenby DE, Leischow SJ, Nides MA, ''et al'' |title=A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation |journal=N. Engl. J. Med. |volume=340 |issue=9 |pages=685–91 |year=1999 |month=March |pmid=10053177 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=10053177&promo=ONFLNS19 |issn=}}</ref>
! rowspan="2"|Study!!rowspan="2"|Subjects!!rowspan="2"|Intervention!!rowspan="2"|Comparison!!rowspan="2"|Outcome!! colspan="2"|Results
|-
! Intervention group!! Comparison group
|-
| Steinberg<ref name="pmid19349630"/><br/>2009||Community volunteers with predefined medical illnesses||Triple therapy of nicotine patch, nicotine oral inhaler, and bupropion ad libitum||Nicotine patch alone||Abstinence at 26 weeks by 7 days exhaled carbon monoxide testing ||35% ||19%
|-
| Jorenby<ref name="pmid10053177"/><br/>1999||Community volunteers without medical illness|| Double therapy with bupropion and nicotine patch||Nicotine patch alone||Abstinence at 52 weeks by single exhaled carbon monoxide testing || Both drugs 36%<br/>Bupropion alone 30% ||16%
|}
 
===Incentives===
Financial incentives to either smokers or their health care providers may increase rates of smoking cessation.<ref name="pmid19213683">{{cite journal |author=Volpp KG, Troxel AB, Pauly MV, ''et al'' |title=A randomized, controlled trial of financial incentives for smoking cessation |journal=N. Engl. J. Med. |volume=360 |issue=7 |pages=699–709 |year=2009 |month=February |pmid=19213683 |doi=10.1056/NEJMsa0806819 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19213683&promo=ONFLNS19 |issn=}}</ref><ref name="pmid19370599">{{cite journal |author=Reda AA, Kaper J, Fikrelter H, Severens JL, van Schayck CP |title=Healthcare financing systems for increasing the use of tobacco dependence treatment |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004305 |year=2009 |pmid=19370599 |doi=10.1002/14651858.CD004305.pub3 |url=http://dx.doi.org/10.1002/14651858.CD004305.pub3 |issn=}}</ref><ref>Karlan D; Zinman J. (August 2008) [http://www.expeconatcirano.qc.ca/workshops/EEDC2008/program.php Put your Money where your Butt is: A commitment Savings Account for Smoking Cessation]. Workshop on Economics Experiments in Developing Countries at CIRANO</ref>
 
==Adverse effects==
Smoking cessation may lead to weight gain, which may lead to [[diabetes mellitus type 2]].<ref>http://pubmed.gov/20048267</ref>
 
==References==
<references/>

Latest revision as of 13:06, 16 June 2024


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