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Smokers where smoking cessation is required, but who are still hesitant (or refractory) face a sudden stop can now start by reducing their consumption of cigarettes with the help of nicotine replacement therapy, experts said together in Paris by the French branch of the world's leading pharmaceutical company.

Step by Step

The total and sudden withdrawal is no longer the only recommended strategy, and the strategy to reduce smoking as a first step to a complete stop figure among the indications of some NRT (gum and inhalers).

Dr. Beatrice Master, tobacco specialist, responsible for tobacco addiction unit of the University Hospital of Caen (Calvados), said that if this approach were already widely practiced by tobaccologists, it is now officially recognized in the authorization for the (AMM) of different nicotine replacement.

This strategy of reducing tobacco consumption supported by the use of nicotine replacement therapy ("smoking reduction" in English), which must always be considered as a step towards a complete halt, has been validated by several clinical trials, she explained.

The target population for any particular

In fact, "quitting is like climbing a hill, mountain or Everest, depending on whether one is more or less-dependent: it takes a willingness and two, good facilities" summarized by Professor Bertrand Dautzenberg, pulmonologist at Pitié-Salpêtrière Hospital in Paris (XIII arrondissement), President of the French Office for the Prevention of smoking.

Despite the increased pressure exerted on smokers (war against tobacco in the cancer plan, increase the price of tobacco, information campaigns and awareness), some of them are not at all willing to stop, and this approach can provide assistance.

These are the people that form the basis of the target population for which the strategy to reduce tobacco use through nicotine replacement therapy may be considered (40 to 75% of smokers).

Thus, in addition to smokers not considering quitting in the next six months (either because they are not ready, either because they have been burned by previous failed attempts), those with diseases cardiovascular or respiratory conditions that "do not want to hear stop", although their smoking boosts their problems, or pregnant women who are unable to quit smoking, are good candidates for this option, said Dr. Beatrice Master.

But beware, this strategy is only for people who fail to completely and abruptly stop their consumption of cigarettes, stressed Professor Bertrand Dautzenberg, recalling that the total withdrawal must always be considered first line. "The reduction is not an end in itself, it must always be part of a total stop strategy," added his colleague tobaccologist.

Overcome resistance

While many people think it is dangerous to combine a nicotine replacement and smoking, all combinations are possible (patch / patch, patch / oral, patch / cigarette patch / oral / cigarette form) stressed Parisian pulmonologist.

Concretely, MA recommends the candidate to the reduction of alternate use of substitutes (as soon as the urge to smoke, to avoid withdrawal symptoms) and cigarettes that allows smoking, respecting the maximum quantity specified in the manual. "The fear of having too much nicotine is totally unjustified: it should not be more afraid of NRT as cigarettes", said Professor Bertrand Dautzenberg.

However, if this strategy fails (no real reduction in consumption at the end of six months, no attempt to stop after nine months or total failure of weaning), consultation with a specialist is needed.

The advantage of the combination of the reduction in the number of cigarettes smoked and the consumption of nicotine replacement therapy prevents the phenomenon of "compensation" which usually occurs when the attempt is not supported by the use of substitutes has said Dr. Beatrice Master.

This phenomenon explains why a number of "false alternatives" should be avoided completely, as the use of light cigarettes "that are lighter than the name of" herbal cigarettes (which on combustion including tars and carbon monoxide), or decreasing the number of cigarettes smoked. All these approaches have only one purpose: to get to get the same dose of nicotine, cigarettes are smoked more intensely, which reinforces dependency and decreases in any exposure to harmful substances in the cigarette smoke.

Significant benefits

Well explained, this method can reassure the smoker who does not want to stop completely, fixing it easier to achieve. In the short term, it provides a real reduction in the number of daily cigarettes and inhalation of toxic substances. In the medium term, it allows the smoker to regain confidence in his ability to control his consumption to discover the effectiveness of nicotine replacement therapy and mature motivation to stop, identified the smoking addiction.

This strategy allows us to support smokers who are not yet ready to quit, leaving the rule of "all or nothing" and offering a realistic goal against their wishes (eg halving consumption), with a specific process according to their needs, she said.

The laboratory has organized this conference announced that a working group meeting (attended by pulmonologists, cardiologists, tobaccologists, gynecologists, general practitioners and pharmacists) to further define the rules for proper use of this strategy. And should be more precisely defined profiles of smokers most likely to respond to this approach, the monitoring arrangements to implement, to provide advice to ensure the success of this strategy and an order of magnitude to achieve its objectives in terms reduction of consumption of tobacco.