Identification of the most effective pharmaceutical products for smoking cessation: A literature review

Introduction: The major causes of excess mortality among smokers are diseases related to smoking, including cancer as well as respiratory and vascular diseases. People who stop smoking greatly reduce their risk of disease and early death, so effective smoking-cessation interventions are extremely important management strategies.

Aims: To undertake a major literature review to identify the most effective pharmaceutical products for smoking cessation and detail the latest research in smoking-cessation interventions.

Methods: The Google Scholar, PubMed, Medline, and the Cochrane Library of Systematic Reviews databases were searched. The types of studies searched for were randomized controlled trials, systematic reviews, and meta-analyses. All studies were included except those involving patients with chronic obstructive pulmonary disease or infection by human immunodeficiency virus. Searched studies assessed nicotine replacement therapy (NRT), varenicline, combination therapy, bupropion, and antidepressants.

Results: The literature search focused on the three first-line treatments for smoking cessation: NRT, bupropion, and varenicline. Current research in non-first-line treatments (electronic cigarettes, cytisine, “heat-not-burn” tobacco products) as well as smoking-cessation strategies in high-risk individuals (pregnant women, individuals with mental-health or addiction issues) was also detailed.

Conclusions: Except for high-risk groups, use of NRT, bupropion, and varenicline can result in a higher prevalence of smoking cessation compared with placebos. Varenicline and combination NRT appear to be the most effective smoking-cessation strategies.     

The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia

The purpose of this study was to determine the effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. This was a longitudinal study and sixty-eight schizophrenic patients were assigned to 8 weeks of a nicotine-patch therapy program or a control group. The generalized estimating equation analysis revealed that there were significant reductions in the subjects' nicotine dependence (Fagerstrom Tolerance Questionnaire), the number of cigarettes per day, and CO levels over an 8-week period of nicotine-patch therapy and 3-month follow-up. The point-prevalence rates of abstinence from smoking were an abstinence of 26.9% at 8 weeks and 26.9% at a 3-month follow-up. At the 3-month follow-up, the rate of continuous smoking abstinence in the nicotine-patch group was 23.1%.     

Meeting national tobacco challenges: recommendations for smoking cessation groups

PURPOSE: To review the literature on model smoking cessation programs and provide an overview of the practice guidelines for intensive smoking cessation groups. DATA SOURCES: Selected evidence-based literature and AHCPR/AHRQ clinical practice guidelines. CONCLUSIONS: Smoking is the leading cause of preventable death in our global society and is expected to kill more people than any other disease within 20 years. Data support that most smokers want to quit and are more likely to succeed with a combination of behavioral and pharmacological support. IMPLICATIONS FOR PRACTICE: Smoking cessation must be a priority in the delivery of patient care. Intensive interventions are more effective than brief interventions and should be available for all smokers.     

A systems change intervention for nurse-led smoking cessation care in hospitals

AimThe aim of this study was to determine the feasibility and acceptability of a systems change intervention on nurses’ inpatient management of tobacco dependence.MethodsA mixed methods study involving an uncontrolled pre and post study design and qualitative methods. The systems change intervention consisted of: tobacco use questions within the routine nursing care admission assessment forms; provision of nicotine replacement therapy (NRT) as a ‘nurse-initiated’ medication; and nurse education. A medical record audit was conducted 4 months before and 1 month after implementation to assess recording of: smoking status, offer of NRT and referral to a telephone tobacco cessation counselling service ‘Quitline’. Focus groups and semi-structured interviews were conducted to ascertain acceptability of the systems change intervention. Chi square analysis compared identification of inpatients’ who smoke and offer of NRT pre and post implementation. Constant comparative analysis was used to analyse qualitative data.FindingsNurse recording of inpatient smoking status (83% to 90%) did not significantly improve. However offer of nurse-initiated NRT significantly increased from 0% to 34% (p = 0.02). Acceptance of NRT increased from 50% to 64% (p = 0.055) and offer of referral to Quitline increased (0% to 4%) but increases were not significantly different. Three themes emerged from the qualitative data: Education for the nurses, nurse leadership and therapeutic alliance.ConclusionThe study results show promise as our intervention increased nurses’ offer of NRT for inpatients’ who smoked. New approaches need to be developed to support patients who do not want to or are not ready to quit.     

护理干预对腰椎手术患者戒烟效果的影响

目的:探讨护理干预对腰椎手术患者吸烟强度和戒烟成功率的影响。方法:选择2007年11月～2011年6月行腰椎手术的住院患者、有吸烟史且住院前正在吸烟者共238例,随机分为两组。对照组116例行健康教育,从而劝其戒烟。干预组122例在健康教育基础上,采用"5A"方法和"5 R"方法进行个体化戒烟护理干预。随访并比较两组患者术后3,6,9个月时的吸烟强度和戒烟成功率。结果:术后3,6,9个月随访时,干预组患者吸烟强度下降,按每日吸烟量计分别为(14.25±4.62)支/d,(17.36±4.81)支/d,(20.34±5.86)支/d,较对照组均下降(P<0.05);戒烟率分别为51.64%,47.54%及42.62%,与对照组比较戒烟率增高,差异有统计学意义(P<0.05)。结论:护理干预能显著改善腰椎手术患者戒烟效果,降低吸烟强度,提高戒烟率。     

Application of trans-theoretical model for smoking cessation in sample of Iranian men

This is a quasi-experimental study conducted on 200 men smokers living in Fasa City, Iran, in 2016. The data gathering tools consisted of five parts: demographical information; questions related to the construct of the stages of change model; assessment of behavioral and cognitive change processes; self-efficacy; the outcomes of smoking; and the obstacles in the way of continual use of smoking; and smoking cessation. The courses consisted of eight sessions each 55-60 min. After six months, data were collected once more by inviting the subjects to the clinics and asking them to fill out the questionnaires. Linear regression showed that the stages of change in variables, pros, cons, the age of starting smoking, experimental processes, and self-efficacy were the predictors of smoking. Moreover, comparison of the control and experiment groups with regard to the change stages before and after the intervention did not show a significant difference between the two groups before the educational intervention. However, we observed a significant difference between the two groups after the educational intervention. The findings revealed the efficiency of the educational intervention, based on stages of change model, in the form of increase in the number of cessation smoking attempts.     

冠心病患者戒烟意愿与戒烟行为的调查

目的了解吸烟冠心病患者的戒烟意愿与戒烟行为及其相关因素。方法选择2所三级甲等医院206例冠心病吸烟患者,采用问卷调查患者吸烟史、烟瘾情况、戒烟意愿与戒烟行为等。结果本组戒烟成功者占32.5%,有戒烟意愿者占18.0%,没有戒烟意愿者占12.6%。出院组患者戒烟情况好于住院组患者（P＜0.01）。61.53%患者认为吸烟与自己的疾病没有必然的联系,62.2%认为戒烟成功与否关键在于自己有没有信心和毅力。结论冠心病患者戒烟的成功率好于普通人群,对冠心病患者应不失时机地给予宣教,提高患者对吸烟危害及戒烟好处的认知。     

伐尼克兰对冠心病吸烟患者的有效性及安全性研究

目的探讨冠心病患者服用伐尼克兰药物的戒烟疗效及其对氯吡格雷抗血小板作用的影响。方法连续选取2010年9月至2013年8月在武警总医院住院择期行PCI术的冠心病吸烟患者128例,随机分为伐尼克兰组和常规治疗组。伐尼克兰组:服用伐尼克兰治疗2周,2周后继续提供戒烟方法和咨询随访。常规治疗组:仅提供戒烟方法和咨询随访。其他治疗均按常规冠心病患者治疗。分别于入院时、服用伐尼克兰前、服用伐尼克兰2周检测血小板反应指数(PRI)、尿素氮(BUN)及肌酐(Cr),并记录2周及6个月不良事件及严重不良事件。结果两组患者入院时、服药前及服药2周时PRI比较无统计学差异(P>0.05)。6个月时伐尼克兰组戒烟率高于常规治疗组(P<0.01)。两组不良事件发生率没有统计学差异,6个月严重不良事件再发心绞痛发生率伐尼克兰组发生率低于对照组(P=0.042)。结论伐尼克兰对冠心病吸烟患者戒烟效果明显,对氯吡格雷抗血小板聚集作用没有明显影响,安全性好。     

个体化戒烟方案对肺癌患者术前吸烟状态的影响

目的 探讨个体化戒烟方案对肺癌患者术前吸烟状态的影响.方法 将2020年6-12月首次拟人院行肺癌手术治疗的未戒烟患者196例作为研究对象,按随机数字表法随机分为对照组和观察组各98例.对照组给予术前常规戒烟指导;观察组根据烟草依赖程度采用个体化戒烟方案全程干预其吸烟行为.分别记录2组患者术前完全戒烟时间、烟草依赖程度...     

Nicotine dependence: health consequences, smoking cessation therapies, and pharmacotherapy

Nicotine dependence is a significant addiction with many health consequences. Consistent attempts and efforts at addressing this condition, guiding and advising afflicted patients using motivational techniques and the 5-A stepwise strategies, and instituting appropriate therapies will result in better health outcomes and less incidence of diseases. In pharmacotherapy, Nicotine replacement therapy and oral medications can be used alone or in combination with varying degrees of success.     

Implementing a smoking cessation program for pregnant women based on current clinical practice guidelines

PURPOSE: To describe the U.S. Department of Health and Human Services clinical practice guideline for treating tobacco use and dependence and demonstrate how the guideline was utilized in a pilot program for a small sample of pregnant women (n = 20) to help them decrease smoking. DATA SOURCES: A convenience sample of 20 pregnant women was recruited from a health maintenance organization at their initial prenatal contact either by telephone or in person. A comparison group of pregnant women (n = 28) was used for analysis of outcomes. CONCLUSIONS: Clinical results showed better outcomes for women in the pilot program when compared to a similar group who did not participate in the program. There was a statistically significant difference between the two groups in average number of cigarettes smoked per day at delivery and two weeks after delivery with pilot program participants reporting less smoking (p < .05). Women in both groups showed a pattern of returning to smoking after delivery of the baby. IMPLICATIONS FOR PRACTICE: Although a few tobacco users achieve permanent abstinence in first or second attempts, the majority continue to use tobacco for many years and typically cycle through many lapse and relapses before permanent abstinence. Ambulatory care systems need to be developed and funded to treat tobacco use and dependence over the life span. Recognition of the chronic nature of the problem and development of long term care delivery systems are needed to assist clients to achieve goals of permanent abstinence and better personal and family health. This cycle of lapse and relapse before permanent abstinence is typical and demonstrates the chronic nature of tobacco use and dependence and the need for long term follow-up.     

戒烟干预对慢性气道疾病发病和预后的影响

目的：观察戒烟干预对慢性气道疾病发病和预后的影响。方法将145例吸烟的慢性气道疾病住院患者（包括COPD、哮喘、间质性肺疾病等）按照区组随机化法分为两组,干预组75例,非干预组70例。干预组除常规治疗外,采用5 A/5 R法进行戒烟干预,出院后继续给予戒烟支持;非干预组仅进行常规治疗,两组患者通过复诊或随访12个月,统计观察期内急性加重次数,并在入院时和观察期结束时进行COPD评估测试（CAT）及肺功能（FEV1％）检查。结果干预组患者的CAT终末值为（17．72±6．76）分,较初始值（19．08±6．53）分明显下降,差异有统计学意义（t＝-2．399,P＜0．05）,FEV1％终末值为（59．19±11．19）,较初始值（57．10±10．06）明显增大,差异有统计学意义（t＝2．192,P＜0．05）。非干预组患者的CAT终末值为（20．01±7．22）分,较初始值（18．79±6．12）分增大,差异有统计学意义（t＝2．764,P＜0．05）,FEV1％终末值为（54．56±10．56）,较初始值（59．06±9．89）降低,差异有统计学意义（t＝-3．038,P＜0．05）。结论戒烟干预可减轻慢性气道疾病患者的症状,延缓肺功能的下降,提高生活质量。     

Motivational interviewing as a smoking cessation strategy with nurses: An exploratory randomised controlled trial

Background

Despite the important role that health professionals have in reducing tobacco use, many have a smoking habit themselves. The prevalence of smoking is particularly high among nurses.

Objective

To test the efficacy, acceptability and feasibility of a motivational interviewing (MI) based smoking cessation intervention with nurses.

Design

Two group parallel experimental design with random allocation to groups.

Setting

A large teaching hospital in the North of Spain.

Participants

Nurses who smoked (n = 30) were randomised into two groups: motivational interviewing based intervention (n = 15) and usual care (n = 15).

Methods

Motivational interviewing based intervention consisted of four individual MI sessions. Usual care consisted of brief advice. Variables considered to assess efficacy were biochemically verified smoking cessation, mean cigarettes smoked, stages of change, self-efficacy and depression score. Variables to assess acceptability and feasibility included participant satisfaction, adherence to MI, and duration of sessions. Data were collected at: baseline, end of intervention and three months after the end of the intervention.

Results

At three month follow up, compared with the control group, more nurses in the intervention group had quit (absolute difference 33.3%; 95% confidence interval [CI] 2.6–58.2). In the nurses who did not quit, there was no significant difference between the intervention and control groups in the number of cigarettes smoked per day, although progress in the stages of change was greater in the intervention group compared to the control group. Measures of acceptability and feasibility indicated good satisfaction with the intervention, with high levels of attendance and completion.

Conclusion

This study found a beneficial effect of motivational interviewing on nurses’ smoking cessation. The intervention was acceptable for nurses and a number of aspects were identified that need to be considered prior to conducting a larger scale in order to optimise the intervention. Using MI might be a novel approach to the problem of health professionals who smoke.     

Nurses’ smoking habits and their professional smoking cessation practices. A systematic review and meta-analysis

BackgroundA better understanding of whether nurses’ own smoking behaviours influence their engagement with smoking cessation interventions is needed.AimTo establish whether the smoking status of nurses is associated with their professional smoking cessation practices.MethodsTwelve electronic databases covering English and Spanish language publications from 01 Jan, 1996 to 25 Mar, 2015 were systematically searched. Studies were included if they reported nurses’ smoking cessation practices in relation to their personal smoking habits. Proportions of nurses' smoking status and smoking cessation practices were pooled across studies using random effects meta-analysis.ResultsFifteen studies were included in this systematic review. Levels of reportedsmoking cessation interventions were generally low across the studies. The meta-analyses suggested that nurses’ personal smoking status was not associated significantly with nurses always asking patients about their smoking, but nurses who smoked were 13% less likely to advise their patients to quit and 25% less likely to arrange smoking cessation follow-up. More intense interventions (assessing motivation and assisting) were not significantly associated with the smoking status of the nurse.ConclusionsThe smoking status of nurses appears to have a negative impact in the delivery of smoking cessation practices. The overall level of nurses’ engagement with the delivery of smoking cessation interventions requires attention if nurses are to be effective agents of smoking cessation.     

The participation of health professionals in a smoking-cessation programme positively influences the smoking cessation advice given to patients

This study assessed the degree of smoking cessation advice given by health professionals, before and after their participation in a smoking cessation study using bupropion-sustained release (bupropion SR, Zyban). A total of 690 physicians and nurses who had smoked an average of 10 cigarettes/day over the previous year and were motivated to quit smoking, were randomised in a double-blind manner to receive bupropion SR (days 1-3, 150 mg/day; days 4-49, 150 mg twice daily) or placebo for 7 weeks, with follow-up to week 52. All subjects received regular follow-up and brief motivational support throughout the study. Questions regarding their smoking cessation advice formed part of the study, with the aim of determining whether study participants became more proactive with their smoking cessation advice. A positive shift from baseline to end of study was observed with respect to the advice and support they gave to their smoking patients. These changes were not related to study treatment or current smoking status. An increase in advising patients to quit smoking and in offering cessation counselling was observed. Participation in a smoking-cessation study by physicians and nurses who smoke has a positive effect, regardless of study medication, in smoking cessation advice and counselling given to their patients.     

Predictors of 1-, 6- and 12-month smoking cessation among a community-recruited sample of adult smokers in the United States

Baseline socio-demographics, substance use and smoking history characteristics, as well as intra-treatment indicators (i.e. nicotine patch adherence and tobacco use during patch treatment) of smoking cessation were examined among 65 community-based adult male smokers recruited from a metropolitan area within the United States. All participants were recruited between 2009 and 2010 and were enrolled in an 8-week smoking cessation programme involving nicotine patch treatment and adjunctive counselling. Stepwise multiple regression analyses were performed to examine unique predictors of smoking status at 1-, 6- and 12-month follow-up. Abstinence rates at 1-, 6- and 12-month follow-up periods were 34%, 18% and 17%, respectively. Results indicated that less smoking during patch treatment, and particularly during weeks 1 through 3, was the most robust predictor of successful abstinence, and this predicted smoking status at all follow-up periods. These results underscore the importance of total abstinence during the cessation process, especially at the outset of treatment, which is paramount to ultimate cessation success. Study limitations and clinical implications are discussed.     

Theoretical applications of smoking cessation interventions to individuals with medical conditions: women's initiative for nonsmoking (WINS)-part III.

This paper reviews the Theory of Self-Efficacy, Transtheoretical Model of Readiness for Change, and Theory of Addictions to provide a basis for smoking cessation, and explores how these theories have been used to guide clinical research and clinical interventions. Selected randomized controlled trials of the past ten years are reviewed for demonstrated efficacy, integration of theory into the design of the interventions, and how theories guide analysis. Results show that surprisingly little effort has been put forth to examine and develop these theories within the context of clinical interventions, despite the claims of importance. For example, the relationship between stages of readiness of change and smoking cessation outcome has not been examined. Despite the complexity of smoking behaviors (quitting, relapsing, maintaining, occasional smoking and so on), the concept of self-efficacy was mostly measured on single occasions over the course of most studies reviewed; multiple measurements of concepts were not utilized in the randomized controlled trials. Taking into account the gaps between theory and application, theory driven nursing strategies are offered.     

A systematic review of the efficacy and safety of Rosa damascena Mill. with an overview on its phytopharmacological properties

Rosa damascena Mill. is one of the most famous ornamental plants cultivated all over the world mostly for perfumery industries. Traditionally it has been used as an astringent, analgesic, cardiac and intestinal tonic.The paucity ofauthoritative monographs urged usto summarize its clinical effectiveness and safety with acomprehensive review of the literature.“PUBMED”, “SCOPUS”, “WEBOF SCIENCE” were searched up to April 30, 2017 with search terms:(“Rosa damascena” OR “Damask Rose”). All human studies with any mono-preparation were included. In vitro and animal studies from “PUBMED”were also reviewed and outlined.Of “1000” identified publications, twelveeligibleclinical trials were retrieved. Antimicrobial, anti-inflammatory, antioxidant, anticancer, protective neuronal, cardiac, gastrointestinal and hepatic effectsin 30 in vitro and 21 animal studies were also shown. there are promising evidences for the effectiveness and safety of Rosa damascena Mill in pain relief, but confirmatory studies withstandardized products is suggested.     

The use of the nicotine inhaler in smoking cessation

PURPOSE: To raise awareness among nurse practitioners (NPs) about the nicotine inhaler by providing clinical and practical information about the use of the nicotine inhaler as a treatment option for smoking cessation. DATA SOURCES: This included data-based and review articles in the medical literature, tobacco use and dependence clinical practice guideline, and Medline and Cinahl search engines. Criteria for search keywords were "nicotine inhaler" and "nicotine replacement therapy." Initial search was done in December 2004. CONCLUSIONS: The nicotine inhaler has been tested as safe and efficacious in the treatment of tobacco cessation. Clinical trials show the nicotine inhaler to be useful alone or as an adjunct to other pharmacological therapies. Current national guidelines recommend that the nicotine inhaler be used in smoking cessation therapy. IMPLICATIONS FOR PRACTICE: The nicotine inhaler is appropriate for many different smokers, including certain types of cardiac patients. NPs can include the nicotine inhaler in a group of nicotine replacement therapies to ensure that smokers are successful in tobacco cessation.