Effect of nicotine, silver acetate, and ordinary chewing gum in combination with group counselling on smoking cessation.

Four hundred and ninety six smokers participated in a randomised comparison of the effect of silver acetate, nicotine, and ordinary chewing gum on smoking cessation. All were motivated to stop smoking abruptly and all had smoked at least 10 cigarettes a day for at least five years. Side effects and taste acceptability were related to outcome after six months. The participants attended nine meetings over a year, at which lectures, support, and advice about stopping smoking were given. Tobacco abstinence was confirmed by measurement of carbon monoxide in expired air. The chewing gums were used for 12 weeks. After 12 weeks there was a trend towards more abstainers in the nicotine group (59%) than in the silver acetate (50%) and ordinary (45%) chewing gum groups that was not quite significant (p = 0.07). At 26 and 52 weeks the number of cigarette abstainers was similar in the three treatment groups. Subjects in the nicotine chewing gum group had a longer mean time before relapse than those in the silver acetate and ordinary chewing gum groups. Mean success rates for all subjects combined at 12, 26, and 52 weeks were 52.8%, 39.7%, and 23.3%. The side effects of nicotine and silver acetate chewing gum were generally mild and transient, and unimportant except for mouth irritation from silver acetate, which had a negative effect on outcome, and the low taste acceptability of nicotine, which had a strong negative influence on the success rate. The results suggest a short term effect on nicotine chewing gum on smoking cessation, but the abstinence rates after one year were generally disappointing.     

Smoking cessation, decline in pulmonary function and total mortality: a 30 year follow up study among the Finnish cohorts of the Seven Countries Study

BACKGROUND: Permanent smoking cessation reduces loss of pulmonary function. Less is known in the long term about individuals who give up smoking temporarily or quitters with lower initial pulmonary function. Little is known also about the relationship between decline in pulmonary function and mortality. We examined these aspects and the association between smoking, decline in pulmonary function, and mortality. METHODS: Two middle aged male Finnish cohorts of the Seven Countries Study and their re-examinations on five occasions during a 30 year period of follow up were analysed. RESULTS: During the first 15 years (n=1007) adjusted decline in forced expiratory volume in 0.75 seconds (FEV(0.75)) was 46.4 ml/year in never smokers, 49.3 ml/year in past smokers, 55.5 ml/year in permanent quitters, 55.5 ml/year in intermittent quitters, and 66.0 ml/year in continuous smokers (p<0.001 for trend). Quitters across the entire range of baseline FEV(0.75) had a slower decline in FEV(0.75) than continuous smokers. Among both continuing smokers and never smokers, non-survivors had a significantly (p<0.001) more rapid decline in FEV(0.75) than survivors. The adjusted relative hazard for total mortality was 1.73 (95% confidence interval (CI) 1.41 to 2.11) and 1.24 (95% CI 1.02 to 1.52) in the lowest and middle tertiles of decline in FEV(0.75). Never smokers, past smokers, and quitters had significantly lower total mortality than continuous smokers, partly because of their slower decline in FEV(0.75). CONCLUSION: These results highlight the positive effect of smoking cessation, even intermittent cessation, on decline in pulmonary function. Accelerated decline in pulmonary function was found to be a risk factor for total mortality. The beneficial effect of smoking cessation on mortality may partly be mediated through a reduced decline in pulmonary function.     

Peripheral leucocyte count and longitudinal decline in lung function.

A six year follow up study of 750 aluminium smelter workers was undertaken to evaluate the relationship between the leucocyte count at the start of the study and the rate of decline in lung function. An inverse relationship between the leucocyte count and the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was present cross sectionally irrespective of cigarette smoking habit. The initial leucocyte count was also significantly related to the mean annual decline in FEV1 in smokers (p = 0.04) but not in former smokers or those who had never smoked. These observations suggest that the leucocyte count is a factor influencing the annual decline in FEV1 in smokers.     

Contrasting renal effects of nicotine in smokers and non-smokers

Background: Cigarette smoking is associated with acute increase in arterial pressure due to systemic vasoconstriction and decreased skin and coronary blood flow. Virtually all cardiovascular effects of cigarette smoking are due to nicotine. However, whether nicotine also affects the renal circulation and function in humans is at present unknown. Methods: In the current study the acute effects of a 4-mg nicotine gum on arterial pressure, heart rate as well as renal haemodynamics and function were assessed in non-smokers and chronic smokers. Results: In non-smokers, mean arterial pressure (+8±1 mm Hg, P<0.001) and heart rate (+13±3 beats/min, P<0.001) increased whereas effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) decreased by 15±4% and 14±4% respectively; in addition, urinary cyclic GMP decreased by 51±12% in response to nicotine administration. In smokers, mean arterial pressure and heart rate increased similarly; however, in contrast with non-smokers, ERPF and GFR remained unchanged whereas urinary cyclic GMP rose by 87±43%. Changes in ERPF induced by nicotine were positively correlated with changes in urinary cyclic GMP. Conclusions: These findings indicate that nicotine administration is associated with renal vasoconstriction in healthy non-smokers, possibly through alteration of a cyclic-GMP-dependent vasoactive mechanism. Tolerance to the renal effect of nicotine was observed in chronic smokers, despite the maintenance of the systemic response to nicotine.     

Decline of the lung function related to the type of tobacco smoked and inhalation.

Data from a five year follow up study on 4372 smokers and 3753 non-smokers were analysed to investigate the influence of the type of tobacco smoked and whether the subjects said they inhaled or not on the decline in forced expiratory volume in one second (FEV1). The study sample comprised 1492 smokers of plain cigarettes and 1936 smokers of filter cigarettes, 1711 smokers of cheroots or cigars, and 233 male pipe smokers. Over the five years, smokers, especially those who said that they inhaled, had a higher rate of decline of FEV1 than non-smokers, in whom the average decline in FEV1 was 25 ml/year for women and 30 ml/year for men. There was no significant difference in the decline in FEV1 between filter cigarette smokers and plain cigarette smokers. The decline in FEV1 in cigar or cheroot smokers was the highest for all the smoking groups, and associated with a very high tobacco consumption in this group. Among pipe smokers who inhaled, the decline in FEV1 was slightly higher than in the cigarette smokers, whereas non-inhaling pipe smokers had a decline in FEV1 that was similar to that of non-smokers. In general, the smokers who said that they did not inhale had a smaller decline in FEV1 than those who said that they did. The effect of inhalation varied in magnitude in different smoking groups, being most pronounced in pipe smokers.     

Smoking, allergy, and the differential white blood cell count

Dutch workers have proposed that people with asthma and those smokers who develop chronic airflow obstruction share a common allergic constitution. To study whether smoking itself is associated with indicators of allergy, we have examined 237 men aged 51-61 years (120 smokers, 73 ex-smokers, and 44 non-smokers) who were recruited to a long term study of lung function in 1974, at which time men with a clinical diagnosis of asthma were excluded. Smokers, ex-smokers, and non-smokers did not differ in personal or family history of allergic disease, but the prevalence of positive responses to skinprick tests was greater in ex-smokers (59%) than in the other two groups (33% and 34%). In men with negative responses to skinprick tests total serum IgE was greater in smokers (log10 mean 1.41 IU/ml) and in ex-smokers (log10 mean 1.53 IU/ml) than in non-smokers (log10 mean 1.12 IU/ml). In men with positive skin test responses serum IgE was similar in the three groups (log10 mean ranging from 1.68 to 1.78 IU/ml). Geometric mean total white cell counts in the peripheral blood were higher in smokers (7.34 X 10(9)/l) than in non-smokers (5.82 X 10(9)/l); the value in ex-smokers (6.16 X 10(9)/l) was intermediate. Absolute blood eosinophil counts were increased in smokers disproportionately to the increase in total white cell count. Thus smoking is associated with small increases in some markers of allergy. These changes are probably acquired after the onset of smoking but sequential studies are required to amplify these cross sectional observations. Smokers whose skin test responses are positive appear more likely to give up smoking.     

Does smoking cessation improve quality of life in patients with coronary heart disease?

OBJECTIVE: To evaluate whether smoking cessation after a coronary event improves quality of life, and to assess whether quality of life is a predictor of smoking cessation. DESIGN: Health-related quality of life at baseline and at 12 months follow up were measured in a randomised smoking cessation trial of 240 smokers aged under 76 years admitted for myocardial infarction, unstable angina or coronary bypass surgery. At 12 months follow up 101 had managed to give up smoking (quitters), and 117 were smokers (sustained smokers). RESULTS: The quitters and sustained smokers had similar improvements in all quality of life domains from baseline to 12 months follow up. Further, after adjustment for differences in baseline characteristics, the quality of life was not significantly different in the quitters compared to the sustained smokers neither at baseline nor at 12 months follow up. CONCLUSIONS: Smoking cessation did not improve quality of life compared to sustained smoking after a coronary event in a 12 month follow up. Quality of life was not a significant predictor of smoking cessation.     

The effect of cigarette smoking and smoking cessation on spinal fusion

STUDY DESIGN: The effect of cigarette smoking and smoking cessation on spinal fusion was studied in a retrospective review of 357 patients who had undergone instrumented spinal fusion. OBJECTIVE: To document the widely assumed but unreported benefit of cigarette smoking cessation on fusion rate and clinical outcome after spinal fusion surgery. BACKGROUND DATA: Cigarette smoking has been shown to inhibit lumbar spinal fusion and to adversely effect outcome in treatment of lumbar spinal disorders. Prior reports have compared smokers and nonsmokers, as opposed to comparing smokers and quitters. METHODS: This study retrospectively identified 357 patients who underwent a posterior instrumented fusion at either L4-L5 or L4-S1 between 1992 and 1996. Analysis of the medical record and follow-up telephone surveys were conducted. Clinical outcome and fusion status was analyzed in relation to preoperative and postoperative smoking parameters. RESULTS: In this study, the nonunion rate was 14.2% for nonsmokers and 26.5% for patients who continued to smoke after surgery (P < 0.05). Patients who quit smoking after surgery for longer than 6 months had a nonunion rate of 17.1%. The nonunion rate was not significantly affected by either the quantity that a patient smoked before surgery or the duration of preoperative smoking abatement. Return-to-work was achieved in 71% of nonsmokers, 53% of nonquitters, and 75% of patients who quit smoking for more than 6 months after surgery. DISCUSSION: These results validate the hypothetical assumption that postoperative smoking cessation helps to reverse the impact of cigarette smoking on outcome after spinal fusion.     

Absorption of nicotine and carbon monoxide from passive smoking under natural conditions of exposure.

Seven non-smokers were exposed to tobacco smoke under natural conditions for two hours in a public house. Measures of nicotine and cotinine in plasma, saliva, and urine and expired air carbon monoxide all showed reliable increases. The concentrations of carbon monoxide and nicotine after exposure averaged 15.7% and 7.5% respectively of the values found in heavy smokers. Although the increase in expired air carbon monoxide of 5.9 ppm was similar to increases in smokers after a single cigarette, the amount of nicotine absorbed was between a tenth and a third of the amount taken in from one cigarette. Since this represented a relatively extreme acute natural exposure, any health risks of passive smoking probably depend less on quantitative factors than on qualitative differences between sidestream and mainstream smoke.     

Association between smoking cessation and sexual health in men

Study Type – Prevention (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Tobacco use is the single most preventable cause of disease and death, and – among other medical sequelae – is associated with elevated rates of erectile dysfunction. This is the first study that shows that quitting smoking enhances both physiological and self‐reported indices of sexual health in long‐term male smokers. It is hoped that these results may serve as a novel means to motivate men to quit smoking.

OBJECTIVE

• ? To provide the first empirical investigation of the association between smoking cessation and indices of physiological and subjective sexual health in men.

SUBJECTS AND METHODS

• ? Male smokers, irrespective of erectile dysfunction status, who were motivated to stop smoking (‘quitters’), were enrolled in an 8‐week smoking cessation programme involving a nicotine transdermal patch treatment and adjunctive counselling.
• ? Participants were assessed at baseline (while smoking regularly), at mid‐treatment (while using a high‐dose nicotine transdermal patch), and at a 4‐week post‐cessation follow‐up.
• ? Physiological (circumferential change via penile plethysmography) and subjective sexual arousal indices (continuous self‐report), as well as self‐reported sexual functioning were assessed at each visit.

RESULTS

• ? Intent‐to‐treat analyses indicated that, at follow‐up, successful quitters (n= 20), compared with those who relapsed (n= 45), showed enhanced erectile tumescence responses, and faster onset to reach maximum subjective sexual arousal.
• ? Although successful quitters displayed across‐session enhancements in sexual function, they did not show a differential improvement compared with unsuccessful quitters.

CONCLUSIONS

• ? Smoking cessation significantly enhances both physiological and self‐reported indices of sexual health in long‐term male smokers, irrespective of baseline erectile impairment.
• ? It is hoped that these results may serve as a novel means to motivate men to stop smoking.

     

Persistence of urothelial carcinoma of the bladder risk among former smokers: Results from a contemporary,prospective cohort study

ObjectivesCigarette smoking is a known risk factor for urothelial carcinoma (UC) of the bladder. However, the persistence of an increased risk for UC following smoking cessation is not well established. We assessed the risk of UC among former smokers using a recent, prospective cohort with a high proportion of former smokers.Materials and methodsStudy participants were members of the VITamins And Lifestyle cohort (VITAL), a group of 77,719 men and women between the ages of 50 and 76 years from western Washington State. Smoking history and other risk factors were obtained at the time of recruitment. The primary outcome was a new diagnosis of UC (n =385), as determined through linkage to a population-based cancer registry.Results and limitationsThe cohort included 8% current and 44% former smokers, and among the UC cases, 15% were current and 60% former smokers. Both the current and former smoker had an increased risk of UC compared with never smokers (hazard ratio [HRs]: 3.81; 95% confidence intervals [CI] 2.71–5.35 and 2.0; 95% CI 1.55–2.58, respectively). Among former smokers, the risk of UC increased with the pack-years smoked and decreased with the years since quitting. When both the measures of smoking were considered together, the risk of UC was similar for long-term quitters and recent quitters for a given level of pack-years. For example, for those with pack-years of 22.5–37.5, the HR of UC was 1.91 (95% CI 1.17–3.11) for the distant quitters (≥23.5 y before baseline) and HR = 1.92 (95% CI 1.26–2.94) among the recent quitters. Limitations include the small number of cases at the extremes of smoking history and errors in self-reported smoking history.ConclusionsThe risk of bladder cancer in former smokers remains elevated>32 years after quitting, even among those with moderate smoking histories. This argues that a history of smoking confers a lifelong increased risk of UC.     

Lack of influence of acupuncture and transcutaneous stimulation on the immunoglobulin levels and leucocyte counts following upper-abdominal surgery

The changes in immunoglobulins (IgA, IgG and IgM) and total and differential leucocyte counts in the peripheral blood during, and for 6 days after, surgery were evaluated in 29 male patients submitted to standardized upper-abdominal surgery performed under two different anaesthetic techniques. Group 1 received stimulation of ear and paravertebral points, supplemented by small doses of fentanyl (mean 1.2 micrograms kg-1, range 0.0-5.7) and Group 2 received moderate-dose fentanyl (mean 22.9 micrograms kg-1, range: 17.5-29.8). All were induced with thiopentone 5 mg kg-1, intubated after vecuronium 0.1 mg kg-1 and ventilated with 67% nitrous oxide in oxygen. Inhalation anaesthesia was not used. Surgery was followed by a fall in immunoglobulins, lymphocyte and eosinophil counts and a rise in leucocyte and neutrophil counts in both groups (P less than 0.01). No recovery was observed until the last assessment on Day 6 after surgery in IgA, IgG, leucocyte, neutrophil and lymphocyte counts in both groups, whereas IgM and eosinophil counts recovered by Day 4. Monocyte and basophil counts were unchanged in either group. Acupuncture and transcutaneous stimulation analgesia performed for major abdominal surgery did not influence the body's immune system either during or after surgery as measured by the concentrations of immunoglobulin and total and differential WBC counts.     

Adverse Effects of Smoking on Peak Bone Mass May Be Attenuated by Higher Body Mass Index in Young Female Smokers

Smoking is associated with postmenopausal bone loss and fracture, but the effect of smoking on bone in younger women is unclear. Peak bone mass is an important determinant for fracture risk; therefore, our aim was to evaluate the association between smoking and bone mass in 25-year-old women, specifically the influence of daily cigarette consumption and total exposure, duration, age at starting smoking, and time since smoking cessation on bone density and fracture risk. Smoking and bone mineral density (BMD) data were available for 1,054 women from the PEAK-25 cohort. Analyses comparing current smokers with women who never smoked were performed using number of cigarettes per day, pack-years, smoking duration, age smoking started, and, for former smokers, age at quitting. BMD did not differ between never, former, and current smokers; and the relative fracture risk in smokers was not significant (relative risk [RR] = 1.2, 95 % confidence interval 0.8–1.9). Among current smokers, BMD decreased with a dose response as cigarette consumption increased (femoral neck p = 0.037). BMD was not significantly lower in young women who had smoked for long duration or started smoking early (p = 0.07–0.64); long duration and early start were associated with higher body mass index (BMI; p = 0.038). Lower BMD persisted up to 24 months after smoking cessation (p = 0.027–0.050), becoming comparable to never-smokers after 24 months. Hip BMD was negatively associated with smoking and dose-dependent on cigarette consumption. Smoking duration was not associated with BMD, although young women with a long smoking history had higher BMI, which might attenuate the adverse effects from smoking.     

Urinary nicotine concentrations in cigarette and pipe smokers

Urinary concentrations of nicotine were studied in men who did not smoke (27) and in men who smoked cigarettes only (145) or pipes only (48). The median urinary nicotine concentrations were less than 50 ng/ml (the detection limit of the assay for urine tests) in the non-smokers, 1393 ng/ml in the cigarette smokers, and 1048 ng/ml in the pipe smokers. These values were standardised for urinary pH and creatinine concentration to allow for the fact that nicotine excretion is influenced by the acidity of the urine and by urinary flow rate. The high urinary nicotine concentrations in the pipe and cigarette smokers indicated that both types of smoker have relatively high systemic nicotine concentrations. This observation, together with the fact that large prospective studies have shown that pipe smokers have no material excess risk of coronary heart disease whereas cigarette smokers do, provides evidence that nicotine is unlikely to be the major cause of the excess deaths from coronary heart disease in cigarette smokers. This conclusion is consistent with earlier observations based on serum cotinine concentrations in smokers and non-smokers.     

Expression of ErbB receptors and mucins in the airways of long term current smokers

BACKGROUND: Airway epithelial goblet cell hyperplasia is known to occur in chronic smokers. Although the epidermal growth factor receptor has been implicated in this process, neither ErbB receptor expression nor the mucosecretory phenotype of the epithelium have been characterised in current smokers. METHODS: Bronchial biopsies obtained from non-smokers (n = 10) and current smokers, with or without chronic obstructive pulmonary disease (n = 51), were examined immunohistochemically to measure the expression of epidermal growth factor receptor, ErbB2, ErbB3, ErbB4 and mucin subtypes (MUC2, MUC5AC and MUC5B) in the bronchial epithelium. The results were correlated with neutrophil counts measured in the airway wall and induced sputum. RESULTS: Epidermal growth factor receptor, ErbB3 and MUC5AC expression, in addition to PAS staining, were significantly increased in all smokers compared with non-smokers, irrespective of the presence of chronic obstructive pulmonary disease. MUC5AC expression was significantly associated with both PAS staining and ErbB3 expression; no correlation was observed between either mucin or ErbB receptor expression and neutrophil counts. CONCLUSIONS: The results suggest that long term current smoking induces enhanced epidermal growth factor receptor, ErbB3, and MUC5AC expression in vivo; these increases are not associated with the presence of neutrophilic inflammation. ErbB receptors may contribute to epithelial responses to cigarette smoke.     

Smoking cessation interventions in clinical practice.

OBJECTIVES: Physicians are in a unique position to advise smokers to quit by integrating the various aspects of nicotine dependence. This review provides an overview of interventions for smokers presenting in a clinical setting. RESULTS: Strategies used for smoking cessation counselling differ according to patient's readiness to quit. For smokers who do not intend to quit smoking, physicians should inform and sensitise them about tobacco use and cessation. For smokers who are dissonant, physicians should use motivational strategies, such as discussing barriers to cessation and their solutions. For smokers ready to quit, the physician should show strong support, help set a quit date, prescribe pharmaceutical therapies for nicotine dependence, such as nicotine replacement therapy (i.e., gum, transdermal patch, nasal spray, mouth inhaler, lozenges, micro and sublingual tablets) and/or bupropion (atypical antidepressant thought to work by blocking neural reuptake of dopamine and/or nor epinephrine), with instructions for use, and suggest behavioural strategies to prevent relapse. The efficacy of all of these pharmacotherapies is comparable, roughly doubling cessation rates over control conditions. Varenicline is a promising new effective drug recently approved by many health authorities. CONCLUSION: Physician counselling and pharmacotherapeutic interventions for smoking cessation are among the most cost-effective clinical interventions.     

Stopping smoking might reduce tumour recurrence in nonmuscle-invasive bladder cancer

OBJECTIVE: To evaluate effects of stopping smoking on the outcome of nonmuscle-invasive bladder cancer, as cigarette smoking is a risk factor for bladder cancer and little is known about whether stopping smoking reduces the risk of recurrence or progression. PATIENTS AND METHODS: Between January 1997 and July 2005, 297 men with primary nonmuscle-invasive bladder cancer were treated with transurethral resection (TUR); their smoking status before and after the diagnosis of bladder cancer was obtained by a post hoc questionnaire and interview. 'Quitters' were those who ceased smoking within a year before and 3 months after the diagnosis. Ex-smokers were those who ceased smoking more than a year before diagnosis. Several pathological and clinical variables were compared, with all statistical comparisons being two-sided. RESULTS: In all, 265 patients completed the questionnaire, including 64 non-smokers, 64 ex-smokers, 59 quitters, and 78 continued smokers. The median follow-up was 38 months. There were no significant differences in the strata of stage, grade, tumour multiplicity, intravesical therapy, or median follow-up duration between the four patient groups. The respective 3-year recurrence-free survival of continued smokers, non-smokers, ex-smokers and quitters was 45%, 57%, 62% and 70%. By multivariate analysis, high-grade, T1-stage, multiple tumours and continued smoking were significant independent predictors for a shorter recurrence-free survival. Quitters had a lower risk of recurrence than did either continued smokers or non-smokers, but had a similar risk to ex-smokers. CONCLUSION: Stopping smoking might be associated with a lower recurrence rate for patients with nonmuscle-invasive bladder cancer.     

Cigarette smoking: Acute main and small vessel hemodynamic responses in patients with arterial disease

While cigarette smoking is a major risk factor in lower limb ischemia, not all smokers develop symptomatic lesions, which suggests an individual susceptibility. Using Doppler probes the acute main vessel response to smoking was quantified in terms of the pulse transit time delay. Patients with occlusive arterial disease had a significant shortening in the transit time delay, suggesting a stiffening in the main vessels in response to smoking not seen in control subjects without disease. In patients with occlusive disease the digital pulse volume recorder amplitude decreased significantly in response to both low and high nicotine cigarettes, and these patients tended to self-titrate their nicotine intake, suggesting that little is to be gained by switching from high to low nicotine cigarettes: rather, cessation of smoking should be considered. These preliminary results suggest that patients with atherosclerotic occlusive disease are more susceptible to cigarette smoking and that Doppler or pulse volume recorder testing may help identify those habitual smokers who are at risk.     

体外循环心内直视手术对患者外周血白细胞中性粒细胞T淋巴细胞亚群影响

选择３０例择期心内直视术患者，治疗期间连续观察麻醉前后、术毕、术后第１、７、１４天其外周血白细胞、中性粒细胞、Ｔ淋巴细胞亚群变化，借以判断麻醉与体外转流手术后上述免疫参数变化，为及时防治心内直视术患者术后并发症提供实验依据。结果发现静吸复合麻醉近１ｈ后外周血淋巴细胞数急剧下降，术毕、术后第１至１４天外周血白细胞、中性粒细胞数及其所占百分率显著升高，而淋巴细胞数及其百分率则明显下降。Ｔ淋巴细胞亚群分析发现麻醉后ＣＤ＋３、ＣＤ＋４细胞及ＣＤ＋４／ＣＤ＋８比值明显下降，术毕、术后第１天进一步下降，至术后第７天或１４天恢复至麻醉前水平，这些参数变化是患者术后易并发感染等的原因之一。