Get aggressive with smokers

To truly help people quit smoking, doctors need to treat the habit as a chronic disease that might require repeated or intensive interventions, including pharmacotherapy and counselling, say two new studies.

One study included 750 people who smoked at least 10 cigarettes a day. They were randomly assigned to pharmacotherapy (nicotine patch or bupropion), pharmacotherapy supplemented with up to two calls from trained counsellors, or pharmacotherapy and up to six counselling calls. The two-year study found that people in the high-intensity counselling group had the highest quit rates.

Disease management approach
The findings "show the importance of taking a disease-management approach to smoking," the study's lead author, Dr Edward Ellerbeck, associate professor and chairman of the Department of Preventive Medicine and Public Health at the University of Kansas, said in a news release from the Annals of Internal Medicine. The study is in the journal's April 7 issue.

"We found that smokers are willing to make repeated medically-assisted attempts at quitting smoking, resulting in progressively greater smoking abstinence. Physicians should talk to their patients continually about quitting and should facilitate access to a smoking cessation medication," Ellerbeck said.

Combination therapy best
The second study, also published in the journal, included 127 smokers with chronic health problems such as cardiovascular disease or chronic obstructive pulmonary disease (COPD). They were randomly assigned to use a nicotine patch for 10 weeks or a combination of a patch, a nicotine oral inhaler and bupropion for as long as required.

After six months, about 35% of those in the combination therapy group had quit smoking, compared with 19% of those who used only the nicotine patch.

"Medically ill smokers are often highly addicted and at great risk for complications from continued smoking," the lead author, Dr Michael B. Steinberg, from the Robert Wood Johnson Medical School at the University of Medicine & Dentistry of New Jersey, said in the news release. "Our trial demonstrates that intensive treatment with a triple combination of medications could work well for them." - (HealthDay News, April 2009)

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