The Pharmaceutical Journal
Vol 277 No 7414 p214
19 August 2006

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Tobacco dependence is chronic disorder that needs ongoing therapy

Tobacco dependence might be better viewed as a chronic disorder requiring repeated episodes of treatment, rather than a condition that can be cured with one course of treatment such as nicotine replacement therapy (NRT), researchers suggest.

They performed a meta-analysis of randomised controlled trials of NRT with a follow up of more than one year. They identified 12 eligible trials, involving 4,792 participants. Of the patients who had stopped smoking with the help of NRT, 30 per cent had started to smoke again over a year after the start of treatment and before the final follow up. Because of this relapse, the efficiency of NRT fell, with the success rate dropping from 10.7 per cent to 7.2 per cent after one year. The researchers say that trial results published after six to 12 months’ follow up will therefore overestimate the lifetime benefit and cost efficiency of NRT by about 30 per cent.

Since the long-term benefit of NRT is modest, they suggest that treatment “should probably be closer to the long-term treatment of other chronic diseases such as hypertension than that used for acute diseases like infections”. They say that for many smokers prolonged treatment is probably necessary, and should include the encouragement to make repeated quit attempts accompanied with multiple treatment episodes over many years (Tobacco Control 2006;15:280).

Andrew McCoig, a community pharmacist from Croyden involved in smoking cessation services, commented that although nicotine addiction could be regarded as a chronic disease, treatment should not be continued ad infinitum.

He pointed out that although there is a proportion of people who will resume smoking a year or more after quitting, there is another group who want to stop all intake of nicotine and who successfully quit smoking after just one short course of NRT. He said that the smoking cessation pharmacist is ideally placed to identify which group each patient falls into and provide the appropriate encouragement.