title: Aiding reduction of smoking with nicotine replacement medications: hope for the recalcitrant smoker?
abstract: OBJECTIVE
  To assess the effect of the various nicotine replacement therapies (NRT) on smoking reduction.
  
  
  METHODS
  During an initial sampling week, the subjects familiarised themselves with nicotine gum, patch, nasal spray, vaporiser (vapour inhaler) and sublingual tablet. A crossover design was used during the next four study weeks; during two of these weeks the subjects could select one nicotine replacement product of their choice to use, whereas during the other two they were randomly assigned a product to use.
  
  
  METHODS
  143 men and women smoking an average of 22.6 (SD 7.0) cigarettes per day and exhibiting a Fagerström Tolerance Questionnaire (FTQ) score of 7.0 (SD 1.9).
  
  
  METHODS
  Subjects were asked to use as much NRT as they wished, yet to smoke enough to feel comfortable.
  
  
  METHODS
  Self-reported cigarette consumption, exhaled carbon monoxide (CO), withdrawal symptom score, cotinine plasma levels and motivation to quit were monitored over a period of five weeks.
  
  
  RESULTS
  Self-reported smoking declined steadily over the five weeks, from 22.6 (SD 7.0) to 10.4 (SD 1.0) (P<0.001) cigarettes daily (54% decrease), with the biggest drop (37%) during the first product-sampling week. Smoking reduction was greater on average during the weeks when the subjects could choose their nicotine product than when products were assigned. CO readings decreased from 22.7 (SD 8.5) to 14.8 (SD 8.4) ppm (P<0.001) confirming a reduction in smoking (35% decrease), although cotinine levels remained steady, suggesting that subjects were titrating nicotine to their original levels. Withdrawal scores decreased over time (32% decrease, P<0.001), showing that there was no discomfort associated with the smoking reduction, and motivation to quit was enhanced by the treatment in most subjects (93%).
  
  
  CONCLUSIONS
  NRT for aiding smoking reduction appeared to be safe, was associated with a clinically significant reduction in smoke exposure over a five-week follow up, and increased motivation to stop smoking. A smoking reduction procedure may help the very recalcitrant smoker gain confidence and increase the control over his/her smoking behaviour. More controlled research is needed to follow up these promising results.
authors.affiliation: Pharmacia & Upjohn Consumer Healthcare, Helsingborg, Sweden. Karl.Olov.Fagerstrom@am.pnu.com
authors.forename: K O
authors.initials: KO
authors.lastname: Fagerström
authors.forename: R
authors.initials: R
authors.lastname: Tejding
authors.forename: A
authors.initials: A
authors.lastname: Westin
authors.forename: E
authors.initials: E
authors.lastname: Lunell
mesh_terms: D000328:Adult; D002248:Carbon Monoxide / Q000032:analysis; D003367:Cotinine / Q000032:analysis / Q000097:blood / Q000627:therapeutic use; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009538:Nicotine; D010947:Plants, Toxic; D012463:Saliva / Q000737:chemistry; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires; D014026:Nicotiana; D014029:Tobacco Use Disorder / Q000628:therapy*
chemical_list: D009538:Nicotine; D002248:Carbon Monoxide; D003367:Cotinine