title: Pre-quitting nicotine replacement therapy: findings from a pilot study.
abstract: BACKGROUND
  Using nicotine replacement therapy (NRT) while still smoking in the lead up to quitting could enhance success at quitting, one of the most cost-effective means of improving health, but little is known about its acceptability and tolerability.
  
  
  OBJECTIVE
  To test the acceptability and tolerability of using NRT while smoking for two weeks before quitting, to inform a randomised controlled trial of pre-quitting NRT versus usual NRT-based quitting practice.
  
  
  METHODS
  Prospective pragmatic uncontrolled clinic-based pilot study in which 14 adult smokers recruited from a smoking cessation clinic were prescribed nicotine patches or gum with follow up for two weeks. Data were collected on participants' concerns about smoking while using NRT, importance of quitting, urges to smoke, smoking behaviour, previous NRT use and the length of the pre-quitting period. Urine tests were collected weekly for cotinine, and participants recorded smoking activity and noted experiences and changes in their health in diaries.
  
  
  RESULTS
  Only 21% of 14 participants expressed concerns about using NRT while smoking. All of the nine followed up used it as recommended, 56% of these reporting no unpleasant symptoms. Median urine cotinine levels declined over the two weeks. Urges to smoke averaged 1.8 on a 4-point scale. All participants decreased the number of cigarettes per day. Diary records showed wide variation in smoking and NRT use, with an increased sense of control and determination to quit.
  
  
  CONCLUSIONS
  Smokers using pre-quitting NRT over two weeks appeared to titrate nicotine levels and symptoms of toxicity were uncommon and of low intensity.
authors: Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.
authors: Chris
authors: C
authors: Bullen
authors: Robyn
authors: R
authors: Whittaker
authors: Natalie
authors: N
authors: Walker
authors: Mark
authors: M
authors: Wallace-Bell