Reduction versus abrupt cessation in smokers who want to quit

  • Review
  • Intervention

Authors


Abstract

Background

The standard way to stop smoking is to quit abruptly on a designated quit day. A number of smokers have tried unsuccessfully to quit this way. Reducing smoking before quitting could be an alternative approach to cessation. Before this method is adopted it is important to determine whether it is at least as successful as abrupt quitting.

Objectives

1. To compare the success of reducing smoking to quit and abrupt quitting interventions. 2. To compare adverse events between arms in studies that used pharmacotherapy to aid reduction.

Search methods

We searched the Cochrane Tobacco Addiction Review Group specialised register using topic specific terms. The register contains reports of trials of tobacco addiction interventions identified from searches of MEDLINE, EMBASE and PsycInfo. We also searched reference lists of relevant papers and contacted authors of ongoing trials. Date of most recent search: July 2012.

Selection criteria

We included randomized controlled trials (RCTs) that recruited adults who wanted to quit smoking. Studies included at least one condition which instructed participants to reduce their smoking and then quit and one condition which instructed participants to quit abruptly.

Data collection and analysis

The outcome measure was abstinence from smoking after at least six months follow-up. We pooled the included trials using a Mantel-Haenszel fixed-effect model. Trials were split for two sub-group analyses: pharmacotherapy vs no pharmacotherapy, self help therapy vs behavioural support. Adverse events were summarised as a narrative. It was not possible to compare them quantitatively as there was variation in the nature and depth of reporting across studies.

Main results

Ten studies were relevant for inclusion, with a total of 3760 participants included in the meta-analysis. Three of these studies used pharmacotherapy as part of the interventions. Five studies included behavioural support in the intervention, four included self-help therapy, and the remaining study had arms which included behavioural support and arms which included self-help therapy. Neither reduction or abrupt quitting had superior abstinence rates when all the studies were combined in the main analysis (RR= 0.94, 95% CI= 0.79 to 1.13), whether pharmacotherapy was used (RR= 0.87, 95% CI= 0.65 to 1.22), or not (RR= 0.97, 95% CI= 0.78 to 1.21), whether studies included behavioural support (RR= 0.87, 95% CI= 0.64 to 1.17) or self-help therapy (RR= 0.98, 95% CI= 0.78 to1.23). We were unable to draw conclusions about the difference in adverse events between interventions, however recent studies suggest that pre-quit NRT does not increase adverse events.

Authors' conclusions

Reducing cigarettes smoked before quit day and quitting abruptly, with no prior reduction, produced comparable quit rates, therefore patients can be given the choice to quit in either of these ways. Reduction interventions can be carried out using self-help materials or aided by behavioural support, and can be carried out with the aid of pre-quit NRT. Further research needs to investigate which method of reduction before quitting is the most effective, and which categories of smokers benefit the most from each method, to inform future policy and intervention development.

Plain language summary

Comparing reducing smoking to quit with abrupt quitting.

The standard way to quit smoking is to smoke as normal until a quit day at which point the smoker stops using all cigarettes. Most smokers who try to quit end up relapsing, therefore there are a number of people who have tried to quit abruptly in the past without success, and are disillusioned with this approach. An alternative way to give up could be to reduce the amount of cigarettes smoked before going on to quit completely. There is evidence to suggest that reducing smoking before quitting would be popular with smokers. This means that offering this approach to quitting could encourage more smokers to give up, however before offering this approach it is important to ensure it is at least as successful as abrupt quitting. This is because given a choice smokers who would otherwise have quit abruptly may choose to reduce first instead. If reduction isn't as effective, smokers who choose that method will be at a disadvantage. The aim of this review was to compare quit rates in reduction to quit and abrupt quitting interventions to see if reducing to quit is at least as successful as abrupt quitting. Ten studies were found which compared reducing smoking before quitting with abrupt quitting. Pooled results found that neither reducing or abrupt quitting produced superior quit rates. This was true whether nicotine replacement therapy was used as part of the intervention or not, and whether participants were offered self-help materials or behavioural support. These results suggest that smokers should be given a choice of quitting methods, either reducing smoking before quitting or abrupt quitting, however, to inform the development of new interventions more research is needed into which method of reducing smoking is the most effective.

Laički sažetak

Smanjenje ili nagli prestanak za pušače koji žele prestati pušiti: što je bolje?

Standardni način prestanka pušenja je pušiti normalno do dana prestanka pušenja, kada pušač prestaje koristiti cigarete potpuno. Većina pušača koji pokušavaju prestati ponovno počne pušiti nakon nekog vremena (relaps). Dakle, postoji veliki broj osoba koje su pokušale naglo prestati u prošlosti bez uspjeha i nisu bili zadovoljni tim pristupom. Drugi način prestanka pušenja bi mogao biti da smanje količinu popušenih cigareta prije potpunog prestanka. Postoje dokazi koji ukazuju da bi postupno smanjenje pušenja prije prestanka moglo za pušače biti prihvatljivije. To znači da bi se poticanjem takvog pristupa prestanka moglo potaknuti više pušača da prestanu pušiti. Međutim prije nuđenja ovog pristupa važno je da su zdravstveni radnici sigurni da je barem uspješan kao naglo odvikavanje. To je zato jer pušači koji bi inače pokušali naglo prestali dobiju izbor da mogu odlučiti da prvo smanje količinu popušenih cigareta umjesto toga. Ako smanjenje nije učinkovito, onda je takav savjet štetan. Cilj ovog Cochrane sustavnog pregleda je bio usporediti stope prestanka u osoba koje su naglo prestale pušiti i osoba koje su postupno prestajale pušiti kako bi se utvrdilo je li postupno smanjenje pušenja barem jednako uspješno kao nagli prestanak. Pronađeno je deset studija koje su uspoređivale smanjenje pušenja prije prestanka s naglim prestankom. Zajednička analiza svih rezultata tih studija pokazala je da nema razlike u ta dva pristupa u stopi prestanka pušenja. Nije bilo razlike u tim pristupima bez obzira na to jesu li ispitanici dobivali zamjensku terapiju nikotinom kao dio intervencija ili ne, i da li su ispitanicima bili ponuđeni materijali samopomoći ili bihevioralna podrška (savjetovanje). Ti rezultati ukazuju da pušačima treba dati izbor načina odvikavanja od pušenja. Mogu pokušati ili smanjenjem pušenja prije prestanka ili naglim prestankom pušenja. Međutim, kako bi se razvili što bolji načini prestanka pušenja, potrebno je više istraživanja o tome koja metoda smanjenja pušenja je najučinkovitija.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Ivana Sruk
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Streszczenie prostym językiem

Porównanie stopniowego ograniczania liczby wypalanych papierosów z nagłym rzuceniem palenia

Standardową metodą rzucenia palenia jest kontynuowanie palenia papierosów jak zwykle do dnia rzucenia palenia, gdy palacz zaprzestaje palenia jakichkolwiek papierosów. Większość palaczy, którzy w ten sposób próbowali rzucić palenie, wraca do nałogu. Istnieje zatem pewna grupa osób, które po nieudanej próbie zaprzestania palenia z dnia na dzień, czują się rozczarowane takim podejściem. Alternatywą dla nich mogłoby być stopniowe ograniczanie liczby wypalanych papierosów, prowadzące do całkowitego rzucenia palenia. Istnieją dane wskazujące na to, że ograniczanie palenia poprzedzające całkowite zerwanie z nałogiem, mogłoby cieszyć się popularnością wśród palaczy, co oznacza, iż zaoferowanie takiego podejścia, mogłoby zachęcić ich do rzucenia palenia. Ważne jednak, by zanim zaproponuje się palaczom tę metodę, upewnić się, że stopniowe ograniczanie palenia jest co najmniej tak samo skuteczne, jak jego nagłe zaprzestanie. Mając bowiem wybór, palacz, który mógłby rzucić palenie z dnia na dzień, może zastosować zamiast tego metodę stopniowego ograniczania liczby wypalanych papierosów, a przypadku gdyby nie była ona równie skuteczna – będzie to dla niego niekorzystne. Celem tego przeglądu było porównanie częstości rzucenia palenia przy stosowaniu metody stopniowego ograniczania liczby wypalanych papierosów i metody zakładającej całkowite zaprzestanie palenia z dnia na dzień, aby ocenić czy ta pierwsza metoda jest co najmniej tak samo skuteczna jak nagłe rzucenie palenia. Znaleziono 10 badań, w których porównane zostało rzucenie palenia poprzedzone stopniowym ograniczaniem papierosów oraz nagłe zaprzestanie palenia. Zsumowane wyniki wykazały, że ani metoda ograniczania liczby wypalanych papierosów, ani metoda zakładająca nagłe rzucanie palenia, nie wiążą się z większymi odsetkami rzucenia palenia. Potwierdzało się to zarówno w badaniach, w których częścią interwencji była nikotynowa terapia zastępcza, jak i bez jej zastosowania oraz w tych, w których palaczom oferowane były materiały do samopomocy lub wsparcie behawioralne. Wyniki te sugerują, że palacze powinni mieć możliwość wyboru metody rzucania palenia, czy to poprzez ograniczanie liczby wypalanych papierosów czy też nagłe zerwanie z nałogiem, jednakże, aby zapewnić rozwój nowych rodzajów interwencji, potrzeba więcej badań oceniających, która z metod rzucania palenia jest najbardziej skuteczna.

Uwagi do tłumaczenia

Tłumaczenie Joanna Błońska Redakcja Katarzyna Mistarz, Małgorzata Bała

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