Tobacco consumption increases the risk of several diseases and significantly increases mortality. Therefore, the topic of smoking cessation plays an increasingly important role in the daily routine of general practitioners. Despite various programs and aids such as nicotine replacement medications, quitting smoking remains a major challenge. But it pays to keep at it….
More than a quarter of all Swiss smokes [1]. So this group is in good company. According to the WHO, we are dealing with a veritable epidemic. The number of smokers worldwide is expected to rise to more than one billion people in the next few years – despite all smoking cessation measures [3]. Most people are aware that tobacco use can be associated with major limitations to their health. Arteriosclerotic cardiovascular diseases, various malignant diseases or chronic obstructive pulmonary disease can be traced back to active tobacco smoking. Even passive smoking can lead to respiratory infections, lung problems but also myocardial infarction or lung cancer [2]. In addition, tobacco use is the leading cause of mortality, accounting for 9500 deaths per year [2]. Accordingly, effective and rapid smoking cessation is important to improve life expectancy and quality.
Stop smoking – easier said than done
But quitting smoking is not so easy. The real horse’s foot in terms of addiction is nicotine. However, nicotine dependence does not exist only when the affected person has to consume increasingly more in order to feel the same effect. Addictive behavior may already be present beforehand (tab. 1). Moreover, typical withdrawal symptoms, such as increased excitability and restlessness, cannot be reduced by consuming nicotine again, as is often assumed. They are even reinforced in the long term. Other withdrawal symptoms may include increased feelings of hunger, sleep disturbances, and anxiety [4].
Proceed according to plan
In fact, a large proportion of the nearly 2 million Swiss smokers would like to quit (Fig. 1) [5,6]. This makes sense not only with regard to the rapid physical improvements (Tab. 2) [3]. But for this, those affected usually need support. Because of psychological and physical dependence, numerous daily rituals, and social influences, tobacco abstinence is a long and difficult process for most smokers [7].
A variety of tobacco cessation methods have since been developed. These include, for example, individual, group, or telephone counseling by health professionals, pharmacologic treatments with nicotine replacement medications, and interactive programs [2]. An “opportunistic” brief intervention can take a first step toward smoking cessation by making the individual aware of the problem. The motivational intervention aims at the active decision to quit smoking. During the more intensive intervention, this decision should be strengthened and a weaning plan should be created.
Supporting measures
Tobacco cessation is based on the individual needs of the person concerned. In principle, helping people quit tobacco use has more impact when tobacco control strategies are combined [3]. This may include telephone consultations, internet or smartphone-based programs, and written documentation.
Several options are available for pharmacological treatment (Table 3) [2,7]. Nicotine substitution facilitates withdrawal and reduces withdrawal symptoms. Therefore, is considered to be effective support. The different options deliver between ¹⁄3 and ²⁄3 of the nicotine ingested during smoking, but without producing peaks as fast as a cigarette. There is no significant difference in efficacy between the different dosage forms of nicotine replacement products, although studies are heterogeneous [7]. The success rate with varencilin or bupropion is said to be similarly high. Also, although studies report abstinence rates over 12 months of between 22% (varenciline) and 15% (bupropion), these are not always achieved in everyday practice. Side effects also play a greater role. According to the Drug Compendium, persons taking varencilin in particular should be monitored closely for neuropsychiatric symptoms [7].
Do e-cigarettes help to quit smoking ?
E-cigarettes for smoking cessation have been the subject of controversy since their market launch. Currently, the question has not yet been conclusively clarified. However, the results of a large-scale clinical trial show that e-cigarettes can indeed make a significant contribution to smoking cessation – compared with the previous use of nicotine replacement products [8]. For this, 886 smokers were randomized to smoking cessation using either e-cigarettes or other means such as nicotine patches or gum. After one year, it was shown that 18% of the subjects had managed to quit addiction with the help of the e-cigarette. For the other nicotine replacement products, the share was only 9.9%. A clinical trial is also currently underway in Switzerland to verify the results obtained to date. Therefore, the efficacy, safety, and tolerability of e-cigarettes as tobacco cessation aids are under closer scrutiny [9]. A now newly published update to a Cochrane review highlights that as the evidence on smoking cessation grows, there is clearer evidence that e-cigarettes with nicotine can support more people in terms of successful smoking cessation than other approaches. The scientific consensus is that e-cigarettes are significantly less harmful than traditional cigarettes, but they are not considered risk-free. In this regard, studies are lacking regarding the long-term effects of nicotine vapor [10].
Literature:
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- Humair JP: Effective methods and place of electronic cigarette. Tobacco cessation. Primary and Hospital Care – General Internal Medicine 2018; 18(19): 339-342.
- https://apps.who.int/iris/bitstream/handle/10665/326043/9789241516204-eng.pdf?ua=1 (last accessed 08.05.2020)
- www.netdoktor.de/krankheiten/nikotinsucht (last accessed 08.05.2020)
- www.freivontabak.ch/index.php/de/das-projekt (last accessed 08.05.2020)
- Kuendig H et al. Désaccoutumance tabagique en Suisse en 2015. Analyse des données du Monitorage suisse des addictions. Addiction Switzerland, Lausanne. 2016
- Cornuz J, Jacot Sadowski I, Humair JP: Physician smoking cessation counseling, 3rd edition FREE FROM TOBACCO 2015.
- Hajek P et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. NEJM 2019. DOI: 10.1056/NEJMoa1808779
- www.estxends.ch (last accessed 10/13/2020)
- www.cochrane.de/de/news/cochrane-review-zeigt-nutzen-von-e-zigaretten-für-den-rauchstopp (last accessed 10/15/2020)
HAUSARZT PRAXIS 2020; 15(10): 28-29
