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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Smoking cessation approaches

The Cochrane Library has published a review of the available evidence for smoking cessation to investigate the efficacy of a reduction in smoking cigarettes prior to a quit date compared to abrupt cessation.

The review noted that the most common approach to smoking cessation is to stop abruptly on a planned day but that this approach does not work for some individuals. This review identified 10 studies including 3,760 participants. All the studies were randomised controlled trial, five studies offered behavioural support, four offered self help material and the final study offered both. Three of the studies employed pharmacotherapy.

The analysis found no difference in abstinence rates when comparing the two methods (Relative Risk 0.94, 95% CI 0.79 to 1.13). This remained the same whether pharmacotherapy was use or not and was not affected by use of behavioural support or self help materials.

The authors conclude that, "reducing cigarettes smoked before quit day and quitting abruptly produced comparable quit rates, therefore patients can be given the choice to quit in either of these ways".

Action: Clinicians should be aware of this review; advising some smokers to reduce their smoking, perhaps supported with nicotine replacement therapy, may be an effective strategy if abrupt cessation has been unsuccessful in the past.

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