Managing smoking cessation
A systematic review and meta-analysis of 10 randomized controlled trials (RCTs) involving 3760 participants concluded that interventions to reduce and quit smoking produced cessation rates comparable to quitting abruptly.18 There is also evidence that cessation medications and support can be offered...
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Veröffentlicht in: | Canadian Medical Association journal (CMAJ) 2016-12, Vol.188 (17-18), p.E484-E492 |
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Zusammenfassung: | A systematic review and meta-analysis of 10 randomized controlled trials (RCTs) involving 3760 participants concluded that interventions to reduce and quit smoking produced cessation rates comparable to quitting abruptly.18 There is also evidence that cessation medications and support can be offered to smokers with no immediate intention to quit, but who are interested in reducing their smoking.7 A 2015 systematic review and metaanalysis involving 7981 participants who smoked supported the efficacy of using nicotine replacement therapy or varenicline to achieve long-term cessation among patients who want to reduce their smoking.7 Participants were given standard doses of nicotine replacement therapy or varenicline for periods of 2-18 months. Cessation rates measured at least 6 months after starting treatment ranged from 4.2% to 17.5% for reduction support in conjunction with medication compared with a range of 2.6% to 12.2% with no intervention.7 Rates of cigarette smoking are two to four times higher in people with current mood, anxiety and psychotic disorders.48 A 2015 review of studies assessing smoking cessation treatment in patients with schizophrenia, depression, anxiety disorders and posttraumatic stress disorder showed that smokers with chronic mental illness can quit smoking using standard cessation approaches, without adverse effects on psychiatric symptoms.49 Two RCTs5051 evaluating varenicline for smoking cessation and a systematic review52 showed that bupropion and varenicline are effective in patients with schizophrenia. Two RCTs53,54 and a systematic review and meta-analysis55 found that varenicline was effective in patients with depression and severe mental illness. Fewer studies have reported about treatments for smoking cessation in patients with anxiety disorders and posttraumatic stress disorder; therefore, appropriately powered RCTs involving these populations are needed.49 Relapse rates are higher in those with mental illness, which suggests that additional support and prolonged treatment are needed. We searched PubMed, Cochrane and MEDLINE databases using combinations of the terms "tobacco-use cessation," "smoking cessation," "pharmacotherapy," "medication," "counseling," "behavioural" and "review" along with the "related articles" function, and we restricted our search to research published since 2005. We focused attention on recently published research: in particular, systematic reviews, systematic reviews of reviews and randomized |
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ISSN: | 0820-3946 1488-2329 |
DOI: | 10.1503/cmaj.151510 |