Quitting Smoking Cold Turkey Better Than Quitting Gradually

Smokers who quit smoking abruptly are more likely to be abstinent at 4 weeks and 6 months compared with those who quit gradually, according to a new randomized controlled trial involving 697 smokers.

Researchers randomly assigned 355 adult smokers to the abrupt-cessation group and 342 to the gradual-cessation group. Participants were recruited from 31 primary care practices.
Participants in the abrupt-cessation group picked a day 2 weeks in the future on which to quit.
Participants in the gradual-cessation group reduced their smoking 50% by the end of the first week and by another 25% in the second week before quitting completely on quit day.
Nurses provided behavioral support for participants in both groups, and patients in both groups used nicotine replacement patches both before and after quitting. Participants in the abrupt-cessation group also anticipated times that avoiding tobacco would be particularly hard and developed coping strategies to avoid relapse. Participants in the gradual-cessation group were given short-acting nicotine replacement therapy in the form of their choice.

The researchers assessed the amount patients smoked and measured salivary cotinine and exhaled carbon monoxide concentration at each subsequent clinic session. The researchers used the Mood and Physical Symptoms Scale to measure tobacco withdrawal symptoms and monitored the participants for possible nicotine overdose during the 2 weeks of concurrent nicotine replacement therapy and smoking before quit day.

At 4 weeks, 39.2% (95% confidence interval [CI], 34.0% - 44.4%) of participants in the gradual-cessation group and 49.0% (95% CI, 43.8% - 54.2%) of participants in the abrupt-cessation group were abstinent. The data did not show noninferiority (unadjusted relative risk [RR], 0.80 [; 90% CI, 0.68 - 0.96]); moreover, participants in the gradual-cessation group were less likely to be abstinent at 4 weeks (adjusted RR, 0.80; 95% CI, 0.66 - 0.93) compared with those in the abrupt-cessation group, which was the primary endpoint.

At 6 months, 15.5% (95% CI, 12.0% - 19.7%) of those in the gradual-cessation group and 22.0% (95% CI, 18.0% - 26.6%) of those in the abrupt-cessation group were abstinent, with a relative risk of 0.71 (95% CI, 0.46 - 0.91).

The authors also note that when they stratified participants according to their preferred method of quitting — gradual or abrupt — those who preferred to quit gradually (38.3%) were significantly less likely to be abstinent than participants who preferred to quit abruptly (52.2%), regardless of their allocation in the trial (P = .007).

"We found clear evidence that quitting abruptly was superior in the short and longer term. Adherence to behavioral instructions and prequit [nicotine replacement therapy] was good, and medication was well-tolerated," the researchers write. "Participants who preferred to quit gradually were less likely to achieve abstinence, regardless of how they were allocated to quit."
Dr Lindson-Hawley reports a grant from the British Heart Foundation to conduct the reported study and grants from the National Institute for Health Research outside the submitted work. One author reports grants, personal fees, and nonfinancial support from Pfizer and personal fees from GSK outside the submitted work. One author reports grants from United Kingdom Centre for Tobacco and Alcohol Studies and the National Institute for Health Research School for Primary Care Research during the conduct of the study and personal fees from Pfizer and McNeil outside the submitted work. The remaining authors have disclosed no relevant financial relationships.

source : medscape.com

13:24:00