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Clinical guidelines

Supporting smoking cessationA guide for health professionals

Unproven approaches to smoking cessation

There are some approaches that have the potential to assist with maintaining long-term smoking cessation, but they have not yet been adequately investigated for cessation. These approaches include electronic nicotine delivery systems (ENDS), also called e-cigarettes, physical activity, mindfulness and the Alan Carr method.

Electronic cigarettes

E-cigarettes are battery-powered devices that may deliver nicotine in a vapour without tobacco or smoke. Before these products can be recommended for consumers, further research must be conducted on the safety and efficacy for smoking cessation.16 To the extent that these are promoted as an aid to cessation they are subject to regulation by the TGA. Most manufacturers and sellers therefore do not make this specific claim. Consumers may be unaware of this and assume that e-cigarettes are safe and effective but neither has been proven.2 E-cigarettes can relieve cravings and symptoms of nicotine withdrawal as well as simulating the behavioural and sensory aspects of smoking.160 A small number of randomised controlled trials have suggested that e-cigarettes could have a role in cessation and harm reduction, though further research is needed before recommendations for their use can be confidently made.161,162

Concerns about e-cigarettes include a lack of evidence for short-term efficacy and short-and long-term safety, particularly in patients with current chronic disease. Rather than cessation, concurrent use with smoking may continue. There are also concerns that e-cigarettes may potentially act as a gateway to smoking.163 However it is reasonable to conclude that if used as a substitute rather than an addition, e-cigarettes are much less harmful than continuing to smoke.

Other nicotine-related agents

NicoBloc® and Nicobrevin are nicotine-related agents which are occasionally recommended by some healthcare professionals. These are available in some pharmacies,164 despite a lack of any empirical evidence of effectiveness.14,165

Aversive or rapid smoking

There is limited evidence to suggest that rapid (or aversive) smoking may be effective.166 However, this technique should not be attempted without appropriate training.

Biomedical feedback

Demonstration of the effects of smoking, with the exception of using spirometry, to estimate ‘lung age’167 has not been shown to increase quit rates. Strategies used include spirometry in primary care, expired carbon monoxide levels, vascular ultrasounds and genetic susceptibility.168

Physical activity

There are two major aspects to quitting tobacco use: overcoming nicotine addiction and changing lifestyle. It is well known that increased physical activity has many benefits for a healthy life. Exercise has been investigated as a way of helping with symptoms of nicotine withdrawal and cravings during attempts to quit. Exercise may also help by increasing self-esteem and might help to manage the weight gain that often follows quitting. However, there is currently no evidence to show higher abstinence rates long-term with exercise alone.169

However, increased activity should not be discouraged as part of a support program as it brings other health advantages.

Allen Carr method

Although it has considerable popular support, there is no high-quality, empirical evidence that the Allen Carr method is effective.14

St John’s wort

The herbal antidepressant St John’s wort (Hypericum perforatum) herb extract has not been shown to aid in smoking cessation. There is as yet no convincing evidence that St John’s wort, alone or with individual motivational and behavioural support, is likely to be effective as an aid in smoking cessation.170

References

  1. Australian Institute of Health and Welfare. Substance use among Aboriginal and Torres Strait Islander people. Cat. no. IHW 40. Canberra: AIHW, 2011. Available at www.aihw.gov.au/publication-detail/?id=10737418268 [accessed 19 August 2011].
  2. Ministry of Health. New Zealand Smoking Cessation Guidelines. Wellington: Ministry of Health, 2007. Available at www.moh.govt.nz/ moh.nsf/pagesmh/6663/$File/nz-smoking- cessation-guidelines-v2-aug07.pdf [accessed 23 March 2011].
  3. World Health Organization. WHO Framework Convention on Tobacco Control, adopted 16 June 2003 (entered into force 27 February 2005). Geneva: WHO, 2005. Available at www.who.int/tobacco/framework/en/ [accessed 25 March 2011].
  4. Caponnetto P, Russo C, Bruno CM, Alamo A, Amaradio MD, Polosa R. Electronic cigarette: a possible substitute for cigarette dependence. Monaldi Arch Chest Dis 2013 Mar;79(1):12−9.
  5. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 2013;16;382(9905):1629-37.
  6. Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One. 2013 Jun 24;8(6):e66317.
  7. Pepper JK, Brewer NT. Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review. Tob Control 2013 Nov 20.
  8. Chiang PP, Chapman S. Do pharmacy staff recommend evidenced-based smoking cessation products? A pseudo patron study. J Clin Pharm Ther 2006;31:205–9.
  9. Stead LF, Lancaster T. Nicobrevin for smoking cessation. Cochrane Database Syst Rev 2006, Issue 2. Art. no. CD005990.
  10. Hajek P, Stead LF. Aversive smoking for smoking cessation. Cochrane Database Syst Rev 2007(3):CD000546.
  11. Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ 2008;336:598–600.
  12. Bize R, Burnand B, Mueller Y, Rege Walther M, Cornuz J. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev 2009(2):CD004705.
  13. Ussher MH, Taylor A, Faulkner G. Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2008, Issue 4. Art. no. CD002295. 170  
  14. Sood A, Ebbert JO, Prasad K, Croghan IT, Bauer B, Schroeder DR. A randomized clinical trial of St. John’s wort for smoking cessation.J Altern Complement Med 2010;16:761–7.
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