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Clinical guidelines

Supporting smoking cessationA guide for health professionals

Smoking reduction rather than smoking cessation

Some smokers are unable or unwilling to completely quit smoking. It has been proposed that reducing the number of cigarettes smoked per day has long-term benefits. However, it is not clear whether this strategy decreases the risk for tobacco-related diseases. Research has shown that smoking reduction by 50% modestly reduces the risk of lung cancer in heavy smokers (15 or more cigarettes each day).171 However, studies have not shown a decrease of risk of fatal or non-fatal myocardial infarction, hospitalisation for COPD or all-cause mortality compared with heavy smokers who do not change smoking habits.172–174 Smoking reduction should therefore be seen as a temporary measure for those not prepared to quit abruptly or in a rapid cut-down protocol. Health professionals should always encourage smoking cessation as the proven method of reducing harm from smoking.

There is insufficient evidence about long-term benefit to support the use of interventions intended to help smokers reduce, but not quit, smoking. Some people who do not wish to quit can be helped to cut down the number of cigarettes smoked by using nicotine gum or nicotine inhaler. Because the long-term health benefit of a reduction in smoking rate is unclear, this use of NRT is more appropriate before quitting.175 Smokers who use NRT for smoking reduction are approximately twice as likely to progress to quitting than those who do not.175

References

  1. Godtfredsen NS, Prescott E, Osler M. Effect of smoking reduction on lung cancer risk. J Am Med Assoc 2005;294:1505–10.
  2. Godtfredsen NS, Holst C, Prescott E, Vestbo J, Osler M. Smoking reduction, smoking cessation, and mortality: a 16-year follow-up of 19,732 men and women from The Copenhagen Centre for Prospective Population Studies. Am J Epidemiol 2002;156:994–1001.
  3. Godtfredsen NS, Vestbo J, Osler M, Prescott E. Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax 2002;57:967–72.
  4. Godtfredsen NS, Osler M, Vestbo J, Andersen I, Prescott E. Smoking reduction, smoking cessation, and incidence of fatal and non-fatal myocardial infarction in Denmark 1976–1998: a pooled cohort study. J Epidemiol Community Health 2003;57:412–6.
  5. Stead LF, Lancaster T. Interventions to reduce harm from continued tobacco use. Cochrane Database Syst Rev 2007, Issue 3. Art. no. CD005231.
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