I was interested to read your report (GP, 1 December 2006) on a recent Norwegian study, which demonstrated that smokers who reduced their daily cigarette consumption failed to achieve improved disease outcomes.
This has been widely understood by those in the tobacco control community for a number of years. The RCP Tobacco Advisory Group’s report, Nicotine Addiction in Britain, set out the research evidence for ‘compensation’, for example, the extent to which tobacco users adjust their nicotine intake on switching to nominally lower tar cigarettes.
This ‘compensation’, along with the known observation that there is a non-linear relationship between smoke exposure and cardiovascular disease (unlike with cancers), helps explain the findings.
Though I support the conclusions of the researchers, we should remember that the advice to cut down the number of daily cigarettes, while at the same time using nicotine replacement therapy (NRT), is a licensed indication for selected NRT products. The aim of the new indication is a complete cessation of smoking over a six to nine month period.
Four studies demonstrated that a third of smokers not ready to quit, who reduced their consumption by 50 per cent using NRT, went on to stop within a year. These studies are supported by a new qualitative review of 19 studies on smoking reduction in smokers who did not want to quit, coupled with the use of nicotine replacement products. The review, led by John Hughes MD, published in the December edition of Nicotine and Tobacco Research, found an increased quitting rate in 16 of the studies.
The ASH website remains a useful source for guidance on smoking reduction as a route
Dr Dawn Milner
Retired GP and freelance tobacco control consultant