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Smoking is the greatest single cause of preventable illness and premature death in the UK. To coincide with the launch of Stoptober we highlight key systematic reviews available on DARE that examine the effectiveness of interventions designed to help smokers quit.

Nicotine replacement therapy (NRT)

NICE recommends that all forms of NRT (and prescription only medicines) should be used only as part of a programme that includes advice from a healthcare professional or other types of support (NICE 2008).

A Cochrane Review has evaluated all of the available forms of NRT including gum, patches, nasal spray, inhalators and lozenges (Stead 2008). This well conducted review identified 132 studies involving more than 40,000 participants. It found that NRT is highly effective and can help smokers increase their chances of successfully quitting by around 60%. The provision of additional counselling although beneficial in facilitating the likelihood of a smoker quitting, is not essential to the success of NRT.

NICE state that NRT can be offered to young smokers aged 12-17 years and to pregnant or breastfeeding women who smoke (NICE 2008).

Medicines only available on prescription

As well as NRT, NICE state that health professionals can offer, where appropriate, varenicline (Champix) or bupropion (Zyban) as possible treatments to help smokers who have said they want to stop smoking (NICE 2008).

A recent Cochrane review (Cahill 2012) evaluating the effects of varenicline identified 15 studies involving more than 12,000 participants. The well conducted review found that for studies evaluating varenicline prescribed at a standard dose doubled the chances of smokers quitting. Another well conducted review from the Cochrane Tobacco Addiction Group (Hughes 2007) included 49 studies evaluating the effects of bupropion. The review found that bupropion increased smokers’ chances of successfully quitting by around 70%.

NICE state that neither varenicline or bupropion should be offered to young people under 18 nor to pregnant or breastfeeding women (NICE 2008).

Advice and support

NICE suggests that providers of NHS Stop Smoking Services should offer tailored advice, counselling and support, particularly to smokers from minority ethnic and disadvantaged groups (NICE 2008).

There is good evidence that proactive telephone counselling (i.e. not initiated by calls to helplines and quitlines) can help helps smokers interested in quitting (Stead 2006; Tzelepis 2011). There is some evidence that three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone (Stead 2006).

Brief advice from doctors can help smokers to quit (Stead 2008). This well conducted Cochrane review suggests that even when doctors provide brief advice about stopping smoking,  this increases the likelihood that someone who smokes will successfully quit.

Electronic cigarettes

Sales of e-cigarettes are on the increase in the UK and internationally.  A recent review by the Canadian Agency for Drugs and Technologies in Health found that no research has been conducted to test the safety and efficacy of e-cigarettes as smoking cessation aids (CADTH 2012). Limited evidence suggests that e-cigarettes may reduce the desire to smoke and reduce withdrawal symptoms in the immediate short term. The Medicines and Healthcare Products Regulatory Agency has announced that all nicotine-containing products including e-cigarettes are to be regulated as medicines from 2016. Trials assessing the safety and effectiveness of e-cigarettes as smoking cessation aids are ongoing.

Other smoking cessation interventions

The CRD Databases provide access to other critically appraised systematic reviews and economic evaluations relevant to smoking cessation. To search for these click here.

References

1. CADTH. Electronic cigarettes: a review of the clinical evidence and safety. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). 2012 Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2012; Issue 4.
2. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2007; Issue 1.
   
3. National Institute for Health and Clinical Excellence. Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. NICE public health guidance 10. London: NICE, February 2008.
   
4. Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2006; Issue 3.
   
5. Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2008; Issue 1.
   
6. Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2008; Issue 2.
7. Tzelepis F, Paul CL, Walsh RA, McElduff P, Knight J. Proactive telephone counseling for smoking cessation: meta-analyses by recruitment channel and methodological quality. Journal of the National Cancer Institute 2011; 103(12): 922-941.