Quit Smoking Programs: What's Better—Short or Long Term?

Quitting smoking is the best thing anyone can do for their health, especially those who have COPD. In fact, quitting smoking is the only way to prevent a rapid decline in lung function and almost certain death, once you are diagnosed¹.

But it's difficult to stop smoking, even when you know you should. Some people who have COPD make efforts to cut down or quit for a while, but never quite get to a permanent break from smoking. Most people who have COPD and continue smoking have tried to quit in the past, sometimes more than once, and failed. These persistent smokers tend to be more dependent on nicotine, thus finding it harder to quit¹.

In fact, smokers who have COPD have more trouble quitting than other smokers¹. Clearly, we need better smoking cessation strategies for this population of smokers.

So researchers out of the University of Kansas Medical Center launched a study to see if people placed in a long-term nicotine replacement program might have greater success in quitting than those who went through the standard intensive, short-term program.

Details of the Study

Almost 400 smokers with COPD participated in the clinical trial¹. About half of them were randomly placed in a traditional, 10-week nicotine replacement program. The other half was placed in an experimental, 52-week program. All participants were at least 18 years old and smoked 5 or more cigarettes a day for the last 25 out of 30 days. They also needed to have a physician's diagnosis of COPD. About 60% were female, while the other 40% were male¹.

Both groups received combination nicotine-replacement therapy, consisting of nicotine patches plus 2 mg of nicotine gum and/or lozenges. The dosage was dependent on their smoking history¹.

Group One: Standard Smoking Cessation. The first group of patients was given baseline counseling focused on motivating their readiness to quit. They had to be willing to set a quit date within 6 weeks of starting the program. If they were ready, a counselor worked with them to develop a personalized quit plan. They also received a 10-week supply of nicotine replacement medication to start on their selected quit date. Follow-up telephone counseling sessions were provided at weeks 1, 3, 6 and 10¹.

Group Two: Long-Term Nicotine Replacement Therapy. The second group also received baseline counseling, focused more on assessing their interest in quitting. They then developed either quit plans or smoking reduction plans. They were started on nicotine replacement therapy right away and the prescription was renewed every 3 months for a year. Follow-up telephone counseling for this group occurred at weeks 1, 3, and 6 and then at 9 months after the baseline session. In addition, they received in-person counseling at months 3 and 6¹.

Outcome Measures

The primary outcome measure was whether the person had quit smoking for at least 7 days before being tested at month 12. Abstinence was confirmed by exhaled carbon monoxide (CO) levels¹.

Secondary outcome measures included¹:

• 6-month sustained abstinence, measured by exhaled CO levels at month 6 and month 12
• Cumulative number of 24-hour quit attempts

Other outcome measures, focused on "harm reduction" included¹:

• Cigarettes smoked per day
• Exposure to carbon monoxide (secondhand smoke)
• Carcinogen exposure, tested in spot urine samples

Finally, researchers also measured¹:

• Changes in pulmonary function
• Respiratory symptoms
• Visits to the ER or hospitalization

Results of the Study

Both groups had similar outcomes. Overall, 94% of the participants completed the program through the 12 months. 95% of them completed all their counseling sessions. Use of the nicotine replacement therapies varied among both groups¹.

In terms of quit rates:

• Slightly less than 12% of the participants in the standard smoking cessation program had a CO-verified 7-day abstinence at 12 months.
• Slightly more than 12% of those in the long term program had a CO-verified 7-day abstinence at 12 months.

The difference was not significant between the 2 groups¹.

Both groups had similar improvements in respiratory symptoms over time. They also had similar numbers of visits for emergency care. And there was no real difference in their numbers of quit attempts either¹.

These outcomes contrasted sharply with previous studies done with smokers who did not have COPD¹. In those studies, long-term nicotine replacement therapy had much higher success rates than short-term approaches.

What Does It Mean?

So, does this mean there is no real value in a long-term approach to quitting smoking? The answer to that question is not necessarily. Heavy smokers who have COPD may be interested in having an option of reduce-to-quit programs that include a gradual tapering or cutting down of cigarettes smoked. However, the long-term approach shows no real advantage when it comes to outcomes¹.

The overall low rate of smoking cessation in both groups illustrates the need for better strategies for quitting smoking. Future research might be of value if focused on:

• Alternative delivery methods for nicotine replacement
• Variations in counseling quantity and/or quality

Have you quit smoking, and if so, what method did you use? Please share your experiences in the comments.