Smoking: combining nicotine patches and inhalers increased rates of quitting

Clinical bottom line (level 1b)

  1. Smokers who want to quit who use nicotine patches and inhalers compared with placebo patches and nicotine inhalers were more likely to have stopped smoking at 3 months (NNT = 9 at 3 months) , but not at 12 months.
  2. Patients on combination therapy were more likely to develop itching initially (NNH = 20 at 7 days) .
Bohadama et al: Arch Intern Med 2000; 160 : 3128-3134
Expires May 2004

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: towns, France

400 patients (aged mean 37, 51% male) recruited via a newspaper advert wanting to stop smoking

Excluded if
  • aged < 18, > 70
  • severe cardiac arrhythmia
  • serious renal, pulmonary, endocrine or neurological disorder
  • pregnancy or breastfeeding
  • using any form of smokeless tobacco or nicotine substitute
  • followed any smoking cessation program within previous 6 months
  • alcoholics or illegal drug users
  • any psychoactive drugs
  • generalised dermatological disorder
  • smoked < 10 cigarettes per day for < 3 years
  • expired carbon monoxide level < 10 ppm
  • never tried to quit before
  • not fluent in French
  • history of MI within 3 months, or unstable angina

Control Group: (n = 200, 200 analysed): nicotine inhaler and placebo patch for 6 months
Experimental Group: (n = 200, 200 analysed): nicotine inhaler and nicotine patch for 6 months

100% followed for 12 months

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
stopped smoking 3 months 62
(31.0%)		 84
(42.0%)		 35%
(4% to 76%)		 11.0%
(1.63% to 20.4%)		 9
(5 to 62)
stopped smoking 12 months 28
(14.0%)		 39
(19.5%)		 39%
(-11% to 120%)		 5.50%
(-1.80% to 12.8%)		 18
(NNT = 56 to infinity;
NNH = 8 to infinity)
itching 7 days 4
(2.00%)		 39
(14.0%)		 -250%
(-950% to -17%)		 -5.00%
(-9.03% to -0.97%)		 -20
(-100 to -11)

Citation

  1. Bohadama A, Nilsson F, Rasmussen T, et al: nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial. Arch Intern Med 2000; 160 : 3128-3134
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient smoker
Intervention or Exposure nicotine patch and inhaler
Comparison nicotine inhaler and placebo patch
Outcome quitting