2023-05-31 11:06:44
The new National Institutes of Health guideline for the treatment of tobacco and nicotine addiction evaluates the effectiveness of all available treatments,
Thinking that vaping can help you quit smoking is a big mistake. He reiterates it the new guideline for the treatment of tobacco and nicotine addiction published by the Higher Institute of Health on the occasion of the World no tobacco day: E-cigs or electronic cigarettes and even heated tobacco cigarettes cannot in any way be considered a suitable tool for starting a therapy for smoking cessation
. E-cigs, introduced on the market as useful tools for quitting smoking have instead generated new categories of consumers, the “dual consumers” that to the consumption of traditional cigarettes they have added the use of electronic and heated tobacco ones.
The new scenarios
The new Guideline for the treatment of tobacco and nicotine addiction, which updates the previous 2008 edition, the first to take into account the scenarios generated by the new products that have entered the market in recent years. Through the answers to nine questions, the document evaluates the effectiveness of all available treatments, from counseling to pharmacotherapy to digital interventions, for example through apps, formulating the related recommendations for operators. For the first time, it is being addressed as well the topic of how to deal with addiction to new devices on the marketfrom electronic cigarettes to heated tobacco devices, with indications of some good clinical practices.
This is the first Guideline which includes, in addition to the treatment of dependence on traditional tobacco cigarettes, also the treatment of nicotine addiction induced by the new products appearing on the market – underlines Simona Pichini, who directs the National Addiction and Doping center of the ISS -. very important to underline that the scientific evidence currently collected indicates that the new products do not represent a tool for the cessation of traditional cigarette consumption.
The scientific path
The recommendations given in the Guideline were developed by a multidisciplinary and multiprofessional panel, composed of experts of recognized authority and professional competence at a national level and by two lay members, who represented the values and preferences of the patients. The working group, coordinated by the ISS, analyzed the scientific literature available on the subject of the guideline and used the GRADE method, developed by the Canadian McMaster University Grade Working Group, to proceed, in a structured and transparent manner, from the evaluation of scientific evidence to clinical practice recommendations, in compliance with the methodological standards for the development of the Guidelines, defined by the National Center for Excellence Clinic, the Quality and Safety of Care (CNEC) of the ISS.
Clinical practice
The development process of the Guideline has also foreseen some p
procedures for public consultation of stakeholdersinvited to comment on the preliminary recommendations formulated by panels and the external review of the document by independent experts, selected by virtue of their professional and methodological skills. This work resulted in 29 clinical practice recommendations, one research recommendation and 8 good clinical practice recommendations., which operators can use to direct treatments. important to be able to make use of the latest scientific evidence available – comments the president of the ISS Silvio Brusaferro — to be able to guide the choices of citizens.
The main questions and answers on the Guidelines
•What are the benefits for those who stop smoking or using other tobacco and nicotine products?
Addiction to tobacco and nicotine consumption represents a serious problem for public health, being one of the major risk factors in the development of neoplastic, cardiovascular and respiratory diseases. Stopping the intake of nicotine and the consumption of any tobacco product has significant public health benefits in the short, medium and long term.
•Does quitting smoking have a positive effect on health?
Tobacco smoking addiction considered a public health problem. Through the cessation of this habit, the risk of pathologies related to it in the short and long term of a neurological, cardiovascular, respiratory type is reduced, as well as the risk of neoplastic formations is reduced. Cigarette smoking transiently increases blood pressure, heart rate and contractility and modifies the plasticity of some receptor areas and structures of the brain.
•Why are new products addictive too?
In all these products, as well as in traditional cigarettes, the addictive substance is nicotine, a neuro-psychotropic substance which creates a high degree of dependence as it increases the secretion of neurotransmitters involved in the regulation of mood and behavior (not only containing tobacco). This is present transversally in several types of products available on the market, from traditional tobacco-based cigarettes to so-called new products, such as e-cigs and HTP (Heated Tobacco Products). It is important to underline that each of these ways of taking nicotine can generate dependence in the user and that, currently, there are no studies demonstrating that the new products are less harmful than traditional cigarettes. Furthermore, as far as new products are concerned, there are not enough studies to determine whether there is an addiction generated not only by nicotine, but also by the flavors they contain.
•What is the difference between electronic cigarette and traditional cigarette in terms of addiction?
There is no difference in terms of nicotine addiction since both traditional and electronic cigarettes allow for the inhalation of nicotine. Even if it is possible to reset the nicotine content in the e-cig liquid, the latter contain aromas and therefore some studies have been started to understand their effect also in terms of addiction. Furthermore, when it comes to addiction, the value of gestures associated with smoking and which is also reproposed with the use of new devices is not negligible in its determination.
•Why is counseling recommended for quitting smoking?
The psychological component is a fundamental factor both in the development and in overcoming addiction. In fact, it is not always possible to rely on pharmacological therapy alone or on medical information alone, even if indispensable. Through the counseling services of the anti-smoking centres, it is possible to develop self-help and motivational tools, sometimes crucial for the success of the path followed. Data show that success in quitting the habit increases by 66% among those who choose to quit smoking with the help of a course of therapy.
• Is a purely pharmacological therapy preferable or one in which psychological support is associated with the patient?
The fundamental psychological component in the success of the smoking cessation process. Pharmacological therapy should always be associated with a psychological path that provides the patient with tools for self-help and motivation maintenance which statistically increase the chances of success of the path.
•What should a smoking cessation counseling therapy consist of?
Evidence shows that simply providing information through standard self-help materials (leaflets or information pamphlets) is not effective. More success, on the other hand, is obtained from counseling therapies and from the individual administration of materials that allow for the personalization of the path in relation to the characteristics of the type of addiction (e.g. brochures that contain therapeutic diaries or self-assessment tests). In addition to the classic modalities of face-to-face individual counseling, therapies in digital format are also currently being tested, with the aid of multimedia material which include the option of being able to make use of a video consultation in real time by the patient.
•How do drugs help to quit smoking?
Pharmacological therapy increases the chances of smoking cessation. However, pharmacological therapies, which must always be managed by healthcare personnel, are structured in a highly personalized way and represent an additional strategy to the counseling intervention, which remains, however, the fundamental tool even in the case of pharmacological therapy.
•Can the use of alternative devices to the traditional cigarette, such as electronic cigarettes or heated tobacco cigarettes, represent a strategy to quit smoking?
E-cigs or electronic cigarettes and even heated tobacco cigarettes cannot in any way be considered a suitable tool for starting a therapy for smoking cessation. E-cigs, introduced on the market as useful tools for quitting smoking, have instead generated new categories of consumers, the “dual consumers” who have added the use of electronic and heated tobacco to the consumption of traditional cigarettes.
•Can pregnant women be supported in their smoking cessation process?
Pregnancy must be a further motivation in the decision to stop the habit of consuming tobacco and nicotine since nicotine crosses the placenta and can create dependence in the fetus and consequent withdrawal crisis also in the fetus. The pregnant woman, in cases of serious addiction, must be followed up in the health sector.
•Can psychiatric patients embark on a process of smoking cessation?
It is possible to start a process of cessation of smoking also for patients with mental pathologies. The principle whereby the patient who receives highly personalized care has a better chance of being successful in his or her journey also applies to patients with this type of pathology.
May 31, 2023 (change May 31, 2023 | 11:06)
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