Smokers who do not want to quit right now but would like to at least reduce their smoking are twice as likely to stop smoking in the long-term if they use nicotine replacement therapy (NRT) to help them cut down gradually, according to research published on bmj.com. 

The research is the first of its kind to focus on sustained smoking abstinence using NRT for smokers who have no immediate plans to stop smoking.

Smoking is one of the greatest causes of illness and premature death in the world. Half of UK smokers try to stop every year but only 2-3% of them succeed. One of the reasons for this is that while the majority of smokers want to quit, only a minority feel ready to do so abruptly. These smokers, say the authors, might have more success by following nicotine assisted reduction to stop (NARS) programmes, also known as 'cut down then stop, 'cut down to stop' and 'cut down to quit.' 

The research team at the University of Birmingham, carried out a systematic review of seven randomised controlled trials that compared the outcomes of using NRT gum or inhalators to placebos. 

The trials enrolled almost 3000 smokers who were given NRT for 6-18 months, 6.75% of NRT smokers achieved six months of sustained abstinence – twice the proportion who were given placebos. This amounts to 3% of smokers quitting who otherwise would not have done so. The authors note that "previous data suggest that half of those who sustain six months of abstinence will maintain it for the rest of their lives." Using the therapy while smoking does not lead to serious health problems.

The authors make it clear that most of the evidence comes from trials with regular behavioural support and monitoring, and it is unclear whether using NRT without this regular contact would be as effective. 

They say this study is important because "it shows that treating a population of smokers not ready to stop means more of them stop." The authors conclude that it is therefore important to consider how NARS can be incorporated into existing tobacco control programmes.

Data sources:  Cochrane Library, Medline, Embase, CINAHL, PsychINFO, Science Citation Index, registries of ongoing trials, reference lists, the drug company that sponsored most of the trials, and clinical experts.

Article: David Moore, senior reviewer, Paul Aveyard, NIHR career scientist, Martin Connock, systematic reviewer, Dechao Wang, systematic reviewer, Anne Fry-Smith, information specialist, Pelham Barton,senior lecturer, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, 'Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis', BMJ 2009;338:b1024 doi:10.1136/bmj.b1024