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Smoking Cessation
that needs further research with respect to its use as a single agent • length of contact with therapist in the intervention and control
for smoking cessation or as an adjunct. The minor benefits found in arms of the study;
subgroup analysis should be investigated further. • use of sham acupuncture – how valid is the site being used?;
• a direct comparison of complementary therapies with NRT,
How Do Complementary Therapies counselling and newer pharmacological agents;
Compare to Pharmacological Agents? • outcome measures looking at sustained quit rates at six, 12 and 18
In comparison with the evidence base available for pharmacological months with biochemical validation; and
agents, evidence about the effectiveness of complementary therapies • gender differences with regards to the techniques being
is sorely lacking. For NRT alone, a meta-analysis identified 111 studies employed.
with over 40,000 participants, and the relative risk (RR) of abstinence
of any form of NRT compared with control was 1.58 (95% CI 1.55–1.6). We conclude that there is a real need for well-designed,
NRTs increase the chance of quitting by 50–70% regardless of the randomised, placebo-controlled clinical trials with robust outcome
setting, and appear to be largely independent of the level of additional measures in complementary therapies before their use can
support provided to the individual.
4
be advocated. ■
However, there have been no studies comparing hypnotherapy
Sundari Ampikaipakan is a Clinical Lecturer at the
directly with either NRT or any of the newer smoking cessation
University of East Anglia and a Specialist Registrar in
agents, and only one study directly comparing acupuncture with Respiratory Medicine. She is working towards her
NRT.
27
This study by Clavel found that the groups given acupuncture
MD and her research interests are mainly in
chronic obstructive pulmonary disorder (COPD), novel
and nicotine gum showed a better response than the control group
anti-inflammatory therapies and physiological
with regard to quit rates at one month, but did not reduce the measurements of airways disease.
tendency to relapse after that. The lack of difference between the two
active groups may have been due to a lack of power in the study.
Andrew Wilson is a Senior Clinical Lecturer in
Respiratory Health at the University of East Anglia and
Currently, there is no good evidence to support the use of an Honorary Consultant in Respiratory Medicine at the
complementary therapies over the current accepted pharmacological
Norfolk and Norwich National Health Service (NHS)
Trust. He is widely published in respiratory airways
agents that have a real evidence base.
disease and has a keen interest in the pharmacological,
nutritional and environmental effects of airways
Conclusion
disease, including asthma, rhinitis, emphysema and
chronic bronchitis. Other research interests include the
Both hypnosis and acupuncture have been looked at in numerous
effect of matrix metalloproteases on airway remodelling
studies with various methodologies, but these trials have been small and the delivery of drugs to the airways.
and the difficulty in getting adequate placebo methods is clearly
Nicholas Steel is a Senior Lecturer in Primary Care at the
highlighted. While interesting observations have been made with
University of East Anglia and an Honorary Consultant in
regard to types of smokers who might benefit from these Public Health at Norfolk Primary Care Trust. His primary
interventions, no real evidence is available to collaborate these claims.
research area is health services and epidemiology of the
quality of healthcare. His research interests in the quality
Furthermore, mere contact with a therapist in this group of patients
of healthcare include asthma management in primary
has a significant placebo effect, as has been shown in previous trials care and evaluating local and national effects of UK
of chronic illness. The following factors need to be taken into account
quality improvement initiatives.
when designing future studies:
1. WHO Report on the Global Tobacco Epidemic, 2008 – The smoking cessation may not depend on the point Cochrane Database Syst Rev, 2000;(2):CD001008.
MPOWER package, 2008. chosen—an exploratory meta-analysis, Acupunct Med, 20. Pederson LL, Scrimgeour WG, Lefcoe NM, Comparison of
2. West R, McNeill A, Raw M, Smoking cessation guidelines 2006;24(4):149–56. hypnosis plus counseling, counseling alone, and hypnosis
for health professionals: an update. Health Education 11. Bier ID, et al., Auricular acupuncture, education, and alone in a community service smoking withdrawal
Authority, Thorax, 2000;55(12):987–99. smoking cessation: a randomized, sham-controlled trial, program, J Consult Clin Psychol, 1975;43(6):920.
3. Stead LF, Bergson G, Lancaster T, Physician advice for Am J Public Health, 2002;92(10):1642–7. 21. Barkley RA, Hastings JE, Jackson Jr TL, The effects of rapid
smoking cessation, Cochrane Database Syst Rev, 2008;(2): 12. Wu TP, et al., A randomized controlled clinical trial of smoking and hypnosis in the treatment of smoking
CD000165. auricular acupuncture in smoking cessation, J Chin Med behavior, Int J Clin Exp Hypn, 1977;25(1):7–17.
4. Stead LF, et al., Nicotine replacement therapy for smoking Assoc, 2007;70(8):331–8. 22. Williams JM, Hall DW, Use of single session hypnosis for
cessation, Cochrane Database Syst Rev, 2008(1):CD000146. 13. Hyun MK, et al, Body Acupuncture for Nicotine Withdrawal smoking cessation, Addict Behav, 1988;13(2):205–8.
5. Shah SD, et al., Systematic review and meta-analysis of Symptoms: A Randomised Placebo-Controlled Trial, Evid 23. Elkins G, et al., Intensive hypnotherapy for smoking
combination therapy for smoking cessation, J Am Pharm Based Complement Alternat Med, 2008;1–6. cessation: a prospective study, Int J Clin Exp Hypn,
Assoc, 2003;48(5):659–65. 14. White AR, Moody RC, Campbell JL, Acupressure for 2006;54(3):303–15.
6. Molyneux A, et al., Clinical trial comparing nicotine smoking cessation—a pilot study, BMC Complement Altern 24. Carmody TP, et al., Hypnosis for smoking cessation: a
replacement therapy (NRT) plus brief counselling, Med, 2007;7:8. randomized trial, Nicotine Tob Res, 2008;10(5):811–18.
brief counselling alone, and minimal intervention on 15. Orne MT, The nature of hypnosis: artifact and essence, 25. Green JP, Lynn SJ, Montgomery GH, Gender-related
smoking cessation in hospital inpatients, Thorax, 2003;58(6): J Abnorm Psychol, 1959;58(3):277–99. differences in hypnosis-based treatments for smoking:
484–8. 16. Covino NA, Bottari M, Hypnosis, behavioral theory, and a follow-up meta-analysis, Am J Clin Hypn, 2008;50(3):
7. Wen HL CS, Treatment of drug addiction by acupuncture smoking cessation, J Dent Educ, 2001;65(4):340–47. 259–71.
and electrical stimulation, Asian Med J, 1973(9):138–41. 17. Spiegel H, A single-treatment method to stop smoking 26. Johnson DL, Karkut RT, Performance by gender in a
8. White AR, Rampes H, Campbell JL, Acupuncture and using ancillary self-hypnosis, Int J Clin Exp Hypn, 1970;18(4): stop-smoking program combining hypnosis and aversion,
related interventions for smoking cessation, Cochrane 235–50. Psychol Rep, 1994;75(2):851–7.
Database Syst Rev, 2006;(1):CD000009. 18. Spiegel D, et al., Predictors of smoking abstinence 27. Clavel F, et al., Helping people to stop smoking:
9. Fuller, Smoking withdrawal and acupuncture, Med J Aust, following a single-session restructuring intervention with randomised comparison of groups being treated with
1982(1):28–9. self-hypnosis, Am J Psychiatry, 1993;150(7):1090–97. acupuncture and nicotine gum with control group, Br Med
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44 EUROPEAN RESPIRATORY DISEASE
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