What’s the best way to quit smoking?

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Giving up cigarettes is no easy task, but smokers motivated to quit can make it easier by using a nicotine patch combined with a nicotine lozenge, gum or nasal spray, according to a new study.

Smoking cessation aides are known to be helpful, but there’s very little data on which products are most effective. Researchers from the University of Wisconsin School of Medicine and Public Health in Madison have filled in that gap with a head-to-head comparison of five different strategies.

The contenders were:

• Nicotine patch
• Nicotine lozenge
• Bupropion, a time-release antidepressant
• Patch plus lozenge
• Bupropion plus lozenge
• Placebo

The research team recruited 1,504 people who had smoked at least 10 cigarettes a day for at least six months. All the volunteers said they were motivated to quit.

They were randomly assigned to one of the five treatment groups; within each group, half got the nicotine replacement therapy and half got a placebo. Treatments lasted for eight weeks after the volunteers went cold turkey. All participants also got six one-on-one counseling sessions.

Their results, published in the November issue of Archives of General Psychiatry, found that all five treatments increased the odds of being a nonsmoker after six months. The benefits ranged from a 63% greater chance of staying smoke-free with bupropion (as compared with taking the placebo) all the way up to a 234% boost from the patch-plus-lozenge combination (compared with placebo).

When the treatments were compared directly with each other, only the patch-plus-lozenge regimen proved to be significantly better than any of the other approaches at helping users abstain from smoking for six months.

There were other benefits, too. Volunteers who combined the patch and lozenges were able to hold out longer, on average, before falling off the wagon and having a cigarette; once they did, they also lasted longer before relapsing to regular smoking.

The findings are in line with the recommendation of the 2008 Update to the Public Health Service Treating Tobacco Use and Dependence Clinical Practice Guideline, which says that using the nicotine patch along with nicotine gum or spray is the most effective way to go. The Wisconsin researchers theorize that these combinations work because the patch provides a baseline source of nicotine replacement, while adjuvants like gum, spray and lozenges provide an extra dose of nicotine when needed to help users abstain from cigarettes.

-- Karen Kaplan

Photo: Smokers who want to quit should pair the nicotine patch with a nicotine lozenge for best results, a new study finds. Credit: Eric Boyd/Los Angeles Times