Reducing risk in smokers.

PURPOSE OF REVIEW: Tobacco smoking is a leading cause of lung cancer and chronic obstructive pulmonary disease. For smokers who want to quit, nicotine replacement therapy and bupropion are frequently recommended. Currently, disagreement surrounds the extent of risk reduction from quitting, the consequences of the change of nicotine replacement therapy to over-the-counter status, and the safety and efficacy of new tobacco products being marketed by tobacco companies. This article reviews the current evidence relevant to these and other developments in smoking interventions and describes the most effective strategies that smokers can use to reduce their risk.

RECENT FINDINGS: Although it may take approximately 10 to 30 years of abstinence for former smokers' risk of lung cancer to reach that of never smokers, quitting at any time is substantially less risky than continuing to smoke. Quitting after diagnosis also prolongs survival. Bupropion and nicotine replacement therapy are effective pharmacotherapies, doubling quit rates compared with self-quitting. However, many users of over-the-counter nicotine replacement therapy are using it inappropriately. More research is needed to determine the long-term health effects of modified tobacco products and their efficacy in helping smokers quit. Switching to "low tar" filter cigarettes to reduce lung cancer risk, however, is clearly ineffective. The most effective interventions for quitting continue to be a combination of behavioral and pharmacologic approaches.

SUMMARY: Health care practitioners should encourage all smokers to attempt cessation and emphasize pharmacotherapy as an important aid to quitting. Professionals who educate patients on the appropriate use of pharmacotherapy and follow-up on smokers' attempts to quit will help reduce the societal burden and personal risks of smoking.