Systematic review and meta-analysis investigating nicotine, cotinine and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy

IF 5.2 1区医学 Q1 PSYCHIATRY Addiction Pub Date : 2023-07-02 DOI:10.1111/add.16279

Anna Podlasek, Ravinder Claire, Katarzyna A. Campbell, Sophie Orton, Ross Thomson, Tim Coleman

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Abstract

Aims

To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid and exhaled air carbon monoxide (CO) concentrations.

Methods

Systematic review and meta-analysis of RCTs, which test interventions permitting concurrent NRT use and smoking and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. Measurements included reported number of cigarettes smoked per day (CPD), body fluid cotinine and expired air CO concentrations.

Results

Twenty-nine studies were included in the review. Meta-analysis of nine showed that, compared with when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, −2.06 CPD [95% CI = −3.06 to −1.07, P < 0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, −0.58 ppm [95% CI = −2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT used in the lead-up to quitting (i.e. as preloading), a similar reduction in exhaled CO was statistically significant (mean difference, −2.54 ppm CO [95% CI = −4.14 to −0.95, P = 0.002]). Eleven studies reported cotinine concentrations, but meta-analysis was not possible because of data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT use and smoking, four reported no differences, and none reported higher concentrations.

Conclusions

People who smoke and also use nicotine replacement therapy report smoking less heavily than people who solely smoke. When nicotine replacement therapy is used in the lead-up to quitting (preloading), this reported smoking reduction has been biochemically confirmed. There is no evidence that concurrent smoking and nicotine replacement therapy use result in greater nicotine exposure than solely smoking.

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调查吸烟和使用尼古丁替代疗法的人暴露于尼古丁、可替宁和一氧化碳的系统综述和荟萃分析

目的确定同时吸烟和尼古丁替代治疗（NRT）对报告的吸烟量、尼古丁（可替宁）体液和呼出空气一氧化碳（CO）浓度的影响。方法对随机对照试验进行系统回顾和荟萃分析，测试允许同时使用NRT和吸烟的干预措施，并在参与者内部比较吸烟时的结果与同时吸烟和使用NRT时的结果。测量包括报告的每天吸烟量（CPD）、体液可替宁和过期空气中的CO浓度。结果共纳入29项研究。9项荟萃分析显示，与单纯吸烟时相比，使用NRT时每天吸烟的次数更少（同时吸烟和使用NRT期间的平均差异为−2.06 CPD[95%CI=−3.06至−1.07，P <； 0.0001]）。对七项研究的荟萃分析显示，在同时吸烟和NRT使用期间，呼出的CO没有显著减少（平均差异，−0.58 ppm[95%CI=−2.18至1.03，P = 0.48]），但在三项测试退出前（即预加载）使用的NRT的研究中，呼出CO的类似减少具有统计学意义（平均差异，-2.54 ppm CO[95%CI=−4.14至−0.95，P = 0.002]）。11项研究报告了可替宁浓度，但由于数据报告的异质性，不可能进行荟萃分析；其中，7例报告在同时使用NRT和吸烟的情况下可替宁浓度较低，4例报告没有差异，没有一例报告浓度较高。结论吸烟并使用尼古丁替代疗法的人比单纯吸烟的人吸烟量少。当在戒烟前使用尼古丁替代疗法（预加载）时，这种报道的吸烟减少已经得到了生物化学证实。没有证据表明，同时吸烟和尼古丁替代疗法的使用会比单独吸烟导致更大的尼古丁暴露。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.