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Triple whammy for smokers recommended

By Joanne Ellul

GPs should use triple-combination therapy to help smokers with chronic illnesses quit, say researchers.

In the first randomised trial to look at intensive therapy in patients – with illnesses such as cardiovascular disease, cancer or COPD – they found using three different smoking cessation treatments at once was more effective than using one.

The data from 127 smokers, found those using nicotine patches, nicotine inhalers and bupropion had a 16% higher abstinence rate at six months compared with patches alone.

Those using the combination treatment had a significant increase in side-effects, such as insomnia and anxiety, but the researchers said this approach should still be considered for general practice.

‘Medically-ill smokers are often highly addicted and at great risk for complications from continued smoking. These patients need intensive treatment to be successful in quitting,' the paper concluded.

NICE guidelines specifically rule out using NRT with bupropion, but do encourage the use of patches with inhalers when appropriate.

Dr Tim Lancaster, GP in Oxford and co-ordinating editor of the Cochrane tobacco addiction review group, welcomed the study but warned combination treatment should be reserved for when monotherapy had not worked.

‘The risk of seizures, for example, with bupropion is about 1 in 1000. This is the main reason why combination therapy would only be appropriate when other simpler treatments have failed,' he said.

A 1999 study in the New England Journal of Medicine found combination therapy with buproprion and nicotine patch therapy resulted in over double the proportion of smokers quitting, compared with patch therapy alone.

This latest study was published in the currentl edition of the Annals of Internal Medicine.

GPs should target smokers with triple-combination therapy GPs should target smokers with triple-combination therapy

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