"The clear implication is that you shouldn't give up, you should stay on the treatment with patch," said Saul Shiffman, one of the study's authors from the University of Pittsburgh.

People who "lapse," or give in to nicotine cravings when trying to quit, are at high risk of giving up and returning to smoking.

But contrary to common perception, they haven't failed at quitting and may get over initial lapses by continuing to use the patch, Shiffman said.

His team's study, published in the journal Addiction, suggests that along with helping people stop smoking in the first place, nicotine patches could also boost their chances of recovering from occasional lapses while trying to quit.

Experts say most people trying to break the habit manage to do so at first, but are unable to sustain their quit attempt over the long run.

"Patch can help overcome these lapses. We're ignoring what could be a very important benefit of treatment," Shiffman told Reuters Health.

According to the American Lung Association, more than 443,000 Americans die from smoking-related diseases each year. Cigarette smoke contains thousands of chemicals, including tar, carbon monoxide, formaldehyde and toxins known to cause cancer.

Nicotine patches, usually applied on the arm, reduce withdrawal symptoms such as headache and nausea in those who give up smoking. They supply lower doses of nicotine than found in most cigarettes -- without all the other extra chemicals.

Other nicotine replacement therapies (NRTs) include over-the-counter gum and lozenges, prescription nasal sprays and inhalers and non-nicotine prescription drugs.

Two past studies suggested that quitters who have a lapse may be better off if they keep using patches (See Reuters Health story of February 9, 2012). But unlike in those trials, the new study mimicked "current real-world use of patch" by giving participants little instruction on how to use the product, Shiffman said.

In a second look at past research, he and his colleagues examined data from a trial of nicotine patches at eight sites across the country.

More than 500 heavy smokers who wanted to beat the habit participated. After enrollment, they received a supply of either active nicotine patches or drug-free placebo patches. Neither the subjects nor the study staff knew who had which type of patch.

At follow-up visits during weeks six and ten, people in the study answered questions about whether and when they had smoked since their last appointment.

Focusing on those who smoked at least once -- after an initial two-week grace period -- the researchers found that active patch users were better able to rebound from a lapse than those on the placebo. At week six, people treated with nicotine patches were 11 times more likely than those wearing placebo patches to have stopped smoking for at least a week before their visit.

Similarly, in week 10, close to 10 percent of active patch users reported abstaining from cigarettes for at least a week, versus between two and three percent of placebo users.

The research was funded by GlaxoSmithKline, which markets NRT products. The study authors also act as consultants to the company and have a stake in efforts to develop new smoking-cessation drugs.

According to Shiffman, the findings suggest smokers trying to quit should keep using a nicotine patch even after setbacks, rather than stop wearing it because of the mistaken belief that using patches and cigarettes together poses a health danger.

The warnings on NRT packages against simultaneous use merely offer common-sense advice against smoking while using such products to beat the habit, he added.

"There is really no particular risk," he said, adding that people incorrectly interpret the label to mean the combination is dangerous.

Nicotine patches typically run for about $2 per day, and can be bought without a prescription.

Because nicotine affects the nervous system, heart rate and blood pressure, most experts and package labels do discourage using the patch while smoking cigarettes, to avoid nicotine overdose.

Dr. Alvin Strelnick, chief of community health at Albert Einstein College of Medicine in the Bronx, said the new study confirms a position supported by experts in the field -- namely, smokers should not give up on nicotine patches just because they lapse once or twice during their quit attempt.

But he cautioned that, as noted in the study, it can be tricky to re-analyze data from prior research that was designed for another purpose.

For smoking cessation, the optimal treatment combines the longer-acting nicotine patch with shorter-acting products like nicotine gum, nasal spray or lozenges, Strelnick, who wasn't involved in the new study, told Reuters Health.

"That more closely mimics the way in which nicotine is (present) in the body of most smokers," he said.

SOURCE: bit.ly/AEUXoX Addiction, online March 22, 2012.

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