Feature Article

The ‘treatment-resistant’ smoker

Renee Bittoun

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Abstract

Strategies to help smokers who are resistant to treatment include intensive combination pharmacotherapies and the use of nicotine replacement therapy to reduce the harm caused by smoking.

Key Points

  • There is a hierarchy of strategies available to help tobacco smokers that begins with permanent cessation and provides safe options for those people unable to achieve this.
  • Some smokers respond well to some pharmacotherapies and others do not. Every smoking cessation pharmacotherapy for which there is substantiated evidence should be tried – a patient just might strike the most suitable one for them.
  • The harm reduction strategy of reducing smoking by the use of nicotine replacement therapy (NRT) should be considered for treatment-resistant smokers. It is less harmful for a person to smoke while using NRT than it is to smoke without it.
  • There is good evidence that it is never too late to quit smoking. Reducing smoking by the transient use of NRT may be a gateway to quitting for treatment-resistant smokers.
  • Algorithms are provided for smoking cessation therapy options and the use of combination NRT in treatment-resistant smokers.

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