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Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Smoking Cessation amongst Adults in United Kingdom

Introduction

Tobacco smoking is a major contributor to many serious diseases that eventually lead to death in the United Kingdom (UK). According to Office of National Statistics (ONS) (2017), 7.4 million of United Kingdom’s population are smokers and 19.7 percent of these smokers are adult with age-range of 25 to 34 years. Tobacco cigarettes contain nicotine. Nicotine changes the balance of two chemicals namely noreadrenaline and dopamine which are found in human the brain. The sudden change on the levels of these chemicals after inhalation may result in changes in mood which could result in reduction of stress, anxiety and increase in pleasure (National Health Service (NHS), 2018a). Transmission of nicotine by inhalation of tobacco is the fastest way of distributing nicotine into the bloodstream according to Action on Smoking and Health (ASH) (2019). Therefore, these facts indicate that smoking cigarettes could be profoundly addictive due to the rapid delivery of the desired effects to its users without taking into consideration any adverse effects on the human body and health.

Cigarette smoking harms human health; and stopping has proven hard to do alone. According to Health and Social Care Information Centre (HSCIC) (2017), in 2017 there were 146,234 people who started to try to quit smoking, only 49 percent successfully managed to stay away from using cigarretes and 33 percent of the individuals who successfully managed to stop smoking utilised licensed nicotine containing products. The government came up with tobacco control plan for England to assist its people to stop smoking; the elements of the plan include making tobacco more expensive, restraining tobacco related publicity, efficient control of tobacco products, developing alertness on harm caused by smoking and lowering the instance to be exposed to second-hand smoke (Public Health England, 2015).

Smoking cessation services and interventions are being offered by the NHS. Affirmed by National Institute for Health and Care Excellence (NICE) (2019), there are few evidenced-based interventions for smoking available in the UK for adults which include behavioural support, bupropion, nicotine replacement therapy (NRT), varenicline and very brief advices (VBA). These interventions are available to individuals who seek help through their general practitioner and to those who are being referred to health professionals for assistance; some of the interventions are combined to be able to achieve the desired goal which is to ultimately forgo smoking tobacco.

This paper will discuss the different kinds of NRT available for adults in the United Kingdom. Nicotine replacement therapy (NRT) includes few ways to supplement smoking. It helps to fight the urge to consume or inhale tobacco and also to reduce the effects of withdrawal. In addition, it will help individuals to slowly reduce their consumption and ultimately give-up smoking.According to NICE (2019b) and National Centre for Smoking Cessation and Training (NCSCT) (2019), the available formulations of NRT available for adults in the UK include gum, inhalers, lozenges, nasal sprays, oral sprays, sublingual tablets, and transdermal patches. Upon consideration of the seven primary research papers which are tabulated in Appendix 1, the effectiveness of NRT used by adults in United Kingdom will be critically analysed and recommendations for alternative interventions for smoking cessation will be offered as part of the conclusion.

Rationale

Nurses provide care for patients who are hospitalised for different kinds of reasons. Many have complex illnesses and comorbidities which are always taken into consideration whilst they are in the hospital to be able to plan for an individualised care for the specific that patient. Being a student nurse the author noticed that most of the patients still continue to practice their normal lifestyle whilst admitted in the hospital and being treated for a specific illness; unfortunately, some of the patients’ daily habits which includes cigarette smoking is still being forged ahead despite of the known side effects and harm it could cause to a person’s health. According to Smokefree (2019), smoking cigarettes damage almost all organs of the body. Nicotine has negative effect on human brain, skin, heart, lungs, stomach, muscles, bones, blood and immune system. The author believes that smoking cessation campaign needs to be made stronger either in wellness centres or in the clinical areas in the UK. Hughes et al (2013) suggested that being admitted in the hospital the smokers experienced higher level of motivation to try to quit their vices and be more likely to adhere to interventions offered by the health professionals or their local stop-smoking services. Being aware of the efficacy of the intervention (NRT) available in the UK will equip nurses with up-to-date and evidence-based information to encourage smokers to quit by encouraging them to seek help and try different techniques like NRT to cease smoking.

Cigarette smoking place the public into many health risks, both first-hand and second-hand smoke. Royal College of Physician (RCP) (2010) stated that exposure to second-hand smoke has a huge impact on human’s health. RCP’s 2010 report found that every year there were 300,000 general doctor consultations and 9,500 admissions in the hospital were results of being exposed to cigarette smoke. Some of the leading cause of death in United Kingdom can be associated with smoking cigarettes. Action on Smoking and Health (ASH) (2019) identified that there were approximately 79,000 deaths from avoidable illnesses in the United Kingdom is associated to smoking.

Aim

The aim of the paper is to find out the efficacy of nicotine replacement therapy (NRT) focusing specifically on adults in the United Kingdom. In addition, to be able to indicate an in-depth comprehension of the different kinds of NRT available for smokers in the UK in which boosted the success of abstinence from cigarette smoking. According to Wakefield (2015), to inhibit coming up with a wide range of topic that could lead to disorganised search strategy and insignificant information, the research question must have some extent of focus.

Method

The author electronically searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Database, Cochrane library, BMC Nursing and MEDLINE for primary research articles conducted to find out the effectiveness of nicotine replacement therapy (NRT) in the United Kingdom from at least January 2008 to January 2019. Boolean Operators were used using keywords like NRT, smoking cessation and United Kingdom to filter the searches. Limiters and expanders which include randomised controlled trials and smoking cessation were applied on the search database to be able to narrow down the number of results found on the searches (see Appendix 2).

The author also scrutinized the reference lists of each of the literature found related to the topic at hand. Google Scholar was also exploited to search for related published research and other related articles that was found useful throughout the essay. Cronin et al (2008) elaborated that to be able to generate valuable information from electronic and computer databases keywords needs to be meticulously considered. According to Smith and Noble (2016), conducting a literature review should be as comprehensive as possible, within the known restrains of the topic and attempted in an orderly manner. Precise exclusion and inclusion criteria must be developed in order to be able to select valid related studies. The literature search yielded 6 primary researches which are controlled randomised trials that were utilised to undertake the literature review on the efficacy of NRT to aid smoking cessation in the United Kingdom. All papers obtained were screened for relevance to the topic at hand and credibility of its authors. The papers were also critiqued and critically appraised using Caldwell’s critiquing framework for health research (see Appendix 3). According to Caldwell et al (2005), ability to critically critique published researches is necessary to be able to establish the efficiency of the specific paper on the preferred area of work. Having the ability to scrutinize a piece of article is an important skill to be able to provide valid, current and evidenced-based literature review. Secondary, opinionated and non-evidenced-based articles were disregarded.

In conclusion, it is crucial to be able to use appropriate keywords, filters, limiters and expanders on the literature search to be able to accumulate significant and relevant papers to tackle a research question. The tabularized lists of primary research articles are presented in Appendix 1.

REFERENCES

Action on Smoking and Health (ASH) (2019) Fact sheets: Smoking statistics. Available at: http://ash.org.uk/category/information-and-resources/fact-sheets/ (Accessed: 14/02/2019).

Aveyard, P., Johnson, C., Parsons, A., and Murphy, M. (2008) ‘Nortriptyline plus nicotine replacement versus placebo plus nicotine replacement for smoking cessation: pragmatic randomised controlled trial’, British Medical Journa:Online First, pp. 1-10. https://www.bmj.com/content/bmj/336/7655/1223.full.pdf.

Beard, E., McNeill, A., Aveyard, P. et al (2011) ‘Use of nicotine replacement therapy for smokingreduction and during enforced temporary abstinence:a national survey of English smokers’, Addiction, 106, pp. 197-204.

https://onlinelibrary-wiley-com.ezproxy.mdx.ac.uk/doi/epdf/10.1111/j.1360-0443.2010.03215.x.

Cronin, P., Ryan, F. and Coughlan M. (2008) ‘Undertaking a literature review: a step-by-step approach’, British Journal of Nursing, 17(1), pp. 38-43. https://www-magonlinelibrary-com.ezproxy.mdx.ac.uk/doi/pdf/10.12968/bjon.2008.17.1’28059.

Caldwell, K., Henshaw, L. and Taylor, G. (2005) ‘Developing a framework for critiquing health research’, Journal of Health, Social and Environmental Issues, 6(1), pp. 45-54.

Hughes L., Mcllvar M. and McEwan A. (2013) ‘How to advise and refer inpatients who smoke’, Nursing Times, 109(1), pp. 14-18. Available at: http://www.ncsct.co.uk/usr/pub/NT_referral_article.pdf (Accessed: 14/02/2019).

Klonizakis, M., Crank, H., Gumber, A. and Brose, L. (2017) ‘Smokers making a quit attempt using e-cigarettes with or without nicotine or prescription nicotine replacement therapy: Impact on cardiovascular function (ISME-NRT) – a study protocol’, BMC Public Health, 17(293), pp. 1-9. https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-017-4206-y.

Lindson-Hawley, N., Coleman, T., Docherty, G. et al (2014) ‘Nicotine patch preloading for smoking cessation (the preloading trial): study protocol for a randomized controlled trial’, Trials, 15(296), pp. 1-18.https://trialsjournal.biomedcentral.com/track/pdf/10.1186/1745-6215-15-296

Lindson-Hawley, N., Shinkins, B., West, R. et al (2016) ‘Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?’, Addiction, 111(7), pp. 1275-1282.

https://onlinelibrary-wiley-com.ezproxy.mdx.ac.uk/doi/full/10.1111/add.13330

National Centre for Smoking Cessation and Training (NCSCT) (2019) Stop smoking medication. Available at: http://www.ncsct.co.uk/pub_stop-smoking-medications.php (Accessed: 15/02/2019).

National Institute for Health and Care Excellence (NICE) (2019a) Stop smoking interventions and services: NICE guideline [NG92]. Available at: https://www.nice.org.uk/guidance/ng92/chapter/Recommendations#evidence-based-stop-smoking-interventions(Accessed: 15/02/2019).

National Institute for Health and Care Excellence (NICE) (2019b) Smoking cessation: Nicotine replacement therapy (NRT). Available at: https://cks.nice.org.uk/smoking-cessation#!prescribingInfoSub (Accessed: 14/02/2019).

National Health Service (NHS) (2018a) Why is smoking addictive? Available at: https://www.nhs.uk/common-health-questions/lifestyle/why-is-smoking-addictive/ (Accessed: 14/02/2019).

Office for National Statistics (ONS) (2018) Adult smoking habits in the UK: 2017. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017(Accessed: 08/02/2019).

Public Health England (2015) Health Matters: smoking and quitting in England. Available at: https://www.gov.uk/government/publications/health-matters-smoking-and-quitting-in-england/smoking-and-quitting-in-england(Accessed: 15/02/2019).

Royal College of Physicians (2010) Passive smoking and children. Available at: https://cdn.shopify.com/s/files/1/0924/4392/files/passive-smoking-and-children.pdf?15599436013786148553 (Accessed: 14/02/2019).

Silla, K., Beard, E. and Shahab, L. (2014) ‘Nicotine replacement therapy use among smokers and ex-smokers: associated attitudes and beliefs: a qualitative study’, BMC Public Health, 14(1311), pp. 1-8.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364650/.

Smith J. and Noble H. (2016) ‘Reviewing the literature’, Evidenced-Based Nursing, 19(1), pp. 2-3. http://dx.doi.org/10.1136/eb-2015-102252.

Smokefree (2019) Health Effects. Available at: https://smokefree.gov/quit-smoking/why-you-should-quit/health-effects (Accessed: 15/02/2019).

Stapleton, J., West, R., Hajek, P. et al (2013) ‘Randomised trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice’, Addiction, 108, pp. 2193-2201.

https://onlinelibrary-wiley-com.ezproxy.mdx.ac.uk/doi/pdf/10.1111/add.12304.

Wakefield, A. (2015) ‘Synthesising the literature as part of a literature review’, Nursing Standard, 29(29), pp. 44-51. http://journals-rcni-com.ezproxy.mdx.ac.uk/nursing-standard/synthesising-the-literature-as-part-of-a-literature-review-ns.29.29.44.e8957

Appendix 1

Summary table of articles reviewed and included in the literature review

#Studies includedCountry of publicationStudy aimsDesign:Sample:Data collection:Analysis methods:Key findings
1Aveyard, P., Johnson, C., Parsons, A., and Murphy, M. (2008) ‘Nortriptyline plus nicotine replacement versus placebo plus nicotine replacement for smoking cessation: pragmatic randomised controlled trial’, British Medical Journa:Online First, pp. 1-10. https://www.bmj.com/content/bmj/336/7655/1223.full.pdfUnited KingdomTo identify the xxxxx xxxxxx xxxxxxx.Design:Sample:Data collection:Analysis methods:
2Beard, E., McNeill, A., Aveyard, P. et al (2011) ‘Use of nicotine replacement therapy for smokingreduction and during enforced temporary abstinence:a national survey of English smokers’, Addiction, 106, pp. 197-204.https://onlinelibrary-wiley-com.ezproxy.mdx.ac.uk/doi/epdf/10.1111/j.1360-0443.2010.03215.xUnited KingdomTo identify the xxxxx xxxxxx xxxxxxx.Design:Sample:Data collection:Analysis methods:
3Klonizakis, M., Crank, H., Gumber, A. and Brose, L. (2017) ‘Smokers making a quit attempt using e-cigarettes with or without nicotine or prescription nicotine replacement therapy: Impact on cardiovascular function (ISME-NRT) – a study protocol’, BMC Public Health, 17(293), pp. 1-9. https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-017-4206-yUnited KingdomTo identify the xxxxx xxxxxx xxxxxxx.Design:Sample:Data collection:Analysis methods:
4Lindson-Hawley, N., Coleman, T., Docherty, G. et al (2014) ‘Nicotine patch preloading for smoking cessation (the preloading trial): study protocol for a randomized controlled trial’, Trials, 15(296), pp. 1-18.https://trialsjournal.biomedcentral.com/track/pdf/10.1186/1745-6215-15-296United KingdomTo identify the xxxxx xxxxxx xxxxxxx.Design:Sample:Data collection:Analysis methods:
5Lindson-Hawley, N., Shinkins, B., West, R. et al (2016) ‘Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?’, Addiction, 111(7), pp. 1275-1282.https://onlinelibrary-wiley-com.ezproxy.mdx.ac.uk/doi/full/10.1111/add.13330United Kingdom
6Silla, K., Beard, E. and Shahab, L. (2014) ‘Nicotine replacement therapy use among smokers and ex-smokers: associated attitudes and beliefs: a qualitative study’, BMC Public Health, 14(1311), pp. 1-8.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364650/United Kingdom
7Stapleton, J., West, R., Hajek, P. et al (2013) ‘Randomised trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice’, Addiction, 108, pp. 2193-2201.https://onlinelibrary-wiley-com.ezproxy.mdx.ac.uk/doi/pdf/10.1111/add.12United Kingdom

Appendix 2 (search results)

Appendix 3

Caldwell et al (2005) Critiquing Framework

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