Diagnosis and treatment of nicotine dependence with emphasis on nicotine replacement therapy - A status report

Tobacco use is a global health care problem. Repetitive exposure to nicotin e produces neuroadaptation resulting in nicotine dependence. Cigarette smok ing is particularly addictive due to the repeated delivery of bolus doses o f nicotine to the bloodstream. Although compulsive tobacco use is sustained by nicotine addiction, it is the toxic combustion products in tobacco smok e such as carbon monoxide and oxidant gases that adversely affect the cardi ovascular system. Smoking cessation produces significant health benefits an d is a very cost-effective intervention. Evidence that nicotine is the addi ctive component of tobacco provides the rationale for using nicotine replac ement therapy to aid cessation. Nicotine replacement therapy doubles succes sful smoking cessation fates and evidence-based guidelines for the treatmen t of tobacco addiction recommend routine use of nicotine replacement therap y, particularly in heavily dependent smokers. Success rates of up to 40% ca n be achieved in specialist clinics. Despite early concerns regarding the s afety of nicotine replacement therapy in smokers with heart disease, it is now clear that the health risks of using nicotine replacement therapy to as sist such patients to stop, or significantly reduce, smoking far outweigh a ny treatment-related risks. (C) 2000 The European Society of Cardiology.