Insight Into Successful Smoking Cessation Strategies

In this randomized study abruptly quitting smoking "cold turkey", in addition to behavioral support and nicotine replacement therapy, was more likely to result in lasting abstinence as compared to a gradual reduction approach.

HealthDay News –  Cigarette smoking is considered a risk factor for the development of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).  Every effort should be made to support smoking cessation in all patients.  In this randomized study, published online March 15 in the Annals of Internal Medicine, abruptly quitting smoking was more likely to result in lasting abstinence as compared to a gradual reduction approach.

The latest research included 697 adult smokers from England. The study participants smoked an average of 20 cigarettes a day. More than nine in 10 of the participants were white. The average age of the smokers was 49, and half were women. The study participants were then randomly assigned to either the abrupt smoking cessation group or to the gradual smoking reduction by 75% in the 2 weeks before quitting.  Participants in both groups received behavioral support from nurses and used nicotine replacement before and after quit day.

The researchers followed up at four weeks and six months after the experiment started. Blood testing was used to confirm whether smokers had actually quit.

The researchers found that at four weeks, 39.2% of those who’d gradually quit had stopped smoking compared to 49% of those who stopped abruptly. At six months, 15.5% of the gradual quitters and 22% of the abrupt quitters were still non-smokers.

“Most people thought cutting down would suit them better,” lead author Nicola Lindson-Hawley, Ph.D., of the University of Oxford in the United Kingdom, told HealthDay. “But whatever they thought, it turned out they were better to try to quit abruptly.”

Summary and Clinical Applicability

There is a high risk of cardiovascular morbidity and mortality associated with smoking in the general population, as well as in patients with rheumatic diseases like RA and SLE. Smoking also increases the risk of vasculitis associated with RA. Clinicians should make every effort to support smoking cessation in all patients. In this randomized, controlled trial abruptly quitting smoking “cold turkey” was more likely to result in lasting abstinence when compared to gradually reducing number of cigarettes smoked per day.   These findings support an approach to counseling patients regarding smoking cessation during patient encounters.


Lindson-hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial. Ann Intern Med. 2016. Published online March 15 2016 doi:10.7326/M14-2805