[Smoking cessation in case of chronic kidney disease]. / Traitement de l'addiction au tabac au cours des maladies rénales chroniques.

Smoking is one of the main causes of morbidity and mortality around the world. In France, despite increase of cost of cigarettes and exclusion of smoking in public places, daily smoking consummation remains high, particularly in women and young. Now, smoking is considered as a compartmental and/or psychologic and/or physic addiction. There are many categories of smokers and smoking cessation strategies must be tailored to individual level. Whatever the etiology of chronic kidney disease, in dialysis patient as transplanted, hypertension and vascular diseases are strong determinants of prognosis. In this way, there is a need for stronger involvement of nephrologists in the process of smoking cessation of their patients. Therapeutics and strategies are reviewed.

Comparison of the effects of a 24-hour nicotine patch and a 16-hour nicotine patch on smoking urges and sleep.

This randomized, open-label, crossover study was conducted to compare the effects of a 24-hr nicotine patch and a 16-hr nicotine patch on morning smoking urges and sleep quality of dependent smokers during a short period of cigarette abstinence. A total of 20 smokers (9 women and 11 men) smoking at least 20 cigarettes/day completed the two smoke-free study periods. For each period, cigarette abstinence started on the first evening and a nicotine patch was applied the next morning (for 16 or 24 hr), after baseline measures; a second patch was applied the next morning, 1 hr before the end of the experimental period. Smoking urges, mood and behavior self-reports, psychomotor performance, and polysomnographic recordings were compared between the two types of nicotine patch according to changes from baseline. Both patches decreased morning smoking urges, although results were significantly superior for the 24-hr patch. Furthermore, the 24-hr patch was more effective than the 16-hr patch in reducing the positive reinforcing dimension of smoking urges. Regarding polysomnographic recordings, the proportion of slow wave sleep was significantly increased from baseline with the 24-hr patch compared with the 16-hr patch. As for psychomotor performance measured through the critical flicker fusion test, significant improvement in morning alertness was observed in the 24-hr patch group. In conclusion, the 24-hr nicotine patch formulation is more effective than the 16-hr formulation in alleviating morning smoking urges and more specifically the positive reinforcing factor. The present findings do not support the idea that nicotine delivery during bedtime might disturb sleep, but rather it improves restorative sleep and postwaking arousal.

[Behavioral and cognitive therapy for social phobia in a smoker]. / Traitement d'une phobie sociale par thérapie comportementale et cognitive chez un tabagique.

INTRODUCTION: Social phobias are associated with nicotine addiction, and treatment for them can enable the patient to stop smoking. CASE: A patient seeking treatment to stop smoking was found to have a social phobia, which was treated with behavioral and cognitive therapy. At the end of this treatment, the patient spontaneously and without aids stopped smoking. DISCUSSION: Social phobias may be a factor in the onset of smoking and in the difficulties and relapses associated with cessation. They must be treated.

[Stopping smoking and constipation]. / Constipation à l'arrêt du tabac.

INTRODUCTION: Among the symptoms that may occur with smoking withdrawal, constipation is relatively frequent, but little studied. CASE: Three women reported that constipation developed when they stopped smoking and improved during transient relapses. DISCUSSION: This constipation sometimes produces serious functional disorders and can induce relapse. It occurs especially among women and those predisposed to it. Nicotine, by acting on the parasympathomimetic system, increases intestinal peristalsis, and a cigarette can appear to be effective self-medication. Magnesium salts are the first-line treatment for this problem. If they fail, neostigmine, an anticholinesterase with parasympathomimetic activity, appears remarkably effective in correcting this disorder.

[Psychosocial distress and stressful life antecedents associated with smoking. A survey of subjects consulting a preventive health center]. / Souffrance psychosociale et antécédents biographiques traumatiques chez des fumeurs. Enquête auprès de consultants d'un Centre de prévention sanitaire et sociale.

BACKGROUND: The relationship between smoking and various socio-demographic or socio-economic factors, as well as the interactions between depressive mood and smoking are already known. However, the respective contribution of psychological factors and stressful life antecedents during childhood and adolescence warrants further specification. METHODS: 2315 consecutive subjects, aged 16 to 59, consulting for a free work-up in a preventive health centre, supported by the National French Health insurance system, were invited to fill out a series of questionnaires: the GHQ-28 and the LOT, respectively measuring psychosocial distress and dispositional optimism, as well as a questionnaire on socio-demographic, socio-economic and biographical data. RESULTS: 78.1% complete records could be analysed: the "smokers" group (n = 870, 48.1%) declared a current tobacco consumption of at least one cigarette/day. This group was characterized by a predominance of male subjects, older age, modest educational level, low income level and responded to socio-economic criteria of precariousness more frequently (p < 0.001, except for age: p = 0.006). Smoking was also associated with higher levels of psychosocial distress, as assessed by GHQ-28, especially for the depressive mood and anxiety items of the questionnaire (p < 0.001), and with lower levels of dispositional optimism (p < 0.01). As regards biographical data, smokers were characterized by a way of life marked by financial problems, reduced social contacts, and a higher frequency, before the age of 18, of divorce or separation of the parents (p = 0.002), frequent parental quarrels (p < 0.001) or separation from the parents (p < 0.001). The presence of a depressive mood at GHQ-28 as well as frequent parental quarrels remained independent risk factors for smoking in multiple logistic regression (odds ratio respectively equal to 1.61 and 1.34), after adjustment on gender, educational level and the notion of socio-economic precariousness. CONCLUSION: These results highlight the complementary role of socio-economic, psychological factors and certain stressful life antecedents among the determinants of smoking and should be taken into account for tailoring smoking cessation programs.

Long-term exposure to nicotine modulates the level and activity of acetylcholine receptors in white blood cells of smokers and model mice.

Long-term consumption of tobacco by smokers causes addiction and increases the level of neuronal nicotinic acetylcholine receptors (nAChRs) in the brain, a phenomenon known as up-regulation. Here, we show that up-regulation of specific nAChR subunits takes place in white blood cells (WBCs) of smokers and mice subjected to long-term administration of nicotine. The basal level of alpha-bungarotoxin binding site, which corresponds to the homomeric alpha7 nAChR subtype, was not affected in WBCs of both smokers and mice administered nicotine. In contrast, epibatidine (EB) binding sites, which correspond to heteromeric nAChR subtypes, were detected in WBCs of smokers but not in WBCs of nonsmokers. The number of EB binding sites significantly decreased after incubation of the smokers' WBCs for 3 days in nicotine-free culture medium. In WBCs of wild-type mice, basal level of EB binding sites was detected before nicotine administration. This basal level is reduced by approximately 60% in knockout mice lacking the genes encoding either the beta2 or the alpha4 receptor subunits. Additional analysis of knockout mice revealed that the remaining approximately 40% do not undergo up-regulation, indicating that the alpha4/beta2 subunits comprise the up-regulated nAChRs. We further found that upregulation in mouse WBCs is accompanied by a significant decrease in the capacity of the up-regulated receptor channels to convey calcium ions. The phenomenon of nAChR up-regulation in WBCs provides a simple tool to evaluate and study tobacco addiction.

Lazabemide, a selective, reversible monoamine oxidase B inhibitor, as an aid to smoking cessation.

BACKGROUND: Previous research has shown that smokers have reduced brain and platelet monoamine oxidase B (MAOB) activity. This is probably due to some components of tobacco smoke. When smokers quit, MAOB activity returns to normal. Reduced MAO activity may increase nicotine's addictive potential. AIMS: To assess whether lazabemide, a reversible selective MAOB inhibitor, promotes smoking cessation. STUDY DESIGN: Double-blind, randomized, placebo-controlled, multicenter phase II study. Placebo, lazabemide 100 mg/day and 200 mg/day were administered for 8 weeks. This was a dose finding, proof-of-concept, exploratory study. SETTING: General practices and anti-smoking clinics in France and Belgium. PARTICIPANTS: Smokers smoking > or=15 cigarettes per day and motivated to quit. MAIN OUTCOME MEASURE: Sustained abstinence during the last 4 weeks of the study. FINDINGS: The study was discontinued prematurely by the sponsor before randomization of the planned 420 smokers because of liver toxicity observed in other indications. Data of 330 randomized subjects could be analysed. Sustained abstinence during the last 4 weeks of treatment was 9%, 11% and 17% in the intent-to-treat population [P for trend: 0.036 (one-sided)]; 11%, 14% and 21% in the intent-to-treat population of smokers without those excluded because of discontinuation of the study [n = 262, P for trend: 0.02 (one-sided)], and 19%, 27% and 35% in completers [P for trend: 0.03 (one-sided)], in the placebo, lazabemide 100 mg/day and lazabemide 200 mg/day groups, respectively. Point prevalence abstinence (intent-to-treat population) at the end of treatment (week 8) was 17%, 19% and 30% in the placebo, lazabemide 100 mg/day and lazabemide 200 mg/day groups, respectively (placebo vs. lazabemide 200 mg/day: P = 0.01, one-sided). No treatment emergent major adverse event occurred. More nausea and insomnia were reported with lazabemide than with placebo. CONCLUSIONS: MAOB inhibitors are promising treatments as an aid in smoking cessation. There may be an interest to develop MAOB inhibitors with an acceptable toxicity profile. Further studies may associate MAOB inhibitors with nicotine replacement therapies to increase therapeutic efficacy.

[Behavioral and cognitive therapy to break the smoking habit. Review of the literature]. / Les thérapies comportementales et cognitives dans l'aide à l'arrêt du tabac.

Nicotine addiction is a chronic disease characterized by frequent relapse. Pharmacological and psychological factors are involved and must be specifically addressed in addicts under treatment. Physicians are familiar with pharmacological treatment with nicotine replacement therapy and bupropion, but not with psychological approaches such as behavioral and cognitive therapy. Various techniques have been evaluated during smoking cessation trials: aversive therapy, contracts, social support, stimulus control, relaxation, diet and nicotine fading. Such approaches have been completed with cognitive strategies and therapeutic programs often use motivational interviews, skills training and relapse prevention strategies. This article reviews these techniques and presents the results of a recent meta-analysis evaluating their efficacy. These results confirm the efficacy of behavioral and cognitive therapy in smoking cessation.