Importance of baseline cotinine plasma values in smoking cessation: results from a double-blind study with nicotine patch.

Nicotine replacement by transdermal patches is more effective than placebo in smoking cessation, but has a low success rate after one year (9-18%). We tested whether this was attributed to insufficient nicotine replacement. We conducted a randomized trial to investigate the effect on outcome of different doses of transdermal nicotine replacement after stratification according to baseline plasma cotinine values. Two hundred and ninety seven adult smokers were enrolled. Those with baseline cotinine < or = 250 ng.ml-1 (low cotinine) were randomly assigned to placebo (LC-P) or to 15 mg 16 h nicotine patches (LC-15), and those with baseline cotinine > 250 ng.mL-1 (high cotinine) were randomly assigned to 15 mg (HC-15) or 25 mg (HC-25) 16 h nicotine patches. Plasma nicotine and cotinine values, expired carbon monoxide and withdrawal symptoms were measured at scheduled intervals during treatment. Smokers in the LC-15 group had a significantly higher success rate than placebo (28 vs 9%). Smokers with high baseline cotinine had lower success rates, and a high dose of nicotine did not increase success rate (HC-25 9% vs HC-15 11%). Subjects in the HC-15 group had the lowest percentage of nicotine replacement and a higher prevalence of withdrawal symptoms than the HC-25 group. Replacement was similar in groups LC-15 and HC-25, but the success rate was significantly lower in HC-25 group, despite similar levels of withdrawal symptoms. We conclude that a higher success rate was obtained after one year in smokers with low baseline plasma cotinine values. Determination of plasma cotinine values may be, thus, helpful in identifying smokers who could benefit from transdermal nicotine replacement.

[Psychological and social aspects in women with syndrome X]. / Aspetti psicologici e sociali nelle donne con sindrome X.

A sizeable proportion (20-30%) of patients undergoing coronary arteriography for a chest pain syndrome are found to have angiographically normal coronary arteries. Some of these subjects (10-15%) have ischemic-like electrocardiographic changes during stress and no evidence of spasm of the epicardial coronary arteries (syndrome X). The vast majority of these patients are middle aged females. In the present investigation we evaluated the psychological and social characteristics of a group of patients with syndrome X (PX, n = 30). The results obtained in the PX group were compared with those in a sex and age matched group of patients with angiographically proven coronary artery disease (PI, n = 32) and with those in a group of control subjects (C, n = 29). Two original questionnaires were employed to collect the demographic and family data. The psychological data were obtained through the following 4 questionnaires: Symptom Rating Test (SRT); Symptom Questionnaire (SQ); Illness Behaviour Questionnaire (IBQ); Maudsley Personality Inventory (MPI). The results of our study indicated that in most of the patients with syndrome X the psychological and social conditions are similar and they are not compatible with a satisfactory lifestyle. In most cases both family and social difficulties are present, which impose excessive workload and distress on the patients. Very often the beginning of the chest pain history tends to coincide with the periods of greatest stress and with the occurrence of dramatic events in the family. On the other hand, the onset of symptoms often has the effect of releasing some of the environmental pressure on the patient.(ABSTRACT TRUNCATED AT 250 WORDS)