Despite evidence from more than 100 randomised controlled trials to show that nicotine replacement therapy (NRT) helps smokers to quit,1 questions have been raised over how applicable these studies are to the 'real world', where behavioural support may be lacking. A study, in Thorax, has shown that NRT helps smokers to quit even without behavioural support.

The study, which monitored the quitting patterns of more than 5,000 smokers from the UK, France, Spain and North America, is the first to look prospectively at the effectiveness of NRT in self-initiated quit attempts.

A total of 1,398 smokers made a quit attempt, of whom 1,089 were followed up for at least six months. Baseline data were collected on demographics, smoking history and nicotine dependence, and these factors were controlled for in the analysis.

A third of the smokers who tried to quit used NRT. These participants were significantly more likely to remain abstinent after six months than those who did not (OR 2.2).

This study confirms that NRT is a valuable aid to quitting and approximately doubles success rates, even when used without any additional support. This is important because NRT is often purchased over the counter.

However, the findings do not mean that additional support is not desirable. There is much evidence from other studies to show that the addition of behavioural support further improves quit rates.¹

The study is also a reminder that two-thirds of smokers who quit on their own are missing out on an effective treatment. Many smokers are reluctant to use NRT, mistakenly believing that it is nicotine in cigarettes that causes smoking-related cancer. Even those who do use NRT often use it sub-optimally.

It is important to ensure that smokers who are interested in quitting are given the greatest chance of success. From the GP perspective, this will usually mean referral to the local NHS stop smoking service for access to a full range of treatments, including behavioural support. However, if patients decline referral they should still be encouraged to use NRT, as it is a safe and effective treatment, even if used alone.

West R, Zhou X. Is nicotine replacement therapy for smoking cessation effective in the "real world"? Findings from a prospective multinational cohort study. Thorax 2007;62:998-1002