The Association Between Epoxide Hydrolase Genetic Variant and Effectiveness of Nicotine Replacement Therapy in a Han Chinese Population

Dear Editor, Nicotine is a psychoactive alkaloid that is thought to play a key role in addiction to commercial tobacco products [1] and cotinine is its primary metabolite [2]. Pharmacological treatment, such as nicotine replacement therapy （NRT）, is a valid solution to this problem. Tobacco smoke contains many carcinogens such as nitrosamines .

Electronic cigarettes — myocardial infarction, hemodynamic compromise during pregnancy, and systolic and diastolic dysfunction: Minireview

The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational purposes.The format of this review begins with relevant research from the basic sciences and follows through with a pertinent review of clinical trials.Daily use of ECs has implications in myocardial infarction(MI)with an odds ratio of 1.70 compared to healthy,nonsmokers and even worse risk for MI with dual use of combustible cigarettes together with EC with an odds ratio of 4.62.Studies measuring cardiac function with echocardiography reported both systolic and diastolic dysfunction along with reduced ejection fractions.Platelet aggregation,endothelial function,and hemodynamics during pregnancy were all but some of the pernicious cardiovascular implications of EC exposure.Though more studies need to be done on the topic of EC use and cardiovascular disease,the majority of studies considered in this review concluded some level of harm albeit in some instances less than that of traditional combustible cigarettes.ECs are toxic to human beings and their harmful effects cannot be overlooked.There is some favorable evidence of efficacy in smoking cessation though mixed with concern of chronic EC use.It will take decades to collect data for chronic EC use on long term sequelae,such as lung cancer.Though more and more reports of acute lung injury and hospitalizations related to EC use have been reported.Due to undergoing investigations of possible harm and life threatening complications of EC use,we cannot recommend ECs as safer or a more efficacious method of smoking cessation to traditional nicotine replacement therapies.A notable consideration for much of the literature reviewed are that standardization of EC use is difficult as device generation and battery voltage,frequency of use,and contents of ECliquid are just some of the vast complicating factors that limit the ability to effectively compare data.

Impact of a Pilot, Pharmacy-Led Tobacco Cessation Medication Protocol at Discharge in a Community Hospital

Purpose： To evaluate the implementation of a pharmacy-led tobacco cessation medication education protocol at discharge in a community hospital. Design： Single center, retrospective quality assessment study. Methods： A retrospective review of a pharmacy-led protocol was completed from November 2016 through April 2017. Data from one year prior to implementation of the protocol was analyzed against the study group. Results： A total of 607 tobacco cessation medication education interventions were made during the study period, 379 patients （62.4%） were given an OTC （Over The Counter） NRT （Nicotine Replacement Therapy） recommendation upon discharge and 148 （24.4%） were referred to the Ohio Tobacco Quit Line. TJC （The Joint Commission） TOB-3/3a measure was met in 44.1% of patients during the study period compared to 0% in the comparator group. Of the 75 patients who were reached via follow-up phone call, 23 （30.7%） purchased an OTC NRT and 22 （29.3%） completely quit using tobacco. Conclusions： Pharmacy-led tobacco cessation interventions during hospitalizations have a positive impact on TJC TOB-3/3a quality measure results and quit rates post-discharge. Our results encourage future studies in this area to further establish the importance of pharmacist involvement in tobacco cessation, specifically in the hospital setting.

Nicotine gum or patch treatment for smoking cessation and smoking reduction： a multi-centre study in Chinese physicians

In China, around 23% of physicians （41% male, 3% female） currently smoke. Pharmacotherapy for tobacco dependence is available, but is not widely used in China. The purpose of this study was to estimate the effectiveness and the safety on smoking cessation of nicotine gum and nicotine patch in Chinese healthcare professionals. Three hundred regular smokers motivated to quit were recruited from six hospitals in China. All subjects were accepted nicotine replacement therapy, and they could choose nicotine gum （2 mg or 4 mg, depending on baseline smoking level） or nicotine patch （15 mg/16 h） for 12 weeks, with a 12-week follow-up. Limited behavioural support was provided. At Week 24, the 2-24 weeks continuous abstinence rate （verified by expired carbon monoxide） was 17%, the point prevalence abstinence rate （no smoking since the previous visit） was 35%, and 38% of subjects had continuously reduced their daily cigarette consumption by at least 50% versus baseline. Compliance with treatment was good, particularly with patch. No serious adverse event was reported, and most adverse events were mild or moderate. The most common treatment-related adverse events were gastro- intestinal （both gum and patch） and local irritation symptoms. Nicotine patch and gum were well tolerated in Chinese smokers. Abstinence rates were comparable to those previously reported with nicotine replacement therapy, and many smokers who did not quit substantially reduced their cigarette consumption.

Tobacco cessation pharmacotherapy use among racial/ethnic minorities in the United States:Considerations for primary care

Pharmacotherapies for tobacco cessation are efficacious and recommended during quit attempts.Racial/ethnic minorities in the United States are less likely to use medication-based aids for tobacco cessation,despite greater difficulty achieving long-term abstinence.The reasons for this include,among others,provider-and patient-level considerations.Primary care clinicians play an important role in encouraging racial/ethnic minority tobacco users to use cessation pharmacotherapy.To better understand pharmacotherapy use,we conducted a narrative review of patient-lev-el factors that may determine uptake and adherence.This review indicates that social and cultural factors impact pharmacotherapy use,including health care experiences,beliefs,perceptions,and norms.The proportion of individuals using pharmacotherapy during quit attempts and adhering to the full course of treatment may be enhanced with greater attention to the ethnocultural concerns of these groups.Culturally appropriate assessment and brief advice delivered by primary care providers could yield significant benefits in population health.Recommendations for treating racial/ethnic tobacco users with pharmacotherapy for cessation are offered.