Objective: To explore the attitudes of hospital doctors towards current smokers with Chronic Obstructive Pulmonary Disease (COPD). Methods: We surveyed 184 hospital doctors of all grades regarding their attitudes to four patient scenarios including: current excess alcohol drinker, current smoker limited by angina, current intravenous drug user and current smoker limited by COPD. Doctors scored to what degree they felt the patients were at fault for their condition and in control of their future health. Results: Most doctors agreed/strongly agreed that current smokers with COPD were the most ‘at fault’ for their condition and when asked to rank the four patients from most to blame to least to blame for their own ill health, 80% doctors ranked smokers with COPD more to blame than smokers with angina. In the last 2 weeks almost all doctors had managed smokers, but only two thirds had offered any form of cessation advice. Comment: A significant proportion of doctors believe that patients with COPD are at fault for their condition; however, they appear to believe there is scope for change in smokers and other addicted patients. By implementing smoking cessation training, doctors can improve the care offered to smokers and avoid the negative attitude towards smokers with COPD.

Among many studies on cytisine only a few have been controlled trials, and the aim of this study was to assess the efficacy of cytisine in a randomized controlled double-blind trial compared to placebo in medium-dependent smoking men working in mining industry. Materials and methods: 171 middle-aged smokers were randomised to either cytisine (25-days regimen) or placebo; both groups received individual counseling with brochure. Self-reported continuous abstinence was assessed at 8 and 26 weeks. Results: At the end of week 8 there were no differences in number of abstinent subjects, but at 26 weeks 10.6% of subjects were abstinent in cytisine group compared to 1.2% in placebo (p = .01). In both groups, we did not find any weight increase, but quality of life improved in both groups, and physical and social functioning improved in cytisine group. Conclusions: Cytisine may be an effective medication to help smokers quit even for those working in difficult working conditions with high relapse rate.

The pharmacological, stimulus expectancy, and response expectancy effects of light cigarettes (0.60 mg yield of nicotine) compared with virtually nicotine-free cigarettes (less than 0.05 mg yield of nicotine) were examined using a between-subjects design. A total of 103 college student smokers completed tests of cognition before and after smoking one type of cigarette, which was evaluated on a number of dimensions. Cigarettes with nicotine were preferred on most dimensions, and stimulus expectancy partially mediated the relationship between nicotine and subjective effects of the cigarettes. Stimulus expectancy also mediated the effect of nicotine on tension reduction immediately after smoking, but not near the end of the experiment. Response expectancy effects of nicotine were related to predicted and actual recall performance, such that participants who performed well tended to attribute the effect to the cigarette they smoked. Implications for smoking cessation and research studies using non-nicotine cigarettes are discussed.

Purpose: To report a case of an increase in Crohn's disease (CD) activity possibly caused by varenicline. Background: Smoking cigarettes has been shown to be an independent risk factor for the development of CD and is associated with a more aggressive disease course. Smoking cessation is therefore considered a primary adjunctive goal for such patients. Varenicline is a partial nicotinic agonist, which selectively binds to the α-4, β-2 receptor. This receptor is thought to play a large role in the additive properties of nicotine and the drug is approved in the United States for this purpose. Case results: A 62-year-old female with a 12-year history of stable, quiescent CD, presented to her physician with symptoms of severe nausea, frequent episodes of vomiting, abdominal cramping, and significant diarrhoea, all of which was thought to be her first exacerbation of CD in years. The patient had started varenicline 2 days prior to the initiation of symptoms and had continued worsening symptoms for the next 2 weeks during which she continued the drug. One week after discontinuing varenicline the symptoms abated completely. Due to its pharmacology as a nicotine partial agonist, varenicline was thought to have possibly caused an exacerbation of this patient's CD. Conclusion: A patient had a possible exacerbation of her CD triggered by varenicline used for smoking cessation. Because smoking cessation is imperative in CD patients, care should be used when starting varenicline for this purpose.

Purpose: To report a case of adverse reaction to nicotine gum in a Chinese female with poor nicotine metabolic status after chewing a piece of 2 mg nicotine gum (NG). Background: NG is prescribed in smoking cessation programs to help individuals stop smoking. In smoking cessation treatment, the dose of NG should control withdrawal symptoms but avoid adverse effects. Case results: We describe a case of an adverse reaction following the administration of 2 mg NG to a female Chinese subject. This study compared a single dose of 2 mg NG with a single low dose cigarette (0.7 mg nicotine). Blood (5mL) was collected at baseline and 2h post exposure to NG. Blood pressure and pulse rate were also recorded. Nicotine metabolic rate was determined by calculation of the ratio of plasma cotinine (ng/mL)/plasma nicotine (ng/mL). The subject developed nausea and severe vomiting with raised blood pressure and pulse rate following administration of NG. The ratio of plasma cotinine/nicotine was 0.4 indicative of poor nicotine metabolic rate. Exposure to nicotine using the subject's normal cigarette did not produce similar adverse effects. Conclusion: NG may be associated with adverse reactions in smokers with low nicotine metabolic rate. Physicians in smoking cessation programs should be aware that some individuals may not tolerate this form of pharmacological treatment.