From Our 2010 Archives
New Nicotine Inhaler May Help Smokers Quit
Vapor Puffs From New Device Carry Nicotine Deep into Lung
Daniel J. DeNoon
Reviewed By Louise Chang, MD
March 1, 2010 -- A new type of smoke-free inhaler gives would-be quitters a vapor with nearly as much nicotine as a cigarette.
Nicotine replacement is one of the most effective tools for helping smokers quit, says Jed Rose, PhD, director of the Duke Center for Nicotine and Smoking Cessation Research.
"There is the patch, gum, lozenges, and the current inhaler. But none effectively satisfy a smoker's craving for the act of inhaling and feeling nicotine going into the lungs and giving that rapid boost of nicotine into the bloodstream in a user-friendly way," Rose tells WebMD.
The problem is that cigarettes are still the most efficient nicotine-delivery device ever created, says Scott McIntosh, PhD, associated director of the smoking research program at the University of Rochester, N.Y., who was not involved in the Rose project.
"It would be great to have a product that would deliver nicotine as well as a cigarette," McIntosh tells WebMD.
That's exactly what Rose's and colleagues -- including James E. Turner, co-inventor of the older Nicotrol/Nicorette inhaler -- set out to invent.
The device they came up with does not use fire or heat. Instead, as the smoker draws air through the cigarette-shaped device, a chemical called pyruvic acid is drawn into contact with nicotine, creating a cloud of nicotine pyruvate vapor.
As pyruvic acid is a naturally occurring chemical that's part of the metabolism of every cell in the body, Rose says it does not add toxicity to nicotine. In this regard, the device is very unlike a cigarette, which delivers tars and a number of other cancer-causing substances along with nicotine.
But would smokers use it? In the device's first test, Rose and colleagues tried it on nine healthy smokers who had refrained from smoking overnight.
Each smoker took 10 puffs on the new device, 10 puffs on a Nicotrol/Nicorette inhaler, and 10 puffs of room air. Before and after each set of 10 puffs, the researchers measured the amount of nicotine in the smokers' blood and determined their smoking withdrawal symptoms.
The Nicotrol/Nicorette inhaler did raise smokers' nicotine levels. But it does not deliver nicotine deep into the lungs. Consequently, smokers did not get as much nicotine from this FDA-approved device as they did from equal amounts of nicotine in the new inhaler.
Moreover, the smokers said that puffing on the new device was less harsh and irritating than puffing on the Nicotrol/Nicorette inhaler.
"We are trying to give smokers the whole package they really are addicted to by trying to recreate that in a way we hope is far less harmful," Rose says. "We think most problems in cigarettes -- carcinogens and so forth -- come from things in smoke other than nicotine. We avoid them by giving nicotine without all those problems."
Rose says that although the device would be used to help people quit smoking entirely, it might also help people who are not ready to quit -- such as people self-medicating with nicotine for depression or schizophrenia.
If more stringent tests of the device's safety go well, Rose says the device would be commercially available in three to five years. Duke University has filed patents on the product.
Quitting Smoking and Nicotine Replacement
Nicotine is not a benign drug. It's addictive, of course, but has a wide range of effects on the body. McIntosh says nicotine may itself be a carcinogen, and appears to promote the spread of existing tumors.
But McIntosh notes that smokers aren't just addicted to nicotine. They're also addicted to the behaviors that go along with smoking. By allowing people to get over these addictions before they tackle their nicotine addiction, McIntosh says nicotine replacement devices double smokers' odds of quitting for good.
Even so, nicotine replacement by itself isn't enough.
"One of the best ways to quit is to get four to six sessions of face-to-face counseling -- and telephone and web-based quit lines are almost as effective," McIntosh says.
Counselors in many states offer smokers several weeks worth of free nicotine patches; free nicotine replacement is also available via quit-smoking web sites. To find out about services available in the U.S., call the national smoking hot line: 1-800-QUIT-NOW.
"Smoking is more addictive than heroin or alcohol or cocaine," McIntosh says. "About 5% of people are able to quit on their own. But if people trying to quit check in with their doctors or counselors, the success rates are as high as 45%."
One hint McIntosh has for would-be quitters is how best to use nicotine replacement. The body gets over nicotine dependence rather quickly, but studies show that quitters have the most success when they stay on nicotine replacement for eight to 12 weeks.
"One big reason people relapse is they think they have it beaten at two weeks," McIntosh says.
Another hint is to use nicotine replacement devices properly. The point of nicotine replacement is to keep a constant level of nicotine in the body so that quitters can avoid the constant cycles of nicotine use and nicotine withdrawal that a smoker experiences throughout the day and night.
"If you only use nicotine when you are having withdrawal symptoms, you will stay addicted," McIntosh says. "So if a person were to use the patch, for example, they could then use this new Rose device or nicotine gum for symptom relief. There is some evidence this is better than using just a single nicotine-replacement medication."
Rose announced his study results in a presentation to the Society for Nicotine and Tobacco Research in Baltimore.
SOURCES: Rose, J. Abstract of presentation to the Society for Nicotine and Tobacco
Research, Feb. 27, 2010, Baltimore.
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