To the Editors:
We welcome the paper by Caponnetto et al. [1], in which they evaluated a nicotine-free inhalator as part of a smoking cessation programme. In the randomised controlled trial, they found no significant improvement with the inhalator, but further analysis of the data showed a significant increase in cessation rate among those with strong and very strong behavioural dependence as measured by questionnaire. While this was a good attempt to find inexpensive means to improve smoking cessation, we question their methodology to assess smoking dependency and abstinence.
Questionnaires such as those used for the Fagerström Dependence Score and the Glover–Nilsson Smoking Behavioural Questionnaire are subject to bias and intentional and unintentional under-reporting. Also, smoke topography, the way a …