Abstract
A growing proportion of smokers are those who have failed prior treatments for cessation. We tested the efficacy of nicotine nasal spray and nicotine inhaler in two uncontrolled, open-label studies of 19 and 20 smokers who had previously failed nicotine patch therapy. As in the three prior studies of treatment failures, 6 month abstinence rates were extremely low both with the nasal spray (0%) and the inhaler (5%). We discuss possible treatments for and methodological issues in researching treatment-resistant smokers.