Randomized Controlled Trial of a Nicotine Dependence Intervention:Evaluating the Efficacy of a Lemongrass (Cymbopogon citratus) Inhaler viaModulation of Nicotinic Acetylcholine Receptors

INTRODUCTION: Nicotine dependence remains a major global public health challenge, with relapse remaining high despite the availability of conventional cessation therapies. In traditional medicine, lemongrass (Cymbopogon citratus) has been widely used for calming, respiratory, and stress-related conditions, and modern evidence suggests that citral, its primary phytochemical, may modulate nicotinic acetylcholine receptors (nAChRs) involved in nicotine addiction. These properties provide a biological and traditional rationale for investigating lemongrass inhalation as a supportive intervention to reduce dependence. This study aims to evaluate the efficacy of a 3% lemongrass essential oil inhaler in reducing nicotine dependence through modulation of nAChRs. METHODS: A randomized, pretest-posttest controlled group design was conducted involving 100 adult smokers (aged 18-30 years) with moderate-to-high nicotine dependence (FTND ≥ 5). Participants were allocated to receive either a 3% lemongrass inhaler or a placebo, administered four times daily for eight weeks. The primary outcomes were changes in FTND scores and serum nAChRs levels measured using ELISA. ANCOVA was used to assess treatment effects while controlling for demographic covariates. RESULTS: The lemongrass group demonstrated significantly greater reductions in FTND scores (mean difference = 2.3; p < 0.001) and serum nAChRs levels (mean difference = 0.6 ng/mL; p = 0.003) compared with placebo. After adjustment for baseline FTND and demographic covariates, ANCOVA confirmed a large treatment effect (partial η² = 0.390). Multivariable logistic regression further demonstrated that participants receiving lemongrass inhalation had significantly lower adjusted odds of remaining highly nicotine-dependent after the intervention. DISCUSSION: These findings show that lemongrass inhalation significantly reduces both subjective dependence levels and biological markers associated with nicotine addiction, consistent with traditional medicinal uses and mechanistic evidence for the interaction of citral with nAChRs. CONCLUSION: This natural and accessible intervention may serve as an effective adjunct to smoking- cessation strategies and warrants further long-term evaluation.