Smoking cessation

Current situation

  • In the UK, the treatment of smoking-related disease has been estimated to cost the NHS £1.4 billion to £1.7 billion  a year.
  • Providing smoking cessation advice is one of the quality outcome measures in the new GMS contract.
  • Over 300,000 people successfully stopped smoking for at least four weeks in 2005/6 using the NHS smoking cessation services.
    Patients aged over 60 years and women were the most successful out of those who attempted to give up.

What is the evidence?

  • Clinics to help people stop smoking have led to an increased number of GPs recording whether patients smoke and referring them for assistance to quit (Public Health 2005; 119: 262–8).
  • One study found that almost half of smokers’ most recent attempts to stop involved no planning, and unplanned quit attempts were more likely than planned ones to be successful (BMJ 2006; 332: 458–60).
  • One study has shown that varenicline — a new treatment that targets the nicotine receptor in the brain — is more effective than bupropion (JAMA 2006; 296: 64–71).
  •  Another study found that one in seven highly motivated patients were not smoking one year after taking varenicline for six weeks (Arch Intern Med 2006; 166: 1,561–8).
  • Patients should be advised that the benefits are from smoking cessation rather than reducing cigarette consumption. A study showed that, for men, cutting back only resulted in slightly lower deaths whereas women it increased their death rate (Tobacco Control 2006; 15; 472–80).
  • A study has shown that a citywide smoking ban was associated with a reduction in the incidence of acuteyocardial infarction (Circulation 2006; 114: 1,490–6).
  • Nicotine replacement therapy has helped patients with COPD to stop smoking (Chest 2006; 130: 334–42).
  • One study has shown that using motivational interviewing to promote change in addictive behaviour is more effective than brief advice in giving up smoking (Br J Gen Pract 2006; 56: 768–74).

Implications for practice 

  • Smoking will be banned in all public indoor spaces in the UK on 1 July 2007.
    Available guidelines 
  • NiCE has issued guidance on smoking cessation. The guidance recommends that smokers should be advised to quit and not just those who are already ill.
  • NICE recommends the most effective treatments for smoking cessation initially which are offered by the NHS stop-smoking services.


USEFUL WEBSITES
www.nice.org.uk — NICE guidance
www.givingupsmoking.co.uk — NHS stop smoking website
www.ash.org.uk. Action on smoking and health

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