Smoking cessation

Current situation: In the UK, the treatment of smoking-related disease has been estimated to cost the NHS up to £1.5 billion a year.

 

  • People over 60-years and women are more successful at stopping smoking.
  • Half of smoking cessation attempts in the UK are actually made without any treatment (BMJ 2007; 335: 37-41).

What is the evidence?

  • Varenicline - the treatment that targets the nicotine receptor in the brain - is more effective than bupropion when stopping smoking (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).
  • Stopping smoking at 40-years-old increased life expectancy by about five years, and at 60-years-old by three years (Tob Control 2007; 16: 107-13).
  • An observational study has shown that a smoking ban was associated with a reduction in the incidence of acute myocardial infarction (Circulation 2006; 114: 1490-6).
  • Intensive smoking cessation programmes have been shown to reduce morbidity and mortality among patients with heart disease (Chest 2007; 131: 446-52).
  • Patients who chose to quit with varenicline had a 70 per cent higher quit rate after the first month than those who opted for nicotine replacement therapy (NRT) (Addiction 2008; 103: 146-54).
  • The continuous abstinence rates after treatment with varenicline compared with NRT for the last four weeks of treatment were 56 per cent versus 43 per cent and for one year 26 per cent versus 20 per cent. (Thorax 2008; 10.1136/thx.2007.090647).

Implications for practice

  • NRT is regarded as the best pharmacological treatment of choice in the management of smoking cessation.
  • Cervical smear appointments have recently been shown to be an ideal time to encourage smokers to quit (Br J Cancer 2007; 96: 1,057-61).
  • One small study has shown that using motivational interviewing to promote change in addictive behaviour is much more effective than brief advice (Br J Gen Pract 2006; 56: 768-74).

Guidelines

  • In its first public health guidance, NICE has issued guidance on smoking cessation. It recommends that healthcare professionals should advise all smokers to quit and not just those who are already ill.
  • NICE recommends the most effective (intensive) treatments initially. These are offered by the NHS stop smoking services.

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners', Pas Test 2006.

Key points

  • Stopping smoking is cost- effective.
  • Smoking cessation clinics are beneficial.
  • NRT is still the treatment of choice.
  • Varenicline is likely to be used more in the future.

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