Stop smoking intervention

This is a new guideline from NICE on stop smoking interventions.

If you do nothing else, I would strongly encourage you to do the National Centre for Smoking Cessation and Training NCSCT e-learning module on offering very brief advice to smokers. It only takes 10 minutes and is excellent. NICE advises that we use the NCSCT methods.

Check self-reported abstinence at 4w with CO monitoring.

Smoking cessation interventions

Ensure the following interventions are available for adults who smoke:

  • Very brief advice. We should be doing this. See below for more information.
  • Behavioural support.
  • Varenicline (Champix). Normally this should only be offered as part of a programme of behavioural support; Varenicline is more effective than bupropion.
  • Nicotine Replacement Therapy. This is best used as a combination of a longer and shorter acting product. Ensure that adequate doses are used - inadequate doses are the commonest reason for not succeeding.
  • Bupropion (Zyban). This is the least effective intervention.

Very brief advice to help quit smoking

Again, I would strongly encourage doing the e-learning module from the NCSCT, which lays all this out.

  • Ask
  • Advise
  • Act

Ask

Ask if they still smoke at every opportunity and especially before referring for elective surgery. You should ask ex-smokers too as a large number of people will go back to smoking.

Advise

Advise people that they have a higher chance of stopping smoking if they seek support and/or medication.

They have a:

  • 68% higher chance of stopping if medication is offered.
  • 217% higher chance of stopping if support is offered.

Act

Give information on where to access stop smoking services and medications.

There is a good NHS site here with links to how to access local services.

Why don't we ask people if they want to stop smoking?

It doesn't help increase the chance of stopping and it just takes time as people start to think of reasons why they can't stop just now.

What if patients just want a prescription?

It is OK to prescribe if patients don't want to see a stop smoking adviser. It is still more effective than not taking any action. It is much better though that they seek support (remember that they are 217% vs 68 % more likely to stop with support than with a prescription alone). It is obviously better to ask them to come back to a 'dedicated' appointment to do this.

What if they start smoking again?

There is no need to wait 6m before another course of treatment is used.

70% of people go back to smoking - reassure people that it can take several attempts before they finally stop.

What about E-cigarettes?

You can advise people who want to use e-cigarettes to help them to stop smoking that:

  • Many people find them helpful to stop smoking.
  • They should stop smoking tobacco completely as it is harmful.
  • Evidence suggests that they are 'substantially less harmful' to health than smoking, but they are not risk free.
  • Evidence is evolving, including that on long-term health impact.

 

This article first appeared in The Sessional GP magazine.

I’m a freelance GP locum in Winchester & Southampton.

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