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Stopping smoking (evidence-based guidance)

Authoring team

There is evidence that helping smokers to stop smoking can be effective and highly cost-effective.

The essentials are:

  • ASK about tobacco smoking at every opportunity
  • ADVISE all smokers to stop smoking
  • ASSIST all smokers to stop smoking
  • ARRANGE follow up

There is evidence that even brief intervention (2-3 minutes) has a worthwhile effectiveness.

Useful features of intervention are to:

  • set a date to stop completely
  • review previous attempts to stop smoking - and what helped/hindered
  • plan ahead - identify potential problems and strategies to cope
  • plan how to handle alcohol-drinking situations
  • try smoking cessation treatment e.g. nicotine replacement therapy, bupropion

Calculating the number of cigarettes a day (2):

 

All Wales Medicines Strategy Group. Initial Clinical Management of Adult Smokers in Secondary Care. June 2021.

NICE state (3):

Tell people who smoke that a range of interventions is available to help them stop smoking. Explain how to access them and refer people to stop-smoking support if appropriate

Ensure the following are accessible to adults who smoke:

Consider NRT for young people aged 12 and over who are smoking and dependent on tobacco. If this is prescribed, offer it with behavioural support.

Do not offer varenicline or bupropion to people under 18

Offer behavioural support to people who smoke regardless of which option they choose to help them stop smoking. Explain how to access it.

Discuss with people which options to use to stop smoking, taking into account:

Consider NRT for young people aged 12 and over who are smoking and dependent on tobacco. If this is prescribed, offer it with behavioural support

Do not offer varenicline or bupropion to people under 18.

Offer behavioural support to people who smoke regardless of which option they choose to help them stop smoking. Explain how to access it.

Discuss with people which options to use to stop smoking, taking into account:

Advise people (as appropriate for their age) that the following options, when combined with behavioural support, are more likely to result in them successfully stopping smoking:

Advise people (as appropriate for their age) that the options that are less likely to result in them successfully stopping smoking, when combined with behavioural support, are:

  • bupropion
  • short-acting NRT used without long-acting NRT
  • long-acting NRT used without short-acting NRT

For adults, prescribe or provide bupropion, varenicline or NRT before they stop smoking:

  • For bupropion agree a quit date set within the first 2 weeks of treatment, reassess the person shortly before the prescription ends.
  • For varenicline agree a quit date and start the treatment 1 to 2 weeks before this date, reassess the person shortly before the prescription ends.
  • For NRT agree a quit date and ensure the person has NRT ready to start the day before the quit date.

    In November 2021, varenicline was unavailable in the UK. See the MHRA alert on varenicline

Study evidence shows that among men and women from diverse racial and ethnic groups, quitting smoking was associated with large reductions in the excess mortality associated with continued smoking (4)

  • all-cause mortality rate ratio (RR) for current vs never smoking was 2.80 overall
  • when comparing those who quit smoking before age 45 years with never-smokers, all-cause mortality RRs were 1.15

A systematic review stated that (5):

  • most effective interventions were nicotine e-cigarettes, varenicline and cytisine
    • found high-certainty evidence that when compared to control, nicotine e-cigarettes, varenicline and cytisine might lead to an additional eight (95% CrI 4-13), eight (6-10) and seven (4-12) additional quitters per 100, respectively

Reference:

  1. British Heart Foundation, Factfile 6/99.
  2. All Wales Medicines Strategy Group. Initial Clinical Management of Adult Smokers in Secondary Care. June 2021.
  3. NICE (November 2021). Tobacco: preventing uptake, promoting quitting and treating dependence
  4. Thomson B, Emberson J, Lacey B, et al. Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex Among US Adults. JAMA Netw Open. 2022;5(10):e2231480. doi:10.1001/jamanetworkopen.2022.31480
  5. Lindson N et al. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses. Cochrane Database of Systematic Reviews 2023, Issue 9. Art. No.: CD015226. DOI: 10.1002/14651858.CD015226.pub2. Accessed 16 September 2023.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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