GEM - smoking cessation

The basic 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, buproprion

Advice plus nicotine replacement therapy - which of these is true?

• up to 10 minutes advice plus nicotine replacement was 6% better than advice alone
• up to 10 minutes advice plus nicotine replacement was 12% better than advice alone
• up to 10 minutes advice plus nicotine replacement was 24% better than advice alone
• GPN reference

When assessing an individual's smoking consumption: what is the equivalence, in terms of cigarette smoking, to a cigar?

• GPN reference

If a patients stops smoking when is there a fall in mortality and morbity associated with smoking?

• GPN reference

NICE have given guidance on use of nicotine replacement therapy and bupropion in smoking cessation:

• patients should normally only be prescribed NRT or bupropion as part of an abstinent-contingent treatment - what is such a strategy?
• what determines the length of the initial prescription of smoking cessation medication
• if a patient requires a repeat treatment with smoking cessation medication, what is the guidance when can a new attempt with smoking cessation medication can be initiated
• GPN reference

Bupropion/zyban:

• what is bupropion?
  • GPN reference
• what are the contraindications for use of bupropion?
  • GPN reference
• how is bupropion initiated?
  • GPN reference
• how does bupropion use in smoking cessation affect weight gain?
  • GPN reference

Nicotine Replacement Therapy

• there is evidence that NRT doubles the smoking cessation rate compared with placebo
• NRT is less addictive than smoking NRT, unlike tobacco smoking, does not provide tar products and carbon monoxide currently, there is no evidence that nicotine causes cancer
• NRT provides nicotine in a slower and less satisfying way than tobacco smoking BUT is safer and much less addictive nicotine does have vascular effects and product licences require caution in patients with established vascular disease, especially after a recent event. However continuance of tobacco smoking doubles risk of recurrent events and mortality nicotine may cause nausea, dizziness, palpitations and headaches in patients who have not become tolerant to it
• NRT is not a magic cure but helps with withdrawal and craving symptoms
• What about use of NRT in pregnancy?
  • GPN reference

Varenicline

• what is varenicline?
• is smoking stopped on initiation of varenicline?
• how long does a course of treatment with varenicline last for?
• GPN reference

Additional reading:

• Zyban section on GPnotebook

Reference:

1. Royal College of General Practitioners. Curriculum Statement 15.8 Respiratory Problems.