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Make use of all resources to quit smoking

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Jennifer Percival, RN, RM, RHV, DipCouns.

Royal College of Nursing Tobacco Education Project Manager, London

...

Too late to stop smoking?
Q: I am 52 years old and have been smoking for 35 years. My GP has told me to stop because of my recurring bronchitis. Surely it's too late for me now - the damage is done, isn't it?

A: Smoking is the biggest single cause of illness and premature death in the UK (Doll et al, 2004). Half of all regular smokers die prematurely - a quarter of these in their middle years.

It is never too late for anyone to benefit from giving up smoking. Stopping smoking is the greatest single thing smokers of any age can do to improve their general health and quality of life.

Sir Richard Doll, the leading research scientist, has just published a paper which shows that smoking can shorten life expectancy by up to ten years. (Doll et al, 2004).

As soon as people stop their bodies can start to recover. The immediate benefits include an increased level of oxygen in the blood, improved lung capacity and circulation. After one year the risk of heart disease is reduced by half and after five to 15 years, the risk for stroke and cancer is the same as that of a non-smoker. Some important short-term benefits of stopping are an increased sense of taste and smell and more disposable income.

Too hard to cope alone
Q: I've tried to stop smoking so many times in the past and it just doesn't work. I get irritable, put on weight and have trouble sleeping. I think I'm one of those people who just can't do it.

A: Although 70% of smokers surveyed say they would like to quit, the unaided success rate remains at 1-2% because of the highly addictive nature of nicotine (Royal College of Physicians, 2000).

To address the problem specialist NHS services for smokers have been set up and nicotine replacement therapy (NRT) and bupropion are now available on prescription. The services support smokers to quit through group or one-to-one sessions. An initial assessment is carried out by an adviser to prepare smokers to think about their quit day and the problems they may encounter.

Smokers are provided with information and encouraged to use the service. Pharmacotherapy use is encouraged.

During the year 2003/04 around 359,000 people set a quit date through the services. At four weeks over half of them had successfully quit smoking (DH, 2004). The Government has increased the investment in these services to and#163;41 million for 2003-04. Nurses can refer patients to local smoking-cessation services or smokers can self-refer.

Coping with withdrawal
Q: I really want to stop smoking, but last time I tried I had terrible withdrawal symptoms. I've tried using nicotine replacement therapy but I didn't like the idea of putting nicotine into my body when I was trying to give it up. Willpower alone doesn't work for me and I feel a failure.

A: In 2002, the National Institute for Clinical Excellence (NICE) produced guidance on the use of nicotine replacement therapy (NRT) and bupropion (Zyban) for smoking cessation. These products are designed to suppress the distressing withdrawal symptoms of quitting smoking.

NICE recommended that both products be made available on prescription for smokers who express a desire to quit smoking, and are ready to make a commitment to stop smoking on a particular date.

NRT comes in a variety of formulations including patch, gum, lozenge, micro tab, inhalator and nasal spray. No one form of NRT is more effective than another and all products significantly increase a person's chance of success. In all cases it is safer for a person to use a short course of NRT than to continue smoking. NRT products are available both on prescription and general sale.

Bupropion is a non-nicotine tablet which works by reducing a smoker's desire to smoke and their withdrawal symptoms. A course lasts two months with smokers giving up in the second week. Bupropion is available only on prescription and is not suitable for pregnant women, people with a history of seizures or blackouts and those withdrawing from high alcohol intake, tranquillisers and antidepressant drugs.

NICE stated that prescribing NRT/bupropion was among the most cost-effective of all health-care interventions. They stress the importance of providing advice and support in conjunction with either of these pharmacotherapy treatments. NICE recommends that the initial prescription should provide sufficient treatment for two weeks after the quit date, with further prescriptions given only if smoking cessation is continuing successfully.

The national guidelines recommend that all smokers attempting to stop be encouraged to use an appropriate pharmacotherapy treatment. If people have had problems giving up in the past, suggest they try a pharmacotherapy product to help them manage the withdrawal symptoms. By doing this they double their chance of success. Stopping smoking is a process that has to be learnt and five or six attempts before success is normal.

Author contact details
Jennifer Percival, PO Box 78, Kings Langley, Herts WD4 8ZN. Email: jennifer.percival@usa.net

Further information
NHS Smoking Helpline, tel: 0800-169 0 169; website: www.givingupsmoking.co.uk Professionals can receive information, campaign posters and NHS leaflets by ordering by phone or online. Members of the public can obtain details of local NHS Stop Smoking services.

Resources
Clearing the Air 2. Smoking and tobacco control: an updated guide for nurses is available from RCN Direct 0845-772 6100.

Giving Up for Life, a 42-page self-help booklet, is available free from the NHS Smoking Helpline: 0800-169 0 169.

Department of Health. (2004) Statistics on Smoking Cessation Services in England, April 2003 to March 2004 (Statistical Bulletin 2003/21). London: DH. Available at: www.publications.doh.gov.uk/public/stats3.htm

Doll, R., Peto, R., Boreham, J., Sutherland, I. (1994)Mortality in relation to smoking: 50 years' observations on male British doctors. British Medical Journal 328: 1519.

National Institute for Clinical Excellence.Guidance on the Use of Nicotine Replacement Therapy and Bupropion for Smoking Cessation. London: NICE. Available at: www.nice.org.uk

Royal College of Physicians. (2000)Nicotine Addiction in Britain: A report of the Tobacco Advisory Group of the Royal College of Physicians. London: RCP.

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