42 | Nursing in Practice | Summer 2023
1
What is the approximate prevalence of smoking among adults in the UK ?
A 5 % B 13 % C 25 % D 35 %
2
Your patient asks if it is too late to stop and whether the damage has already been done . Which of the following is correct ?
A If you have smoked for more than 15 years , then the risk of a heart attack never returns to that of someone who has never smoked
B Within one year of stopping smoking , the excess risk of a heart attack reduces by half
C Stopping smoking at the age of 40 adds an average of 18 months to life expectancy
D Twenty years after quitting , the risk of lung cancer has fallen to about half that of a continuing smoker
3
Which of the following smoking-cessation aids are currently prescribable in the UK ?
A Bupropion B Varenicline C E-cigarettes
D Nicotine replacement therapy ( NRT )
QUICK QUIZ Smoking cessation
SCENARIO You are seeing a patient who is new to your surgery – she asks for her inhalers and you decide to do an opportunistic asthma review . She tells you she smokes 15 cigarettes a day and has tried to stop many times , but never with any long-term success . Is there anything you can do to help ?
1 2 3 4 5
By Dr Toni Hazell , a GP in north London
4
Your patient attends a stop-smoking clinic and you receive a request to prescribe bupropion . She has asthma and wellcontrolled hypertension . She also alludes to a history of ‘ mental health problems and difficulties with eating ’ but offers no further details and you don ’ t yet have access to her old notes . Is it safe to prescribe bupropion ?
A Yes B No
C You don ’ t have enough information to decide
5
After reviewing her notes , you prescribe bupropion . Two weeks later your patient phones – she has not started the drug and has discovered she is pregnant . Would it be appropriate to tell her :
A Not to use the bupropion and that you cannot prescribe NRT as she is pregnant ?
B That it is fine to use bupropion when pregnant , but that you ’ ll prescribe a lower dose ?
C That , ideally , she should stop smoking immediately with no use of NRT , but that if she cannot do that then you will prescribe nicotine replacement ?
D That she can use NRT when pregant , but must stop before term if she wishes to breastfeed ?
Answers . 1 B . In 2021 , 13.3 % of those aged ≥18 in the UK smoked cigarettes – a significant reduction from 20 % in 2011 and 40-50 % in 1972 . 1 , 2 2 B . It is never too late to quit – stopping at the age of 60 , 50 , 40 or 30 adds 3 , 6 , 9 and 10 years of average life expectancy , respectively . Within one year the excess risk of having a heart attack has halved , within 10 years the risk of lung cancer falls to about half that of a continuing smoker and by 15 years the risk of a heart attack returns to the level of someone who has never smoked . 1 3 A and D . Bupropion and NRT can be prescribed in the UK . 4 C . Not enough information has been given to be able to answer this question . Bupropion should not be prescribed to under-18s or those with a history of any of the following : • Seizures ( current or past ) • Central nervous system tumour • Anorexia or bulimia nervosa ( current or past ) • Severe cirrhosis • Bipolar disorder . Use caution if considering a prescription for the elderly or those with a predisposition to seizures . Risk factors include alcohol excess , a history of head trauma , diabetes , the use of other drugs that lower the seizure threshold ( such as antipsychotics ) and the use of stimulants . Caution should also be exercised if there is hepatic or renal impairment , or a family history of Brugada syndrome , a rare disease causing changes to electrical activity in the heart . 1 5 C . This scenario is all about harm reduction . The best thing would be to quit instantly with no use of NRT – but it is likely she would have done that years ago if it was possible . NICE advises against bupropion in pregnancy , but NRT can be considered in women with a failed cessation attempt without medication . It is licensed in pregnancy and is much less damaging to the baby than smoking , and can also be used in breastfeeding , ideally immediately after a feed . Quitters should be supported by a stop-smoking clinic .
References 1 NICE CKS . Smoking cessation . 2023 . tinyurl . com / NICE-cessation 2 Office for National Statistics . Adult smoking habits in the UK , 2021 . 2022 . tinyurl . com / ONS-adult-smoking 3 NHS . Champix ( varenicline ). 2022 . tinyurl . com / NHS-champix 4 MHRA . Guidance for licensing electronic cigarettes and other inhaled nicotine-containing products as medicines . 2022 . tinyurl . com / MHRA-ecigarettes 5 Department of Health and Social Care and Office for Health Improvement and Disparities . E-cigarettes could be prescribed on the NHS in world first . 2021 . tinyurl . com / DHSC-ecigarettes
ALAMY