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Stop smoking services

The guideline upon which this summary is based was updated and replaced by NICE Guideline 92 on Stop smoking interventions and services on 28 March 2018. This summary will be updated according to the new and updated recommendations in due course. The most current guideline can be found at www.nice.org.uk/ng92.

Prescribing and advising on pharmacotherapies

When to prescribe

  • Offer NRT, varenicline or bupropion, as appropriate, to people who are planning to stop smoking
  • NRT, varenicline or bupropion should normally be prescribed as part of an abstinent-contingent treatment, in which the smoker makes a commitment to stop smoking on or before a particular date (target stop date). The prescription of NRT, varenicline or bupropion should be sufficient to last only until 2 weeks after the target stop date. Normally, this will be after 2weeks of NRT therapy, and 3–4weeks for varenicline and bupropion, to allow for the different methods of administration and mode of action. Subsequent prescriptions should be given only to people who have demonstrated, on re-assessment, that their quit attempt is continuing
  • Varenicline or bupropion may be offered to people with unstable cardiovascular disorders, subject to clinical judgement
  • Consider offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past
  • Do not favour one medication over another. The clinician and patient should choose the one that seems most likely to succeed
  • When deciding which therapies to use and in which order, discuss the options with the client and take into account:
    • whether a first offer of referral to the NHS Stop Smoking Service has been made
    • contraindications and the potential for adverse effects
    • the client’s personal preferences
    • the availability of appropriate counselling or support
    • the likelihood that the client will follow the course of treatment
    • their previous experience of smoking cessation aids

When not to prescribe

  • Neither varenicline or bupropion should be offered to young people under 18 nor to pregnant or breastfeeding women
  • If a smoker’s attempt to quit is unsuccessful using NRT, varenicline or bupropion, do not offer a repeat prescription within 6 months unless special circumstances have hampered the person’s initial attempt to stop smoking, when it may be reasonable to try again sooner
  • Do not offer NRT, varenicline or bupropion in any combination

Advice

  • Offer advice, encouragement and support, including referral to the NHS Stop Smoking Service, to help people in their attempt to quit
  • Explain the risks and benefits of using NRT to young people aged from 12 to 17, pregnant or breastfeeding women, and people who have unstable cardiovascular disorders. To maximise the benefits of NRT, people in these groups should also be strongly encouraged to use behavioural support in their quit attempt

People who want to stop smoking, but not immediately

  • Practitioners should provide NRT and appropriate support to individuals who want to follow the nicotine assisted reduction to stop (NARS) strategy only if it is part of a properly designed and conducted research study. Participants should include those who have repeatedly tried – and failed – to quit and those who are adamant that they do not want to quit abruptly

Targeting specific groups

Women who smoke and who are either pregnant or are planning a pregnancy, their partners and other family members who smoke

  • At the first contact with the woman, discuss her smoking status, provide information about the risks of smoking to the unborn child and the hazards of exposure to secondhand smoke. Address any concerns she and her partner or family may have about stopping smoking
  • Offer personalised information, advice and support on how to stop smoking. Encourage pregnant women to use local NHS Stop Smoking Services and the NHS Pregnancy Smoking Helpline by providing details on when, where and how to access them. Consider visiting pregnant women at home if it is difficult for them to attend specialist services
  • Monitor smoking status and offer smoking cessation advice, encouragement and support throughout the pregnancy and beyond
  • Discuss the risks and benefits of NRT with pregnant women who smoke, particularly those who do not wish to accept the offer of help from the NHS Stop Smoking Service. If a woman expresses a clear wish to receive NRT, use professional judgement when deciding whether to offer a prescription
  • Advise pregnant women using nicotine patches to remove them before going to bed

Young people aged 12–17 who show a strong commitment to quit smoking

  • Offer young people aged 12–17 information, advice and support on how to stop smoking. Encourage use of local NHS Stop Smoking Services by providing details on when, where and how to access them
  • Use professional judgement to decide whether or not to offer NRT to young people over 12 years who show clear evidence of nicotine dependence. If NRT is prescribed, offer it as part of a supervised regime

Mothers of infants and young children who smoke, particularly breastfeeding mothers, their partners and other family members who smoke

  • At the first contact, discuss the smoking status of the woman and her partner, provide information about the risks of secondhand smoke to young children and address any concerns about stopping smoking
  • Offer information, advice and support on how to quit smoking and encourage use of local NHS Stop Smoking Services by providing details on when, where and how to access them
  • Use any opportunity to offer those mothers who are (or who may be) eligible for the Healthy Start scheme practical and personalised information, advice and support to help them stop smoking
  • Discuss the risks and benefits of NRT with breastfeeding mothers who have tried but have been unable to stop smoking unaided. Use professional judgement to decide whether or not to advise use of NRT or to offer an NRT prescription
  • Advise breastfeeding women using nicotine patches to remove them before going to bed

People receiving care and advice from a health professional in a primary care setting (such as a GP surgery) or in an acute care setting (such as a hospital)

  • Healthcare professionals should be trained to give brief advice on stopping tobacco use and should have contact with the local NHS Stop Smoking Service to which they can refer people
  • Healthcare professionals should identify and record the smoking and/or tobacco use status of all their patients. Those who use tobacco should be:
    • reminded at every suitable opportunity of the health benefits of stopping
    • offered brief advice and, if they want to stop using tobacco, referred to the local NHS Stop Smoking Service. If patients do not wish to attend the service, they should be offered brief advice and support to help them quit, and pharmacotherapy as appropriate
  • Patients referred for elective surgery should be encouraged to stop smoking before the operation. Patients who want to stop smoking for good should also be referred to the local NHS Stop Smoking Service
  • Hospital patients who use tobacco in any form should be offered advice and, if appropriate, NRT from a trained health professional or smoking cessation adviser while in hospital to help them to quit. They should also be offered an appointment with their local NHS Stop Smoking Service. If they accept the offer, the appointment should be booked prior to their discharge. In exceptional circumstances it might be inappropriate to advise a patient to quit; for example, because of their presenting condition or personal situation
  • PCTs should ensure that NHS Stop Smoking Services can provide cessation support to hospitals. This should include a fast-track referral system after discharge for patients who have tried to quit smoking in hospital. PCTs should develop a clear referral plan with links between primary and acute trusts

People with cardiovascular or respiratory disease who smoke

  • Offer brief advice or, preferably, behavioural support from the local NHS Stop Smoking Service and prescriptions of NRT, varenicline or bupropion, according to clinical judgement

full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT
www.nice.org.uk/guidance/PH10

National Institute for Health and Care Excellence. Stop smoking services. Quick Reference Guide . February 2008
First included: June 2008.