Smoking cessation
As a nurse you are in an ideal role to encourage your patients to stop smoking and should make every contact count.
The side effects of smoking tobacco only became noticeable in the 1920s. Many of these adverse effects and life-limiting illnesses are caused by the 4,000+ chemicals involved.
The widespread effects of tobacco smoking affect the whole body, as well as common smoking-related conditions such as chronic obstructive pulmonary disease (COPD) and lung cancer. Second-hand exposure to other people’s tobacco smoke is also a cause of ill health. Smoking in pregnancy can also cause harm as well as risks to children’s future health.
Third-hand exposure comes from contamination of surfaces with smoke particles. One example is when smoking close to a pet, such as a dog, the particles collect in the fur and can be inhaled/digested when petting or being cuddled. The pet themselves can also be exposed when grooming themselves and are also very susceptible to second-hand smoking damage due to smaller lungs (similar to babies and children).
Smoking cessation should be seen as a treatment. In a current smoker, it is one of the most cost-effective options in chronic disease management. This is especially important in COPD as it is the only intervention that will slow disease progression.
The body starts to recover in as little as 20 minutes when a person quits smoking.
- after 20 minutes blood pressure and pulse start returning to normal
- after 24 hours carbon monoxide is eliminated from the body and the lungs start to clear out smoking debris
- after 48 hours ability to taste and smell improves
- after 3-9 months lung function improves up to 10%
- after 5 years the risk of heart attack falls to about half that of a smoker
- after 10 years the risk of lung cancer is halved and the risk of heart ischaemia falls to that of someone who has never smoked.
Smoking rates have in recent years continued to decline, see: . However, the harm remains high as tobacco smoking kills over half of its users as well as causing significant long-term damage and distress due to poor quality of life.
Smoking is a relapsing addiction and many people have 6-7 attempts before quitting long term. Receiving behavioural support, for example from a NHS Stop Smoking Service, will quadruple chance of success (). It is also recommended that behavioural support is combined with nicotine replacement therapy and/or medication.
Nicotine replacement therapy
Nicotine replacement therapy replaces to some extent the nicotine a person would have received from smoking. The dose depends on the amount of cigarettes smoked, intensity and pattern of habit. NICE (2021) recommends a long-acting product (for example, a patch) and a short-acting product of which there are many varieties; these provide a dose of nicotine to help cravings. Most are absorbed sublingually (for example, vaping, gum, spray or inhalator). The dose is usually titrated down over a 12-week period; however, heavy smokers may need longer.
Electronic Nicotine Delivery Devices (ENDDs) including e-cigarettes (vapes)
ENDDs are electronic devices that mimic cigarettes and release vapor and is commonly known as vaping or electronic cigarettes (e-cigarettes). There are hundreds of different types of devices and juices available. Statutory regulation