Most people are aware of the negative impact smoking can have on health whether you have a medical background or not. Smoking forms a part of our lifestyle advice with a lot of medical conditions but it is especially linked to lung cancer, COPD, stroke, asthma and pregnancy complications. It is the primary cause of preventable illnesses and premature deaths in the UK.

People can start smoking because of many different reasons such as peer pressure, stress relief, socialising etc. However, nicotine found in cigarettes is highly addictive. This makes it really difficult to quit smoking especially without any help. Most people don’t succeed during their first attempt at quitting and it may take more attempts.

Smoking Cessation Pharmacy NI Service

This is a useful video from the Public Health Agency explaining what the smoking cessation service involves for patients. Stopping smoking through this service offers free support, access to nicotine replacement therapy (NRT) and makes smokers 4 times more likely to quit.

Most people will have weekly meeting with the pharmacist for 4 weeks, then less frequently for a further 8 weeks. During this meeting the patient can chat with the pharmacist regarding challenges they face while stopping smoking, their progress and gain help to avoid relapse. This is a free support service in community pharmacy tailored to the needs of the patient. They don’t have to quit smoking immediately, but they should start taking steps towards stopping and they can be offered as many appointments as they need.

The first meeting with the pharmacist will involve talking about why the patient smokes and why they want to quit, as well as past attempts to quit (but don’t dwell on this). The patient will also decide on a quit date. The patient will be offered a breath test too, which shows the levels of carbon monoxide (a poisonous gas in cigarette smoke) in their body. They can be signposted and given support on preparing to stop, setting a quit date, NRT and coping with withdrawal.

Licensed NRT is available free of charge when registered with a specialist stop smoking service based in a pharmacy. The patient should be offered advice and support to help them choose the type of NRT that suits them best. The NRT given to our patient is then labelled and written on a PV1 voucher.

How to quit smoking

Patients should be advised that stopping in one go offers the best chance of lasting success (rather than a gradual reduction), and that a combination of drug treatment e.g., NRT and behavioural support is most effective.

Encourage patients to make a list of reasons they should quit, inform people that they are quitting so they can receive support, encouragement and limit temptation to fall back into old habits. Having a support plan in place if the patient is tempted to smoke is also a good idea. Patients can exercise away their urge to smoke or keep busy to keep their mind off cravings. Furthermore, there are support groups which exist for people trying to quit smoking which they can be signposted to. Patients should be encouraged to throw away all cigarettes and smoking paraphernalia before their quit dates.

Patient consultation

• How many cigarettes do they smoke a day (helps to figure out what strength to start nicotine patches, for example)?

• Have they tried to quit smoking before? Was there a trigger for relapse if so?

• When do they have their first cigarette each day (are they a habitual smoker)?

• Preferences about NRT formulation - have they tried any NRT products before? If so, what about them did they like/dislike? Do they want a product to prevent cravings or taken when cravings occur? Did they experience any side effects e.g., increased nightmares with the 24 hour patch?

• Any other medicines - medication history

• Pregnancy/breast-feeding in women

• Allergies

• Medical history

Different NRT products available: Patches

Nicotine patches are patches containing nicotine which can be applied to the skin and slowly release a controlled dose of nicotine into the body and help keep cravings at bay. These patches are available as either 16 hour or 24 hour patches. If our patient smokes first thing in the morning when they wake up the 24 hour patch might be useful as this can help relieve this craving. However, people may experience an increased occurrence of nightmares when using the 24 hour patch so the 16 hour option might be preferrable. The 16 hour patch would be used applied in the morning and taken off before bed. As well as that, the 24 hour patch mightn’t be necessary if the person doesn’t smoke straight after wakening.

There are also different strengths of nicotine patches available. The strength which they are first given can be decided by how many cigarettes they smoke daily. There is a variety of strengths available and a patient usually decreases the strength of nicotine in the patch over time until they are ready to try without using a patch at all. For example, Nicorette patches are available in 3 ‘steps’ - step 1 which is a 25mg patch, step 2 which is a 15mg patch and step 3 which is a 10mg patch. The image below shows the recommended timeframe to reduce these steps and the starting dose in Nicorette patches. Note: each brand may differ in strengths and timeframes so it is crucial to read to PIL and packaging beforehand.

Different NRT products available: chewing gum, lozenges and sprays

Chewing gums, lozenges and sprays are useful products to help deal with nicotine cravings as they occur. There are a few options available and choice is dependent on patient preference. Patients may like/dislike the flavours of these as well.

Nicotine chewing gum isn’t like regular chewing gum, there is a specific method to using it properly. Some patients would dislike this as it is quite a lengthy process in comparison to other NRT options. The method to nicotine chewing gum is as follows:

• Chew the gum slowly until you feel a tingling sensation

• ‘Park’ the gum between the gums and cheek

• When the tingling fades (usually after 1 minute), chew the gum again

• Continue this process for about 30 minutes

• Dispose of the gum and avoid swallowing

Nicotine mouthspray is also available. The method is as follows:

• Point the spray nozzle towards your open mouth and hold it as close to your mouth as possible

• Press the nozzle to release 1-2 sprays into the side of the mouth, avoiding the lips

• Don’t inhale while spraying to avoid getting the spray down your throat

• For best results, don’t swallow for a few seconds after spraying

A useful video can be found here:

Nicotine lozenges also have a method on how to use them properly:

• Put the lozenge in your mouth between your gums and cheek

• Allow it to dissolve slowly over 20-30 minutes, moving it around occasionally

•  Do not suck, chew or swallow it

Different NRT products available: inhalators

These are forms of NRT which simulate the action of smoking whilst relieving cravings and withdrawal symptoms. Some people are habitual smokers and are used to the feeling of having a cigarette in hand in which case an inhalator might be a preferable choice of NRT.

Inhalators come with a plastic holder and cartridges. The ridges on the plastic holder can be lined up and the cartridge inserted (this will make a ‘click’ sound). These can be used every hour and puffed for about 20 minutes or as needed to help the patient manage their cravings.

Benefits to quitting smoking

• Saving money - cigarettes are expensive and becoming increasingly more so. Smoking is therefore a very expensive habit and addiction. This can often be the trigger for someone to want to tackle their addiction and give up cigarettes for good. Patients can see how much money they have saved so far on their smoking cessation journey and view this as more motivation to continue.

• Secondhand smoking - secondhand smoking is dangerous and can harm the health of your family and friends, e.g., children living with smokers are more prone to chest colds and ear infections.

• Improves smell and taste - you may notice that food tastes and smells different as your mouth and nose recover from being dulled by the many toxic chemicals found in cigarettes.

• Appearance - stopping smoking has been found to slow facial aging and delay the appearance of wrinkles. Smoking also causes a discolouration of the nails and teeth.

• Improved health - over a period of time after quitting smoking a person’s health will gradually improve. This timeline is a useful and encouraging resource to show patients.

The PillBox.