7.2 Smoking

Smoking is the main cause of premature death and preventable illness in the UK

Responsible for approximately 122,000 deaths per year,

People who smoke have a 50% change of dying prematurely

on average 10 years earlier due to smoking

After the age of 35 years, a person loses 3 months of life expectancy

for every year of continued smoking

In 2019, 15% of all deaths in adults aged 35

over in England were attributed to smoking

For every death caused by smoking, approximately 20 smokers will be suffering from a smoking-related disease,

with the cost to the NHS in England per annum estimated at £2.5billion per annum

Smoking during pregnancy

can have many negative effects for both mother and foetus.

benefits of smocking cessation

There are various pharmacological treatments to help patients stop smoking:

• nicotine replacement therapy NRT

• varenicline

• bupropion

nicotine replacement therapy

there are many formulations which provide short term/ long term effects and their combination provides the most effective therapy

there is no evidence that any particular product formulation is more effective an another

products are tailored to the patients need

short acting products should be used to manage cravings

gum

inhalator

long acting products last for either 16-24 hours with different strengths availiable

patches

patient who had 10 or more cigarettes per day

start 25mg patch and reduce

patients who had less than 10 cigarettes a day

start 15mg patch and reduce → 10mg

monotherapy can be preferred

can be used in pregnant/breastfeeding women as benefits > risk

varenicline (Champix)

selective nicotine-receptor partial agonist

varenicline produces agonist activity at α4β2 neuronal nicotinic acetylcholine receptors

(like nicotine does but varenicline is significantly less potent

varenicline has a higher affinity for this receptor than nicotine does

meaning that in the presence of nicotine varenicline will compete for the receptor thus nicotine cannot bind which in turn will help reduce the reward reinforcement associated with smoking.

varenicline dose regimen

• Days 1–3: 500 micrograms once a day then increase,
  Days 4–7: 500 micrograms twice a day then increase,
  Day 8 onwards: 1 mg twice a day

• varenicline To be started 1-2 weeks before target stop date

• 12 week course but varenicline can be repeated for a further 12 weeks in abstinent individuals to stop relapse

• varenicline Cautioned in psychiatric illness and those with a history of seizures

• Avoid varenicline in pregnancy

Bupropion

• Initially was used to treat depression

• Mechanism of action is unclear, but thought to inhibit the neural pathways of addiction and withdrawal

• Bupropion Dosed 150mg daily for 6 days, then 150mg twice daily to give a total course length of 7-9 weeks

• Lower doses of Bupropion in the elderly and those with factors for seizures

• Discontinue Bupropion if abstinence not achieved at 7 weeks

• Bupropion Contraindicated in pregnant/breastfeeding women and those with a history of seizures