Smoking Cessation

Question 1

Symptoms of tobacco withdrawal?

Answer 1

Light-headedness
Sleep disturbance
Irritability
Restlessness
Increased appetite and weight
Mouth ulcers
Urges to smoke

Question 2

What should occur in an initial assessment for smoking cessation?

Answer 2

An assessment of the person’s readiness to make a quit attempt
An assessment of the person’s willingness to use appropriate treatments.

Question 3

What are the steps of VBA+?

Answer 3

Ask - do they (still) smoke?
Advise - don’t ask if they want to stop - just give advice. “The best way to quit is with specialist support and medication.”
Act - refer to trained stop smoking provider. If reluctant, advise they come in for a dedicated appointment for medication and look at NHS stop smoking website in the meantime.

Question 4

How much more successful is smoking cessation with intervention?

Answer 4

Offered medication - 68%
Offered support to stop - 217%

Question 5

Why shouldn’t you ask smokers how much they smoke?

Answer 5

There is no good answers - ALL smokers need to stop.

Question 6

Why shouldn’t you ask a smoker if they want stop?

Answer 6

They will likely start generating reasons why they shouldn’t or can’t stop, and will actually have a negative impact. Its better to just cut to the chase and advise them on the best way to stop.

Question 7

What is the occurrence of smokers who restart in the years after quitting?

Answer 7

70%.

Question 8

What is first choice for smoking cessation?

Answer 8

Varenicline - POM
Combination NRT - patch + faster-acting product e.g., gum.
(e-cigarettes)

Question 9

Name 3 benefits of smoking cessation within 1 year of quitting.

Answer 9

Risk of heart attack falls to 50% of that of a smoker
Ability to taste and smell greatly improved.
Lung function is increased by upto 10%.

Question 10

Explain the components of the initial stop smoking assessment.

Answer 10

1. Assess their readiness and ability to quit and respond accordingly.
2. Assess physical and mental health,
3. Explain that this is to STOP smoking, not cut down.
4. Assess current smoking - duration, frequency.
5. Assess past quit attempts - what worked last time, what was their downfall?
6. “When you smoke regularly, your brain changes so that it expects regular doses of nicotine. The need for nicotine can undermine your motivation to stop smoking, especially when linked with withdrawal symptoms.”
7. Assess dependence - based on number of cigarettes a day and how soon after waking they have their first.
8. Explain and conduct CO monitoring.
9. Explain that cutting down gradually can end up never actually stopping, and they smoke their cigarettes more intensely. Going cold turkey without support is more likely to start smoking again. So, abrupt cessation with support and NRT is the best solution.
10. Ask if they have a preference. If not, recommend patches + gum or lozenges.
11. Set the quit date.
12. Summarise.

Question 11

Why is CO monitored during smoking cessation?

Answer 11

Carbon monoxide is a gas inhaled by smokers when they smoke a cigarette and it causes heart disease. After they stop smoking, the level of CO in the body returns to that of a non-smoker. We can measure the amount of CO in the lungs and monitor it until it reaches 10 parts per million.

Question 12

How is a CO measurement performed?

Answer 12

1. Ask the client to take a deep breath.
2. Activate the monitor so it will start counting down from 15.
3. After 15s, client blows slowly into the mouth piece until their lungs are empty.
4. If result is >10ppm, explain this is because they are still smoking but as they stop it will decrease.
5. If result is <10ppm on initial assessment, explain that the normal reading for a non-smoker is 1-5ppm, and if they achieve quitting, it will be permanently under this.

Question 13

What are the options for NRT?

Answer 13

Patches - steady dose for 24h or 16h.
Nasal spray - fastest
Gum - different strengths. Chew then rest on inside of cheek to absorb.
Lozenge - different strengths. Suck then rest on inside of cheek to absorb.
Inhalator - faster than gum/lozenge and mimics smoking.
Microtab - small tablets which dissolve quickly under tongue.
Mouth spray - fast acting
Vapes - very effective but still carry risks.
Nicotine pouches/snus - not recommended.

Question 14

What is Varenicline?

Answer 14

A partial nicotine receptor agonist which reduces the urge to smoke and suppresses withdrawal symptoms. It also stops nicotine acting on the receptors, so smoking will not have the same effect, discouraging use.

Question 15

Varenicline side effects.

Answer 15

Nausea
Headache
Difficulty sleeping
Abnormal dreams

Question 16

How to take Champix/Varenicline?

Answer 16

Taken for 12 weeks, starting 1 week before the quit date.
Day 1-3: 0.5mg od
Day 4-7: 0.5mg bd
Day 8 onwards: 1mg bd

Question 17

What is Zyban/Bupropion?

Answer 17

An aminketone which reduces urge to smoke and suppresses withdrawal symptoms by mildly inhibiting reuptake of noradrenaline and dopamine.

Question 18

Zyban/Bupropion side effects.

Answer 18

Headache
Dry mouth
Difficulty sleeping

Question 19

How is Zyban taken?

Answer 19

1 tablet od for 7-9 weeks, started 1 week before quit date.

Question 20

What is the process of Stop Smoking Service?

Answer 20

Initial assessment.

Week 4 - establish progress and provide support.
If okay, supply pharmacotherapy. Agree next appointment so NRT overlaps.
If restarted smoking or CO >10ppm, discharge, reassure, signpost, and notify GP.

Week 12 - Establish progress, notify GP, and provide support. Stop pharmacotherapy.

Week 16 - optional CO monitoring to postively reinforce continued quit.

Interim appointments offered every 2 weeks.