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Help smokers cut down if they can’t quit

GPs should suggest multiple types of NRT, inhaling less and ‘off-periods’

Louise Prime

Wednesday, 24 October 2012

Smokers who really don’t feel ready to face stopping smoking completely should be helped to cut down gradually, the National Institute for Health and Clinical Excellence has suggested in draft guidance this morning. It says although evidence shows that stopping all at once is the most successful strategy for those aiming to quit, some smokers may be put off even trying because this seems too difficult to contemplate – and says they should be helped to reduce the harm of smoking.

NICE recommends in its draft guidance that doctors and other stop-smoking advisers should assess smokers’ level of dependence, and use that information to inform discussions about goal setting and reduction strategies.

The guideline includes recommendations on how licensed nicotine replacement therapy (NRT) products can be used to help patients to gradually cut down their smoking before quitting completely. It says that smokers should be offered a choice of all types of NRT, either alone or in combination, and that highly dependent smokers are more likely to succeed in quitting when they use multiple product types. NICE adds that advisers should tell patients that the safety and quality of so-called ‘electronic cigarettes’ and certain other products cannot be assured because they are not covered by the regulatory agencies.

It suggests that doctors and stop-smoking advisers counsel would-be quitters – who comprise about two-thirds of all smokers – on using tactics such as waiting longer for their first smoke of the day, inhaling less, or stopping smoking on certain occasions or during fixed periods of the day, for example while at work, as part of a harm reduction strategy.

NICE has also called for licensed NRT products to be displayed alongside cigarettes wherever they are sold, whether in shops or online.

Professor Mike Kelly, director of NICE’s Centre for Public Health Excellence, said: “If you are a smoker, quitting smoking is the best way to improve health, and quitting in one step is most likely to be successful. However some people – particularly those who are highly dependent on smoking - may not feel able (or don't want) to do this.

“Harm reduction approaches provide an alternative choice, and are more successful when used with licensed nicotine-containing products. Methods such as ‘cutting down to quit' may appeal to people who feel unable to quit in one step. ‘Smoking less’ is an option for those who are not interested in quitting smoking, although the health benefits are not clear. However, for some people this can kick-start a gradual change in behaviour that eventually leads them to quit smoking.

“Health professionals should advise people who smoke and want to try cutting down to quit, or smoke less, that this is easier when using licensed nicotine-containing products.

“Whatever approach people wish to try, they should be advised that there are no circumstances when it is safer to smoke than to use NRT products and experts believe that lifetime use of NRT will be considerably less harmful than smoking.”

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