Smoking cessation

Data gathering

  • Red flags – SOB, haemoptysis, weight loss
  • Others – stop date
  • Examine – BP, sats, chest


Clinical management

  • Explanation
    • nicotine is the addictive ingredient in cigarettes, as levels fall -> cravings/anxiety/headaches
    • can use things to substitute
  • Treatment
    • Nicotine replacement – gum/patches/lozenges
    • Varenicline (Champix) – mimics nicotine, 12wk course, caution if depression, contraindicated if pregnant/renal disease/breastfeeding/child, SE: nausea, insomnia, mood changes
    • Buproprion (Zyban) – relieve withdrawal symptoms, 8wk course, caution if depression, contraindicated if epilepsy, pregnant/breastfeeding/child, SE: dry mouth, insomnia, seizures
    • Refer – smoking cessation service, counselling/telephone support
  • Follow-up – see again in 1/12 for support


  • All medical treatments are more effective with behavioural treatments
  • Nicotine replacement therapy – 12 week course, weaning dosage, patches provide regular background dose, gum provides top up for cravings, safer than smoking during pregnancy/breastfeeding (but avoid patches)