Smoking cessation
All patients should be encouraged to stop smoking and offered support with smoking cessation. Suitable support could involve provision of nicotine replacement therapy (NRT), or other drug treatments such as varenicline or bupropion. This could also involve referring the patient to intensive NHS smoking cessation services.
Patients who are either unwilling or unable to stop smoking should be offered NRT to enable them to reduce the amount of tobacco they smoke. Professional advice and support on smoking cessation should be provided at every available opportunity.
Stopping smoking is beneficial to all patients irrespective of their age, although the sooner a patient stops the greater the improvement in their long term prognosis.
Patients who stop smoking before the age of 35 will have a life expectancy that is only slightly lower than that of a non-smoker, whilst stopping after the age of 35 will reduce life expectancy by approximately three months for every year of continued smoking. Patients who stop smoking before they are 50 will reduce their risk of dying from a smoking relating disease by 50%.5
Patients can be advised that some of the effects of smoking can be quite quickly reversed.
- Their pulse rate will return to normal after approximately 20 minutes.
- Nicotine levels will fall by 90% within 8 hours with all traces eliminated after 48 hours.
- Carbon monoxide levels are reduced by 75% after 8 hours.
- Oxygen levels also return to normal after 8 hours.
The increased risk of myocardial infarction reduces by 50% after 12 months and after 15 years is the same as that of a non-smoker.5
Patients wishing to simply cut down should be encouraged to stop completely as cutting down is not a substitute for stopping completely, and does not provide the same reduction in cardiovascular risk.