BMJ  2007;335:37-41 (7 July), doi:10.1136/bmj.39252.591806.47

Clinical Review

Managing smoking cessation

¹ Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT , ² Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London WC1E 6BT

The first 150 words of the full text of this article appear below.

Cross sectional studies show that most smokers in countries such as the United Kingdom and the United States report that they want to stop and intend to stop at some point.¹ The rate of attempts to stop is high—78 attempts per 100 smokers per year in the UK—with many smokers making several attempts in a year.² Nearly half of all smokers expect not to be smoking in a year's time,³ but only 2-3% actually stop permanently each year.³

The most common reasons smokers give for smoking are stress relief and enjoyment,⁴ but the main reason is nicotine dependence. Nicotine acts in the midbrain, creating impulses to smoke in the face of stimuli associated with smoking.⁵ Consequent changes in brain chemistry also produce "nicotine hunger" when a smoker goes without nicotine. A third mechanism underlying nicotine dependence is nicotine withdrawal: unpleasant mood and physical symptoms that occur on abstinence and are . . . [Full text of this article]

Summary points

Why should healthcare professionals help patients stop smoking?

How should I broach the subject of smoking?

Nicotine replacement therapy

Antidepressants

A new drug

Choosing treatment

How do I treat special groups?

Light and social smokers
Pregnant women
Adolescents

Is behavioural support or counselling effective?

Other strategies

How do I help my patients avoid relapse?

Conclusions

Prescribing smoking cessation drugs
Bupropion
Nortriptyline
Varenicline
Nicotine replacement patches
A patient's story
Methods
Ongoing research and unanswered questions
Additional educational resources
Information resources for patients

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Authors' reply to letter

Paul Aveyard and Robert West
BMJ 2007 335: 222. [Extract] [Full Text] [PDF]

Article skips over weaknesses of nicotine replacement

Manfred Neuberger
BMJ 2007 335: 112. [Extract] [Full Text] [PDF]

New types of Paps and puffs

Douglas Kamerow
BMJ 2007 335: 0. [Extract] [Full Text]

Mortality in relation to smoking: 50 years' observations on male British doctors

Richard Doll, Richard Peto, Jillian Boreham, and Isabelle Sutherland
BMJ 2004 328: 1519. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Sudlow, C (2008). Preventing further vascular events after a stroke or transient ischaemic attack: an update on medical management. PN 8: 141-157 [Abstract] [Full text]  
• (2008). {blacktriangledown}Varenicline for smoking cessation. DTB 46: 33-36 [Abstract] [Full text]  
• Aveyard, P., West, R. (2007). Managing smoking cessation. Authors' reply to letter.. BMJ 335: 222-222 [Full text]  
• Neuberger, M. (2007). Article skips over weaknesses of nicotine replacement. BMJ 335: 112-112 [Full text]  

Rapid Responses:

Read all Rapid Responses

Personal View of Smoking

Bhavesh C. Gohil
bmj.com, 6 Jul 2007 [Full text]

"Managing smoking cessation" driven by commercial interests of pharmaceutical industry ?

Manfred Neuberger
bmj.com, 8 Jul 2007 [Full text]

Isn't prevention better than cure??

Rajasree R pai, et al.
bmj.com, 10 Jul 2007 [Full text]

Spin is a poor Substitute for Science

Andrew J Ashworth
bmj.com, 11 Jul 2007 [Full text]

Smoking: Management of curtailing smoking by educating adolescents universally

Urban J.A D'Souza
bmj.com, 12 Jul 2007 [Full text]

Responses to correspondents

Paul Aveyard, et al.
bmj.com, 18 Jul 2007 [Full text]

Tobacco and oral health

Eduardo M. Curbeira Hernández MDD, et al.
bmj.com, 20 Jul 2007 [Full text]

Exclusion of Psychiatric Patients

Mohammad S Rahman, et al.
bmj.com, 22 Jul 2007 [Full text]