Many of the conditions leading to hospital admission are related to smoking, and smokers admitted to hospital are often particularly receptive to offers of help to quit. In addition, hospitals provide a smoke-free environment supportive of quitting. Hospital admission therefore presents a 'teachable moment', when patients at risk from smoking may be helped to quit.

The evidence for the effectiveness of stop-smoking interventions started in hospital has recently been reviewed by the Cochrane Tobacco Addiction Research Group, who found that counselling increases the odds of a successful quit attempt.

The review covered 33 randomised or quasi-randomised controlled trials, with a total of more than 14,000 participants.

To be included, the studies had to report abstinence data at least six months after the start of a hospital-based stop-smoking intervention. The most conservative measure of quitting at the longest follow-up period was used; ie biochemically-validated, sustained abstinence to one year was used where available.

The researchers found that intensive stop-smoking interventions, started in hospital and continued for at least one month after hospital discharge, can increase the odds of quitting smoking by 65% at 6-12 months after discharge. Less intensive interventions are unlikely to be effective.

The review also provided some evidence that adding nicotine replacement therapy (NRT) to counselling in hospital improves quit rates. Pooled analysis of five studies estimated a 47% increase in the odds of quitting when NRT was added to counselling, but the result was not statistically significant.

The effectiveness of hospital-initiated smoking cessation interventions occurred regardless of the patient's admitting diagnosis, and the researchers suggest that such interventions should therefore be made available to all hospitalised smokers.

From the GP perspective, it is vitally important that the quitting smoker continues to be supported after discharge from hospital, as only then is the benefit of the hospital intervention achieved.

Rigotti NA, Munafo MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2007;3: CD001837