Special interest: Smoking cessation

The use of a nicotine patch before quitting may have a modest effect on abstinence, a large pragmatic randomised trial has found. A total of 1,792 adults were enrolled from Nottingham, Birmingham, Bristol, and London. All were daily smokers with tobacco dependence. The investigators concluded: ‘Nicotine preloading with a 21 mg/24 hr nicotine patch for four weeks seems to be efficacious, safe, and well tolerated, but probably deters the use of varenicline, the most effective smoking cessation drug. If it were possible to overcome this unintended consequence, preloading could lead to a worthwhile increase in long term smoking abstinence.’

Smoking is associated with an eight-fold increased risk of acute ST-segment elevation myocardial infarction (STEMI) in those under 50 compared with former and never smokers, a UK study has found. However, the incidence of acute STEMI in former smokers was similar to that in those who had never smoked, adding further evidence to the benefits of quitting smoking.

Exposure to tobacco smoke through passive as well as active smoking is associated with an increased risk of infertility and menopause occurring before the age of 50, a large observational study has shown. This is the first study to assess the impact of second-hand smoking on infertility and age of menopause.

Pollution caused by fine particulate matter (PM_2.5) is around ten times higher in homes where people smoke indoors compared with non-smoking homes, a study from Scotland has found. Furthermore, home air pollution from smoking appears to dwarf that from outdoor sources. Approximately 20% of those living in smoking homes in Scotland will inhale a lifetime mass of PM_2.5 greater than the median value predicted for a non-smoker living in a heavily polluted urban setting.

A prospective cohort study from the UK has found no evidence that varenicline or bupropion raise the risk of depression, self harm or suicide.

18% of all deaths in adults aged 35 or over in England are still attributable to smoking. Almost all these premature deaths could be avoided if smokers stopped before their mid-thirties but only a quarter of people who have ever smoked regularly manage to quit by this age. GP advice is one of the most important triggers to a smoker making an attempt to quit. Evidence shows that offering help to all smokers is easier, quicker and likely to be more effective than just advising smokers to stop or asking whether they are interested in quitting.