Colin Mendelsohn

Supporting smoking cessation

#### Summary points Despite the decrease in prevalence of tobacco use in developed countries, smoking remains the most common preventable cause of disease and death in the world today. Advice on smoking cessation from doctors and other health professionals has been shown to improve quit rates and is highly cost effective.1 Given the importance to health of tobacco use and the benefits of cessation, every doctor should encourage attempts to stop, be able to provide brief smoking cessation intervention, and be aware of referral options (see box 1). Over the past decade there have been advances in the science and practice of smoking cessation support. These include new medicines to treat nicotine dependence, new ways of using existing medicines, and increasing use of technology to support behavioural change. This review provides an update on evidence based approaches to maximise the effectiveness of the treatment of tobacco dependence. #### Sources and selection criteria This review is based on evidence synthesis from relevant Cochrane systematic reviews; review and distillation of clinical practice guidelines from Australia, the United States, and New Zealand; information from UK National Centre for Smoking Cessation and Training (www.ncsct.co.uk); and other evidence from the authors’ personal libraries. We have focused on developments since the review by Aveyard and West in 2007.2 The prevalence of tobacco use varies around the world. Of …

EFFECT OF TRAINING ON GENERAL PRACTITIONERS' USE OF A BRIEF INTERVENTION FOR EXCESSIVE DRINKERS

Objective: To determine among general practitioners (GPs) the effect of three different types of training on utilisation of a brief, controlled drinking intervention. Design: A non‐randomised intervention study.

Smoking and mental illness. An update for psychiatrists

Objective: We aimed to review research on smoking and mental illness and provide evidence-based guidelines for psychiatrists to help smoking patients quit. Method: We undertook a narrative review of the literature with a special focus on the Australian context. Results: Although one in three people with mental illness smoke tobacco, smoking is often neglected in psychiatric practice. Smoking is a significant contributor to the health gap between people with mental illness and the general population. Smokers with mental illness are motivated to quit and are able to do so, albeit with lower quit rates. Quitting can lead to substantial improvements in mental wellbeing and physical health and does not exacerbate pre-existing mental illness. Psychiatrists should advise all smokers to quit and provide counselling, medication and support, based on the 5As framework. Approved pharmacotherapy – nicotine replacement therapy, varenicline and bupropion – is recommended for nicotine-dependent smokers. Smoking induces the metabolism of certain psychotropic drugs such as clozapine and olanzapine and dose reductions may be necessary after cessation. Conclusions: Psychiatrists have a duty of care to identify the smoking status of their patients and to provide evidence-based support to quit.

Physicians' Views of Programs Incorporating Stages of Change to Reduce Smoking and Excessive Alcohol Consumption

Family medical practice is an ideal context for the early detection and delivery of programs to reduce tobacco and excessive alcohol use. Family doctors have a high contact rate with the general public and are readily accessible. L2 A study conducted among more than 13,000 patients served by 119 family physicians in Sydney reported that 35% of men and 29% of women were smokers 3 and 12 and 10%, respectively, were drinking alcohol at levels considered hazardous or harmful. 4 Indeed, a majority of these patients felt their doctor should be interested in their smoking and drinking. -~

Letter to the Editor: Pulmonary toxicity of electronic cigarettes: more doubts than certainties

to the editor: In a recent issue of the American Journal of Physiology-Lung Cellular and Molecular Physiology , we read with great interest the review article by Chun et al. ([2][1]) about potential pulmonary effects of electronic cigarettes (ECs). This is a timely topic, and the authors do a

Promoting positive attitudes of tobacco-dependent mental health patients towards NRT-supported harm reduction and smoking cessation.

Australian & New Zealand Journal of Psychiatry, 48(10) MHSA-OCP-20130809.pdf?MOD=AJPERES& CACHEID=3d07300040a491ea9660bfe03467 6b7b (accessed 17 May 2014). Harris MG, Buckingham WJ, Pirkis J, et al. (2012) Planning estimates for the provision of core mental health services in Queensland 2007 to 2017. Australian and New Zealand Journal of Psychiatry 46: 982–994. Health Outcomes International (2013) SA Health: Evaluation of the intermediate care services. Final report. Adelaide: Government of South Australia. Available at: www.sahealth.sa.gov. au/wps/wcm/connect/b07eb98042ec81578c28 bc9d0fd82883/ICC+Final+eval+report.pdf?M OD=AJPERES&CACHEID=b07eb98042ec815 78c28bc9d0fd82883 (accessed 17 May 2014). Organisation for Economic Cooperation and Development (2013) OECD health statistics 2013: Frequently requested data. Available at: www.oecd.org/els/health-systems/oecdhealthdata2013-frequentlyrequesteddata.htm (accessed 21 May 2014). Siskind D, Harris M, Kisely S, et al. (2013) A retrospective quasi-experimental study of a community crisis house for patients with severe and persistent mental illness. Australian and New Zealand Journal of Psychiatry 47: 667–675. Thomas KA and Rickwood D (2013) Clinical and cost-effectiveness of acute and subacute residential mental health services: A systematic review. Psychiatric Services 64: 1140–1149.

Electronic cigarettes: what can we learn from the UK experience?

Although the sale, possession and use of nicotinecontaining e-cigarettes without a permit are illegal in Australia, the devices clearly have appeal to smokers and are increasingly popular. Current use of e-cigarettes increased from 0.6% to 6.6% in current and former smokers over a 3-year period from 2010 to 2013. The rate of responders reporting that they had “ever used e-cigarettes” in this population increased from 9.6% to 19.7% over the same period. In 2013, 42.5% of users reported that their current brand contained nicotine.

Electronic cigarettes in physician practice.

There is growing evidence for the effectiveness of e‐cigarettes as a quitting aid and, although not completely harmless, the scientific consensus is that they are substantially less harmful than smoking tobacco. More research is needed, but there is now sufficient empirical evidence and real‐world experience over more than a decade to consider their use as a legitimate tobacco harm reduction tool for smokers who are unable or unwilling to quit with conventional strategies. Smokers should be advised that the highest success rates occur with daily use with nicotine e‐liquid and newer e‐cigarette models. After quitting smoking, it is preferable to aim ultimately to cease vaping if possible, but long‐term use of e‐cigarettes is safer than relapsing to smoking.

The evidence supports prequit use of nicotine patches

Hartmann-Boyce and Aveyard state that there is insufficient evidence for starting nicotine replacement therapy (NRT) before quit day (prequit treatment or preloading).1 While this is true for oral NRT products such as the nicotine gum or lozenge, there is sufficient evidence that starting the nicotine patch two weeks before quit day significantly increases …

Use of Nicotine Replacement Therapy in Young People Entering Custody in New South Wales, Australia

homozygous for a known TNSALP gene mutation. She had persistent hypercalcaemia, failure to thrive and at 3 months developed severe bronchiolitis requiring intubation and ventilation for 2 weeks. Following reports of dramatic improvements in mineralization for this previously untreatable disease in animal models and humans, asfotase alfa was commenced at 4 months (2 mg/ kg subcutaneously (SC) three times per week). Biochemical disturbances resolved quickly and a further episode of bronchiolitis at 5.5 months was managed with nasal prong oxygen only; no further invasive ventilation has been required. She showed marked improvement of mineralization on serial radiographs, with straightening of her femori (Fig. 1). Her linear growth has been steady. She has been making excellent developmental progress, with no ongoing issues. She had persistent craniosynostosis, which required cranial advancement surgery at aged 3, which was uncomplicated with resultant normal cranial shape. Calcification was noted on radiography at injection site but nothing was palpable clinically – this had largely resolved on follow-up radiograph 1 year later with increased injection site rotation and switching to 1 mg/kg SC, six times per week. Nephrocalcinosis had been noted on ultrasound prior to commencement of ERT, but had resolved by age 4. This successful outcome is reflected in the clinical trials showing improved survival and respiratory outcomes, with no significant side effects reported. We conclude that ERT should be strongly considered for this previously untreatable condition.