- Carbon monoxide (CO) assessment
- Intensive behavioural support
- Joint strategic needs assessment
- Licensed nicotine-containing products
- Nicotine-containing products
- Nicotine replacement therapy (NRT) products
- Secondary care
- Smoking cessation (stopping smoking)
- Stop smoking services
- Temporary abstinence
A carbon monoxide assessment is a non-invasive biochemical method for measuring CO from expired breath. It can detect exposure to CO which may come from tobacco smoke, traffic emissions or leaky gas appliances.
A formulary is a list of healthcare treatments and drugs approved for use within a health economy, service or organisation.
Intensive interventions typically involve scheduled face-to-face meetings between someone who smokes, either alone or in a group, and a counsellor trained to provide stop smoking support. The discussions may include information, practical advice about goal-setting, self-monitoring and dealing with the barriers to stopping smoking as well as encouragement. Intensive behavioural support also includes anticipating and dealing with the challenges of stopping. Established and effective behaviour-change techniques should be used (see NICE public health guidance 6 on Behaviour change). Support is typically offered weekly for at least the first 4 weeks of a quit attempt (that is, for 4 weeks after the quit date) or 4 weeks after discharge from hospital (where a quit attempt may have started before discharge), and normally given with stop smoking pharmacotherapy.
A joint strategic needs assessment provides a profile of the health and social care needs of a local population. Joint strategic needs assessments are used to develop joint health and wellbeing strategies. They are also used for commissioning to improve health outcomes and reduce health inequalities.
Nicotine-containing products that are licensed have been given marketing authorisation by the Medicines and Healthcare products Regulatory Agency (MHRA). At the time of publication (November 2013), nicotine replacement therapy (NRT) products were the only type of licensed nicotine-containing product. However, the MHRA has decided that all nicotine-containing products should be regulated and this is expected to come into effect in 2016. In the meantime, the UK government will encourage applications for medicines licences for nicotine-containing products and will make best use of the flexibilities within the existing framework to enable licensed products to be available. For further details, see the MHRA website.
Products that contain nicotine but do not contain tobacco and so deliver nicotine without the harmful toxins found in tobacco. Some, such as nicotine replacement therapy (NRT), are regulated by the MHRA (see licensed nicotine-containing products). Unlicensed products that are currently being marketed, such as electronic cigarettes, and products new to the market will need a medicines licence once the European Commission's revised Tobacco Products Directive comes into effect in the UK (this is expected to be in 2016). For further details, see the MHRA website.
Nicotine replacement therapy products are licensed nicotine-containing products for use as a stop smoking aid and for temporary abstinence, as outlined in the British national formulary. They include: transdermal patches, gum, inhalation cartridges, sublingual tablets and a mouth and nasal spray.
Pharmacotherapy is the treatment of addiction through the administration of drugs. Stop smoking advisers and healthcare professionals may recommend and prescribe licensed nicotine-containing products, varenicline or bupropion as an aid to help people to stop smoking. Licensed nicotine-containing products may also be offered to support temporary abstinence from smoking in the secondary care setting.
Secondary care refers to all publicly-funded secondary and tertiary care facilities, including buildings, grounds and vehicles. It covers drug and alcohol services in secondary care, emergency care, inpatient, residential and long-term care for severe mental illness in hospitals, psychiatric and specialist units and secure hospitals and planned specialist medical care or surgery. It also includes maternity care provided in hospitals, maternity units, outpatient clinics and in the community. It can be planned or emergency care. Planned secondary care generally follows a referral from a primary care provider, such as a GP.
Smokefree means air that is free of smoke and applies to hospital buildings, grounds and vehicles.
Stopping smoking with the intention to stop permanently. Stopping may be abrupt or by cutting down before stopping.
Stop smoking services provide a combination of behavioural support and pharmacotherapy to aid smoking cessation. NHS behavioural support is free but the pharmacotherapy may incur a standard prescription charge. The evidence-based treatment is based on the National Centre for Smoking Cessation and Training (NCSCT) standard programme and involves practitioners trained to their standard or equivalent.
Not smoking for a limited period of time. This could be for a particular event, for example, during a hospital stay or contact with secondary care providers, or in preparation for planned use of secondary care services such as elective surgery, or while visiting or working in a secondary care setting.