Helping people to stop smoking: the new smoking cessation guidelines.

Cigarette smoking is probably the most damaging of all voluntary human behaviour. Half of all smokers die prematurely as a consequence of their own smoking, 1 and in 1995 in the UK alone smoking accounted for over 120 000 deaths, of which about 65 000 were due to respiratory disease. 2 In addition to the harm caused to smokers themselves, passive exposure of other adults to cigarette smoke is associated with increased respiratory morbidity 3 and an increased risk of lung cancer and heart disease, 4 5 whilst children brought up by parents who smoke are more likely to experience lower respiratory illness in infancy, 6 sudden infant death, 7 and middle ear disease, wheezy bronchitis and exacerbation of asthma in childhood. 8–10 In addition to these direct eVects of tobacco smoke, cigarette smoking aVects health indirectly through the cost to the individual of sustaining their smoking habit, which contributes to financial hardship and consequent deprivation of smokers and their dependents. The total social, economic, and health related cost to society of smoking is enormous, and prevention of smoking therefore deserves to be a major priority for all health professionals. Respiratory physicians should have a particular interest in smoking prevention because so much of the morbidity and mortality caused by smoking manifests as respiratory disease. Preventing smoking, particularly at the primary level, is a major task and, as is often the case, the power to enact radical preventive public health measures lies with politicians more than doctors, though the medical profession certainly has its role to play in driving that political debate. At the level of secondary prevention, however, eVective means of helping people to stop smoking have been available to the profession for many years, yet for various reasons it has failed to apply them. Part of the reason for this is perhaps that smoking has tended to be, and is still widely perceived to be, a matter of personal choice rather than an addictive behaviour. Today's doctors were not taught about the addictive nature of smoking or its treatment and, as other articles in this issue of Thorax point out, 11 12 nor is the current generation of medical students. Hence, despite the fact that it is now nearly 20 years since Russell and colleagues documented the eVectiveness of simple advice from the primary physician to give up smoking, 13 relatively few doctors routinely apply even this simple …