Many smokers have not succeeded in quitting using a single nicotine replacement mode. An algorithm was developed for clinicians to enhance success rates when recommending nicotine replacement therapy (NRT) to smoking patients. The algorithm is based on clinical experience with chronic smokers with respiratory illnesses attending one-on-one smokers clinics in the Central Sydney Area Health Service. Based on transdermal nicotine therapy (patch) other forms of NRT are added if required for ‘breakout’ smoking for 2 weeks. Outcomes have shown 60% confirmed continuous abstinence at 3 months. Smokers can be safely and successfully treated symptomatically for nicotine withdrawal relief using combination NRT aggressively. This enhances treatment efficacy by minimising relapse in the first few weeks and months of quitting.
S moking prevalence of pregnant Aboriginal and Torres Strait Islander women is quadruple that of pregnant women in the Australian population, and is associated with significant adverse outcomes in pregnancy. While cessation is a priority, there is as yet little evidence for effective interventions. This paper provides a pragmatic approach to addressing the complexities of smoking in pregnant Aboriginal and Torres Strait Islander peoples and informs clinicians about the initiation of nicotine replacement therapy (NRT) in pregnancy. Experts agree that nicotine replacement is safer than continuing to smoke in pregnancy. Although a pharmacotherapy-free attempt is initially recommended, if abstinence is not able to be achieved in the first few days, the women should be offered an accelerated option of NRT starting with oral forms and then, if required, progressing to nicotine patch or combined oral and transdermal therapy. Support should be offered for at least 12 weeks and post-partum. Offering counselling and cessation support to partners and family is also important, as is linking the woman in with appropriate social and community support and Aboriginal specific services. As long as oral forms of NRT are not included in the Pharmaceutical Benefit Scheme for Aboriginal and Torres Strait Islander women a significant and inequitable barrier will remain.
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