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Giving up smoking

Help from pharmacists, GPs, and Nicotine Replacement Therapies

Although many people decide to try to quit smoking by themselves others seek help from a pharmacist or their GP. Here we discuss the help they got, including their experiences of medical treatments and nicotine replacement therapies (NRT).

Support through pharmacies

Some people went to their local pharmacy for information and nicotine replacement therapy products to help them quit smoking. Pharmacists can offer follow up visits and NRT on prescription; some people were impressed with the service and the range of stop smoking products though Cassie expected a bit more personal help.
 

The pharmacist just gave Cassie forms to fill in when she asked for an NRT inhaler. She expected more support and interest.

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Age at interview: 22
Sex: Female
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My current attempt is not going so great. I gave up. I went to the pharmacist and I got the patches, but he wasn’t very encouraging. He didn’t even talk to me. He just like threw a form at me, got me to fill it out and then just gave me the patches and I asked for the inhalater because my Mum had it, and she’s trying to quit, and no words of encourage, no talking to me to find out how I feel about it. And just literally couldn’t wait to get me out the door. So I just felt really rubbish, because to me it’s a big thing and I kind of wanted the support, but I didn’t get it, and that put me off as well. So when they ran out I didn’t go back to him.
 

When Andrew learned there was a 6 week wait for support at his GPs, he went to his local pharmacy and found flexible and personalised support.

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Age at interview: 32
Sex: Male
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When I went and made an appointment they were like, “Oh there’s a... there’s a six week waiting list.” “I want to give up now. I don’t want to wait six weeks. I want to give up now. I’m ready to give up.” The six week wait was massively… there is only one woman does it at the health centre. So it was a really bad do, it really snowed under. I was like it’s no use to me, I want to give up now. Six weeks time, I said, “I’ll go to the pharmacist.” So I went next door to the, to the chemist. Because there was no waiting list, you just went, just walked in, and … Well you had to make an appointment. But it was like when do you want to come. Whenever. So do whenever. And saw one of the ladies there. You didn’t actually see the chemist. It was just one of those who worked there. I did it through them.

And did you have, you know, a full appointment to talk about things? Or did she just sort hand over patches?

No. You had a full appointment and do the... you blow into something and it measures your carbon monoxide in your blood. They should do it at the doctors I’m sure. They did that and it was just exactly the same. I mean you weren’t seeing a doctor at the, at the GP. You weren’t actually seeing a GP the first time, you were seeing a nurse and so it wasn’t vastly different. I thought it was... in a way, in a way it was better, because they hadn’t got this huge amount of patients to get through. And don’t get me wrong, the nurse was brilliant. She knew your name and everything. She was lovely, really lovely. But she’d obviously have to see all these people. If I had have made an appointment to see her, once you got in with her, it was quite a difficult… she used to see you at set times. She’d have you and you’d be like Tuesdays at 10 o’clock and you’d see her then and that was all, you couldn’t move it or do anything different. The pharmacist, obviously they don’t see many people, so it was just like you.

… and if they said, “You can always ring us or you can just always call in and see…” They all, I mean this is a little village, and the lady I did it with lives in the village and has always lived in the village and works there and you see her like about anyway, and she was like, “Just call in and..” what do I say, yes, and then last... when I actually gave up this time. I think it was the third, I did more than did I do more than the twelve week course? No. Oh no, I kept going back to see her. So even though I done the twelve weeks, because you can only do twelve weeks on the NHS and that’s a cheap way of doing the patches, and they are really expensive otherwise aren’t they? But I said to her, oh the time before I’d given up, I’d finished the patches and I had just started again, and she said, what she could do, she’s not a nurse, she’s not as constrained by the NHS. She said, “Come back and see me. Make another appointment in a week and see me. You can’t have any more patches unless you want to buy them yourself. But you don’t need any more patches. But come back and see me? And may be having that appointment, knowing you’ve got to come back and see someone, will help you stay stopped.” And then, so I did. I went back and seen her, it might have been a week, it might have been a month. So I might have seen her every month, probably for three or four months. And then it was like, well we’ll go to two months this time. So I actually probably stayed seeing the pharmacist for a, I don’t know how long. A little while, which through the GP they wouldn’t have had that flexibility, because they partly crash the numbers and partly because it is very regimented. This is what you have to do. Right this patients done, sign them off, next one. So I actually found the pharmacist better. I’m not knocking the GP’s, but the pharmacist was a lot better, because they’d got that flexibility.
 

Peter went to Boots to get advice and support on giving up smoking. He tried chewing gum as well as patches.

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Age at interview: 39
Sex: Male
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I managed to stop the first time though and that was kind of partially by help buying the Boots programme, by going back and talking to the Boots people and being reminded. You know, just having some scaffolding around which to accompany it is quite important for me anyway. And so I did the same again when I did the second time round, because I knew that I could finish, I could get over the sort of initial hurdle which is the worst and…

Tell me about the Boots help, how you…?

Well it’s very simple. They tell you they set targets, they want you to come up with a date for finishing. So it sort of becomes concrete. And for me it was, it’s just very sensible and they give you a range of products and so the second time round I did it [laughs]. I was kind of clinging to the products more than the first time, because it was just cold turkey, it didn’t bother me, I didn’t bother with the products I just went back to kind of blow into the thing and tell them yes, I haven’t smoked and [laughs] and it was sort of validated and confirmed and that seemed to be its function.

And that kind of scaffolding. The second time round I was much more sort of dependent on the products and sort of oh I’m going away on holiday, I must have and all this kind of stuff. So kind of clinging to it.

So what prompted you to go to Boots and get the help?

Well I think in both, both times, the second time I knew that it, it would work, so why not just do the same thing again? First time I think it was just a sort of sense that because I work from home, alone. I don’t have people around me very much. You know, like it was working like I needed some other kind of context to, in which to fit this. Some other, someone else to be responsible to. And to sort of show it to. And also to sort of talk through what the problems are and all that sort of thing. Because they give you some good advice. I mean some of it is useful to you and some of it, not so useful. I think it depends what you need and you just kind of use and discard what you need.

So yes, so what prompted it was that and obviously the knowledge that it existed. I can’t remember how I found out but I did.

So what for you as an individual were some examples of the good advice that you got some things that you might have discarded?

Examples of good advice the second time round what stuck, what stuck with me, was this comment that the sort of receptors in your brain, she said would you know always be clued into nicotine. So if I have a fag you know, I’m probably going to be instantly addicted again [laughs]. Because that’s what happened. That’s what happened when I started again. So that was sort of quite sort of useful. I suppose.

The other one was that if, I would get quite irritable and that’s according to them that’s associated with a more sort of depressive personality which I thought was quite interesting and yes, setting a date, I think just achievable goals. it’s sort of sensible things. Replacement activities. Finding other things to do. Being systematic about it. Most of which were things that I kind of clung to more desperately in the immediate aftermath and then kind of developed into my own things later. So they give you some concrete little like brochures with, you know, I can’t remember exactly. It was like a, like a little table and, and you could write down sort of alternative activities other than smoking. Actually it just turned into silliness in my case. So I just wrote stupid things and then went and did stupid things, but that was just out of desperation [laughs]. And to make my wife laugh.

And but it sort of worked.
 
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After falling ill with cellulitis and temporarily not wanting to smoke, Blodwen went to the chemist to ask about products to help her quit.[TEXT ONLY]

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Age at interview: 55
Sex: Female
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I just became ill. As I said it sort of, yes, I became ill. I had cellulitis and I felt terrible. I was in bed for about a couple of weeks. And I just couldn’t, I didn’t go out, so I didn’t have any cigarettes, and I didn’t feel the need for a cigarette. And then I think in that, in that meantime, my friend had sort of said, “Well yes, I’m giving up as well.” So that again, well yes, I don’t need to restart again.

So, on that I went to the chemist and because I hadn’t smoked for a fortnight. They sort of encouraged me and said, “Yes, you can do it. Because, you know, like just carry on. You just don’t, you don’t need patches. You know, just to have the chewing gums and the inhalator.” and basically it was the chewing gums that did it for me, more than anything else. So...
Gareth had a friend in a pharmacy and went there to check out what new products there were. His friend gave him some nicotine replacement inhalers, but he never opened the packet but didn’t want to use them in the end.

Support through GPs

GPs can give advice on how to quit smoking. They can also refer people to a nurse specialising in smoking cessation or to other NHS ‘stop smoking’ support services. In addition to advising on lifestyle and behavioural changes, GPs can prescribe drug treatments including:
 
  • nicotine replacement therapy (NRT),
  • bupropion (Zyban; Wellbutrin in the US) originally used for depression but in the UK now only to help people quit smoking,
  • and varenicline (Champix; Chantix in the US) which can help people quit by acting on nicotine receptors in the brain.

 

Dr Helen Salisbury, a GP, talks about what they would do if somebody mentions that they would like to give up smoking.

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As a GP what would you do if somebody mentions that they would like to give up smoking?

First of all I would rejoice because I think it’s very important that people do give up smoking. It’s a very harmful habit. And the first question really is: What sort of help would you like with that? What have you tried? What has worked in the past? What has been difficult for you and for me it’s finding out what are the stumbling blocks to giving up. Often when people say they’d like to give up behind that is also a request for some help. And that help can be in the form of advice and just support. Actually if you have told someone you are going to do something that in itself is more of an impetus to do it rather than if it’s just a promise to yourself. So just being part, just hearing that intention can be helpful but often patients want more than that. They also want something concrete and in our practice and in most GP practices it’s the nurses who provide the detailed smoking cessation advice and also handle the prescriptions for all the different sorts of aids there are to smoking cessation, the different sorts of nicotine replacement and other tablets than can help.
 

Dr Helen Salisbury, a GP, explains what the smoking cessation nurses do.

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Smoking cessation nurses are key in this because they are the people who day in and day out see people, see people again and see people again and again and see people who have failed to quit and come again to be seen. And lots of people have to make lots of attempts to quitting smoking before they succeed and the smoking cessation nurses are there every time to help them to do that. They are there to provide both the psychological support and also to give them the prescriptions for the nicotine patches or whatever other aid they are using. But they are the people with whom patients can sort out the framework for giving up smoking, sort out the timetable they are going to aim for. So they are really very much the key part of smoking cessation for the NHS.
People who went to a GP for help were offered a range of types of treatment and encouragement to help them stop.
 

Munir was referred to a nurse in his GP’s practice. She offered him support, and prescribed NRT patches and varenicline.

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Age at interview: 54
Sex: Male
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The biggest help was my doctor’s nurse… She was fantastic, you know, she was fantastic.

Could you tell me a little bit about her?

She’s a relative of ours, and she works for my GP and she’s been working for him quite a number of years, and I just went in to see her as general, as check up and she says to me, “How many cigarettes are you smoking?” I said. She said, “Do you want to give up smoking?” I said, “Of course I’d love to give up smoking. I wish I could.” She said, “You’ve tried?” I said, “I’ve tried. But I can’t.” You know, all I’ve managed to do, is stay off for a couple of months at the most, and then start again.

She said, “What have you been doing?” I said, “Patches.” So she says, “I’ll give you some stronger patches.” I said, “No. it just won’t work I want to try something else.” So she gave me some medicine, some tablets. And she gave me, I think it was, a 14 day course I think. Within about the 5th or 6th day I just couldn’t smoke. I just don’t smoke and after a while I feel sick, I feel, you know, I can’t sleep at night. And I told her this problem. And she says, “Just hang on in there. Just hang on.” She, she supported me a lot. She, she, yes, she gave me a lot of the support.

And what were the tablets that you took?

I can’t even know what the name of the tablets.

Champix?

Exactly. Exactly. Champix. Every time you smoke they make you feel awful. You know, they tasted so bad as well. Yes. So I’m glad she, she prescribed me the Champix and they did well for me.

And you were talking about using the patches before. Were they prescribed from your GP or…?

No. I brought them from the chemist. But, this year. But they were helpful. You know, they did help me. The patches did help me, but the thing, I expected was after three or four weeks I’d stop using them. You don’t go to buy them again and then you know, you get another cigarette offer and then you smoke it again, and it starts all over again. But my, I think the reason for my giving up cigarettes was one of them Champix made me feel so bad that they made me hate the smell of cigarettes and cigarettes themselves and also my missus and son, you know, they were a big contribution as well for making me no smoking. They’re sweet.
 

On her second attempt to quit Carol got further support through her GP. A nurse prescribed Zyban (bupropion) and coached her through a 9-week programme.

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Age at interview: 54
Sex: Female
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Well I had, I would have to go every week, Zyban was a nine week programme

And then of course, the nurse will sit with you and she will chat to you and help you with your motivations and I suppose help you get into the right head space to continue with giving up smoking. And it’s not, you’re not rushed, and you’re not, you know, if you want to sit and talk, they are more than happy to sit and talk with you, which I enjoyed actually, because I was giving up smoking because I was, my daughter was pregnant and I wanted to have full access to my granddaughter when she arrived, and not having to disappear into the garden to, to have a cigarette, whilst I was half way playing tea parties with her. I didn’t want that.

And so, I had the motivation to actually do it. And I think, that is what you have to have, is the right motivation. If, if you don’t, if you’re not in the right head space, you’re not going to succeed I don’t think. And I think what happened, the nurse in the practice she was able to re-confirm that I was right, in the right head space and able to you know, continue with the non-smoking.

And I must admit, you know, two years later, I can’t thank my practice enough, because that’s what they did. They, they helped me give up smoking. And to be positive about it. So from that point of view, yes. I would say, well I still cross my fingers and I still say, because occasionally I still think ‘oh I’d love a cigarette,’ but as fast as that goes into my head, it disappears out. I just know that I can’t have that first cigarette, and it doesn’t worry me anymore. I don’t think I’ll ever go back to smoking.
Raf had tried many different ways to stop smoking but he found out about Champix (varenicline) through a GP friend of his. It took away his desire to smoke and made cigarettes taste unpleasant. People sometimes expected the GP to just give them a prescription for a medication but they also got advice on behaviour change and support. This was welcomed by some but, others wondered why it was necessary.
 

Chris saw a smoking cessation nurse who supported her through many attempts at giving up. Nicotine gum helped her.

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Age at interview: 65
Sex: Female
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She’s got so much faith in me and each time I’ve let her down, I feel awful, you know, and ‘Right, okay Christine stop for the day, come back when you’re ready again’. She sort of seems to just understand. Yes, well there’s a lot of people think oh yes, waste of space you know. But then she had me a talking to, she said, “You’ve given it how many goes now? At least ten since you’ve been with me.” [Laughs]. You know, there’s only a certain amount of time you can keep going, coming back and going on the patches. You’’ have to sort of have a break for a couple of years and then come back and see if it’s any better. But it wasn’t. She just said, you know, “Right, you’re ready to stop?” I said, “I’m ready.” She said, “Right, we’ll give you some patches.” Oh no, my doctor at the hospital, he said again, “You must, must give up smoking.”

And you were seeing him because?

As, for my lungs. And he said, “I’ll write to your doctor and we’ll give you everything that you need to stop smoking. That’s how serious it is that you have to stop smoking.” So anyway, she said, “Right, what, what, what do you think you fancy?” I said, “Definitely the patches, because I do think they help a certain amount.”
 

Roger’s smoking cessation nurse suggested a mindfulness technique to help him avoid relapse.

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Age at interview: 66
Sex: Male
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I mean she’d pick up on, well, I mean things like, oh, I can remember one thing, when I said, “Oh I nearly, I nearly had a fag, I nearly had a fag.” And I was sitting with a group of people who I normally used to sit with quite regularly, it was an open air café in Leamington where I used to go, just spend an hour there. Because you could get free refills of coffee. So you’d go in and buy one cup of coffee and sit there for an hour, and have four or five for free. So, it seemed like a reasonable place to get coffee. And the but everybody smoked, and I used to sit there and I’d be one of them, and then when I quit, and I went back there and I’d sit there and I’d be the only non smoker, and it didn’t bother me at all. I didn’t feel like having a cigarette at all. It was just wonderful, that idea that you know, you’re just free. The chains are broken, yeah?

And but there was one occasion I can remember when I said, “I really felt like one, just for a moment.” And she said, “Did you?” And I said, I said, “No.” And she said, “Can you remember what your thoughts were between when you wanted one and when you decided you didn’t?” So I said, “Yes.” She said, “So the next time that you get that, that urge to have a cigarette, you just go back in your mind to that moment and remember what you’ve heard, what you feel, what you felt, hear what you heard, see what you saw. And just repeat it. And then you can associate with that feeling of grrr no I don’t want… and you won’t be associated with the feel of whoa…yes.” And that worked a treat, that little technique, which I’ve used a couple of times. And it’s very, very effective too, so…

And can you remember what the feelings were? The trick that you learnt…?

If I go into my head, I can go back there in my mind, and I can sit there and I can actually feel myself sitting there with the sun on me, and I can feel that sort of, ‘God I really feel like a cigarette.’ Because even when you quit smoking for two years as I have which isn’t very long, you still just occasionally get a little ‘ooh I wouldn’t mind a fag.’ But I know whenever I feel like that, I just think, I just literally in my head, I don’t even need to shut my eyes, I just imagine that moment, sitting in that chair when I had that feeling and immediately as soon as I think that, the sense, the desire for a cigarette just [clicks fingers] vanishes. Literally. Instantly. So, that’s my little technique. It’s brilliant.
Although people we interviewed sometimes found that their doctors were ‘delighted’ and eager to help them when they wanted to quit, others didn’t get the support they would have liked or got better support from someone else. Waiting lists for “stop smoking” clinics were sometimes a problem - especially for people with enthusiasm wanting to quit straight away. The advice to prepare and set a quit date at some point in the future was sometimes at odds with the approach that seemed most natural.
 

Cassie thought that her GP wasn’t supportive; the nurse who treated her asthma was much better.

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Age at interview: 22
Sex: Female
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Have you ever spoken to your GP about smoking? Either wanting to give up or on any connection in your appointments over the years?

I’ve spoken to my GP when I was like about 16, just about, you know, quitting and what was available and only in other times in them telling me I was stupid for smoking and being very rude to me, and trying to, you know, trying to tell me off. Which is not cool like, you need support, not someone trying to slap my hand like a child. So …because even my asthma nurse is more understanding than any GP that I’ve had, you know, they tell me, “Oh well you’ve probably got the lungs of a 40 year old. You know, don’t you understand what you’re doing to your body.” And it’s like, “Well I’m an adult of course I understand.” But I’m sure my doctor’s a non smoker, never having had smoked, so they don’t understand. So when it’s that situation I’m not going to listen to them.

What’s your asthma nurse like? You say she’s better than your GP?

She’s more understanding. Yes, well my asthma nurse is, she’s just quit smoking. So with her it’s easier for me to relate because she’s done it, and then it’s easier for her to relate with me as well, because we both talk and we both understand each other and she tells me things that nobody else has ever told me. Like she told me there’s an ingredient in cigarettes which opens the lungs because they want to get down as deep as they can. So then for me, it makes me feel like I can breathe better, but obviously the long term effects of smoking are going to cause me to have a lot of problems when I’m older. So she’s very real like, and she doesn’t hide anything. She tells me how it is, and she tells me what helps her and you know, that’s quite positive for me, because she has actually quit. Like she’s well I don’t know, somebody once said to me “a smoker never quits” And I don’t know whether that’s true, but I suppose she could go back to it, but for now she’s successfully done it. And that’s really good, because and I look to her and I think well if you’ve achieved that I can achieve it. She’s giving me advice and help so hopefully that will give me more of an advantage and help me be stronger. And then I’ll actually crack it and do it.
 
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Khan went to a smoking cessation clinic and liked finding that his carbon monoxide levels had decreased and that his physical health was improving.

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Age at interview: 29
Sex: Male
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Carbon monoxide was six or five, quite high. I started going after a few weeks. It went to three. It’s averaged. And that made me realise I am doing good basically. And you know, everything’s clear, so it’s good to you know, you need support, you need support, anything you do, any sort of, you know, if you’re smoking or whether you’re drinking or taking drugs, you need, if you can’t come off something, if you haven’t got the willpower, you do need willpower though, but you need this spark, then just go for it. Take advice, go counselling, take up….

But some people say they can’t stop smoking or drinking or, but I don’t believe in that, if I could do it, I’ve been broke three or four times, now, three times. Not intentionally, but sometimes like I say, you don’t realise, that if you do something wrong, but what’s the consequence? Or if you’re going to see someone, this will be the outcome, or if you smoke fags or with all of them you just need willpower, you need to be strong. But I think the smoking advice place, they’ve helped me out quite a lot. They sent forms to me and DVDs. The Quit Line, and the, you know, the brochures like if you stop for one day, no you stop for twenty minutes, an hour is it? I don’t know off the top of me head. Your blood pressure goes back to normal, your pulse. Your taste buds get better. You know, everything, you’re given more confidence.
 

When Abdul went to the GP after he’d given up smoking he was surprised that there wasn’t more support and information available to reinforce the health benefits.

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Age at interview: 37
Sex: Male
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Did you get any other sort of help in giving up smoking?

There’s no help. I mean they say there’s help but there isn’t. I mean I had…

Tell me about that?

I had a lung test. This was after I’d given up and I went to the doctor and I said, “I wanted to ask about, you know, my giving up smoking. What kind of help or support. Can you tell me about what I will go through in the months to come.” And the nurse had nothing at all, nothing constructive to offer. She, the best thing she did was take a breath test, you know. At the end of which I was shocked you know. I play regular sport three to four, you know, three times a week I’d say on average. And she told me, you know, at the age of 37 that I had the lungs of a 48 year old and that was a shocker. Because you know, I’m still, you know, in many respects I’m fitter than the average person, because I play sport that often, and that regular. But I knew my lungs weren’t good. Because I chain smoke and I used to chain smoke like crazy with my, you know, the whole… cannabis which goes straight to your lungs. You’ve got no filter or anything, you know. And so I mean I was shocked, like 48, I thought blimey, you know, and when I mentioned it to some of my smoker friends they went really quiet, because they haven’t given up. There were some of my friends, and they were like whoa, and one said, “Yes, but…” You know, you could see the denial on his… “Yet but I went to have a test and the nurse said that there was nothing wrong with my lungs.” And I’m standing there thinking, you’ve been smoking as long as me. May be not as harsh as me, you know, as hard as me, but you’ve been smoking as long as me and not far off as much as me. Your lungs aren’t okay. I don’t know what test you took, but your lungs aren’t okay. You’re in denial. You know. I didn’t tell him all that but you could see them go quiet, because they understood suddenly like. He’s got lungs of 48 and he plays sport three times a week. What’s going on there?

But I just thought, but at the time when I wanted more she just didn’t seem to have any more to give in terms of, the nurse at the general practice I went to, and so I thought right fine I’ll just have to kind of muddle my way through it. But I didn’t, I didn’t think there was the support that they say is available. I certainly kind of, they didn’t sound like it to me.

So what type of support would you have wanted?

I don’t know. Someone to take me through some of the kind of the health things that would come along, with what are the phases, so you know, when you give up smoking, you know, what happened the first month? What will happened in say three months? What will happen in six months? What’s like to be the case in a year to two years? You know, how long does it take your lungs to clear completely? You know, will they ever be okay again? So this sort of thing. I thought that they should have this knowledge, you know, after all the smoking and these campaigns you know, to try and help people quit. I found that there was nothing you know. I thought she should have jumped at the chance of giving me the stuff. And she just didn’t, and I was just gob smacked that you know, I thought yes, okay, I’ve got lungs of a 48 year old. I have got anything else to happen? And she didn’t.
 

Sue’s GP had been advising her to quit on and off over 30 years period, but he recently forgot that she had already stopped smoking three years ago.

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Age at interview: 57
Sex: Female
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Did you have any subsequent discussions with either you know, a practice nurse, a GP, anything like that?

No. In fact I saw my GP a couple of weeks ago and he said, “So how many a day are you smoking now?” I said, “I haven’t smoked for nearly three years.” And he went, “Oh.” I said, “This is the third time you’ve asked me that in three years. It should be on my notes.” “No, I’m just so used to you saying yes.” And I thought that again that says something, he sees me as a smoker, even as a medical professional whose been advising me for 30 years to stop smoking, he’s forgotten that I don’t so it’s, yes, it’s very odd. I mean when he looked it was on my notes that I’d stopped but he just kind of, he’s remembering the past.

And how would you manage that, you say he’s been advising you for 30 years to stop smoking…?

Oh it’s all a bit lack lustre. Yes. And at one point, I think I went and said, “Oh I think I’ll stop smoking soon.” And he went, “Well you don’t want to cause yourself too much stress. You don’t really smoke enough to be a real problem.” So, okay, that’s given the green light then, thanks very much. I can go home and tell my husband that my doctor says I should carry on smoking. But I think he was thinking that if you’re not smoking very many, which I wasn’t, then the giving up smoking can be stressful. You know, I’d started smoking because I was stressed and I think he probably thought that it would add to my stress to try and stop. But then a while later, he sort of said, “You should stop smoking.” I said, “But you said it was…” He said ‘Well’ but I think it depended on what course he’d been on recently [laughs] to be honest. His continuing professional developing seems to throw him at all sorts of things. And oh, but he was quite lack lustre about it. He’d sort of say, as he said to me the other week, “So you’re still smoking then?” And until three years ago, I’d say, “Yes.” And he’d say, “How many?” And I’d say, “Well five, ten a day. And no more than that. And usually sort of at the lower end.” He go, “Hm. Well it would be better not to.” And that would be it, you know, pass on…
Some people admitted that they hadn’t always been honest with health professionals about whether or not they still smoked or tried to influence the lung function tests. Neil said he didn’t smoke for about a day before the level of carbon monoxide was measured and would smoke again directly after his appointment with the nurse.
 

Caroline was offered support through a smoking cessation clinic and pretended she had stopped. She said she wasn’t offered much practical advice.

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Age at interview: 53
Sex: Female
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It was when they offered this smoking cessation programme that was with the nurse, and I spoke to other people that were doing it, on this forum I told you I used and they all had their, is it your CO meters or whatever, so they couldn’t cheat at all. Whereas I went she never measured anything, so when she said have you smoked, I was like, “No.” [laughs] And because she believed me, I was like, I, I believed myself, I wasn’t smoking even though I was smoking. So I was never given any advice on how to quit. I did with the nurse talk through which was the best course of NRT if you like, and we decided on the patches with her. So I think she offered me, there was like a nose spray or something, patches, or lozenges and we went for patches. But there was never any sort of real advice I was given.

I did have somebody phone me up once from the NHS, they do a Hertfordshire Smoke Free Zone or something and she did find me up and ask me how I was doing, and I think that day I hadn’t really smoke so I was just like oh fine, you know, but she didn’t sound very sincere so, we didn’t really keep the conversation going for very long.

So I guess kind of they’re busy, they haven’t got time to really help each individual anyway, so I didn’t get that much help from them. Though that’s not say other people don’t, just because it didn’t for me [laughs].
Some GPs spoke about smoking when the patients themselves hadn’t brought up the issue. Several people like Haseen and Laura didn’t think giving up smoking was a ‘medical issue’; others like Miles, Tom and Peter said that they had avoided going to their GP over the years.

People had widely differing preferences about the kind of advice and information they wanted from professionals. Some they wanted kind, reassuring and motivational information, such as how much the lungs could be expected to recover in six months or a year after quitting, others felt they needed to be shocked into quitting. Judith said, “I always used to think that if I could get a photograph or an x-ray or something like that of my lungs and have a photograph of what they should look like if I was a non-smoker that would be a really powerful visual and would almost jolt me into actually trying to do something like giving up”.

(Also see ‘Unsolicited advice from health professionals, family and friends’).

Nicotine replacement therapy (NRT)

NRT is offered as skin patches that deliver nicotine slowly, as chewing gum, nasal spray, inhalers, and as lozenges/tablets, all of which work by reducing the intensity and frequency of the urge to smoke. The use of NRT makes it more likely that someone will quit smoking. They helped people like Jules, Andrew and Sarah when they quit. Some used these products on the NHS with advice from professionals (as mentioned) while others bought products over the counter at pharmacies. Many had seen ads for nicotine replacement therapy.
 

Sarah tried NRT gum and patches, and chose patches as she didn’t have to taste anything.

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Age at interview: 33
Sex: Female
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I guess it is just about exploring and there are so many different things on the market nowadays to support you, and if you decided that actually I want some kind of nicotine replacement, jumping to the first one that’s offered, isn’t necessarily the right thing, because there are a lot.

So how did you make that decision about which one to go for in this flooded market?

I didn’t, I wanted, I always, I just wanted patches. I wanted something quick and easy that I could put on and I didn’t have to taste. Because it was what was missing for me was the nicotine and I felt that if I started taking I don’t know chewing gum, if I started using the chewing gum or the inhaler, I’d probably knowing my own characteristics would just get addicted to using one of them. Whereas with the patches I had a process, a stepped process that I would go through to, you know, to get to the end of it. So I think that’s why.
 
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Blodwen had a chewing gum whenever she would usually have had a cigarette – for example with morning coffee.[TEXT ONLY]

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Age at interview: 55
Sex: Female
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And basically it was the chewing gums that did it for me, more than anything else. So...

What were they like for you?

Okay, yes. I’ve, you know, I was chewing a lot [laughs]. You know, my jaws were a bit , but no I actually got to the point with work, when I was again, thinking about it, where I wasn’t smoking during the day. So I’d cut that down, you see. I’d have, I’d have about three before going to work in the morning. And then I wouldn’t have one unless I was going somewhere in the car, like I say, and then, you know, but if I was just at my base all day I wouldn’t have one until I came home at night.
 

Bethan gave up with the help of NRT patches, an inhaler on prescription, and ordinary chewing gum.

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Age at interview: 53
Sex: Female
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So I went to the chemist and saw the man and said, “I want to give up smoking.” And anyway they gave me, the patches. Which were the higher dosage, because I did smoke… Well there was a time when I’d smoke about 40 a day and then I went down to 30. And I think before I gave up I was down to about 20, 20 – 25 I’d say.

Anyway, so yes. So I had the patches and they gave me the inhalator as well, because I thought oh God, I can’t do without, you know. But surprisingly enough after a couple of weeks…. I mean I went back because I was going every week for the first I can’t remember now. Well I tried to go every week, but because I find it very difficult to get to this chemist when I’m working, so I’d try and do it in between appointments, you know, and if the pharmacist was there, and if the pharmacist wasn’t there there’d be a problem.

But I have to admit I have done it with the patches. I didn’t need the inhalator, but I found that I was chewing a lot, chewing, chewing gum. Not, not smoking, you know, it’s just ordinary chewing gum. And basically I just popped into the pharmacist when I could to get some more patches. There was a couple of occasions when I couldn’t get any patches. So because the pharmacist wasn’t there, which was a bit annoying, because then I know they like to make appointments as well, but because of my work, I couldn’t actually make an appointment. But then I should put myself first and you know.

So anyway, so when the pharmacist wasn’t there, I couldn’t get any patches, I’d have to go to the doctors then to you know, to get a prescription. And they were very helpful. Very, you know, they would get me a prescription straight away.
 

Chris tried different types of NRT: the gum and patches in combination worked for her.

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Age at interview: 65
Sex: Female
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So I tried the patches and the inhalator together. That wasn’t very successful. So then, I thought, I’ll try the patches and the gum. And that worked for me anyway, it worked, so I had the patches and I had the gum, and that done it for me.

What was that like?

It was okay, because the patches on their own just wasn’t enough. I still kept wanting a cigarette quite badly. And then when I had the gum with it, every time I wanted a cigarette I just pushed a piece of gum in my mouth and that releases a little bit of nicotine. And now I just chew ordinary gum, you know, I just feel I’ve got to chew something. It’s still a habit I think, of chewing nicotine, but I just buy chewing gum now. If I want a cigarette I just chew some chewing gum.
Keith, Roger and Jules said that NRT met the immediate need but didn’t help them in the longer term.
 

Caroline used nicotine lozenges and patches, but disliked the taste of the lozenges and reacted badly to the patches.

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Age at interview: 53
Sex: Female
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I’m cold turkey. I just I missed it too much, or I thought I missed it too much. The lozenges which I do use now actually, but when I first gave up they really taste disgusting and they, they always get, they seemed to give me the hiccups and I couldn’t kind of quite swallow properly, but now if I’m honest, I think I’m quite addicted to them like, oh I really, really fancy a lozenge and I do always have some in my bag. Down to the lowest strength, but the way I see it, if I ever really needed a cigarette I’ve just had a lozenge instead.

Patches I wore for a while, but I found them so irritating. They’re itching, plus you kind of, every now and then you get this funny sort of pain, wherever you put them on. Really hard to explain and I did try talking to the chemist about it. He thought I was totally mad, but it was, I suppose it was as the nicotine is released from them I could kind of, I either had it had my arm, or on my hip and I’d get this almost sort crampy pain. So the chemist was just like I think you’re imagining it, and I wasn’t imagining it, so I stopped using them.
 

Neil went on smoking while using high dose nicotine patches. He soon felt ill and a doctor told him it was due to nicotine poisoning.

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Age at interview: 64
Sex: Male
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Oh more modern day of course, the patches. And the patches sensitised my skin. You had to buy the patches then you didn’t get them on the National Health [coughs]. And they sensitised my skin and I had to move them all round your body and everywhere I put a patch left a big red itchy mark afterwards. Well you can imagine what my bum looked like can’t you [laughs]. But yes, you just literally stuck them everywhere to avoid using the same place. But I gave up smoking. In fact, only looking back, for two days, because I was taking the high dose nicotine patches. And I continued to smoke, not as many as I was smoking. But I did smoke, and by the end of the day I felt so ill. I went to bed, and the next day I never got out of bed. I felt so, so ill. And then I went to the doctors and he told me that it was nicotine poisoning. I’d actually poisoned myself by smoking on top of these nicotine patches. So I was a bit frightened of using nicotine patches after that. Because I was still having a cigarette [laughs]. This must sound absolutely stupid.
Sue’s skin reacted to adhesive patches. Mariam was prescribed patches but didn’t use them and didn’t like the taste of lozenges, whilst Val actually became addicted to the lozenges themselves. John tried the nasal spray and found it a nasty ‘body shock’ like having a shot of caffeine. Other people thought NRT merely fed their addiction to nicotine, and that instead of replacing nicotine they needed to face their deeper psychological reasons for smoking.
 

Tom didn’t try patches or gum because he focused on why he wanted to quit.

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The thing that finally clicked for me, I never, I’ve never done any of the sort of patches or gum or anything like that. It was only ever willpower. There was there was two things that really kind of two kind of points at which I realised right this is now, this is how I’m going to do it kind of thing, or this is why I am going to do it.

And the first thing is, it seems like such a simple thing now, but it took me a long time to get there - I finally realised that, actually this is not about convincing yourself that you don’t enjoy this anymore. It’s about accepting that it’s something that you enjoy that you have to stop doing, for other reasons, and not sort of financial reasons, that was never even when I was in a shittily paid job and skint all the time, I still always managed to have tobacco somehow. It was just purely about sort of, I don’t know, I guess it was health reasons. But, but the big thing, the big point at which at which I thought, ‘right now is the time it’s going to happen,’ is as I was getting near to turning 30, and I thought, ‘right, OK, well this is kind of, this is a watershed moment in a lot of ways. It’s a milestone birthday.’ If I stop before I turn 30, then, and I know I don’t smoke beyond that point, then I can say, ‘yeah, I smoked in my teens and twenties and that was it.’ It’s, yeah, it’s actually, that was kind of what did it. It was realising that, OK, you still enjoy it, but you have to stop now, and let’s actually stop now, this is a good point. And I can vividly remember the last cigarette that I had, I was driving home from work, and it was four days before my 30th birthday and I had a cigarette in the car, and that was it, I didn’t have another one after that.
 

At first Judith wanted products to help her quit, but then decided she didn’t want to have to quit nicotine after she had given up smoking.

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Age at interview: 36
Sex: Female
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So I’d got over the first day or two. Going back though to the smoking cessation I had been given. I had said that I wanted products. I want nicotine replacement. So I’d got patches and I got an inhalator as well. Which has a sort of cartridge, which gives you nicotine if you suck on it. Just like a cigarette essentially.

But I was also, at the smoking cessation they also gave me little bits of cut straw, just about that size and that was a really interesting thing as well, the fact that when you sucked on the straw, it was essentially, it wasn’t like a cigarette, but it slowed your breathing down, and it just reminded you of what it was like when you smoked, to just take that long breath and so that was really, really interesting for me, is the fact that I could have it in my hand, and I could drive with it, in my, you know, between my fingers and suck on it, and realise that it was slowing my breathing down, and that in itself relaxes of course, just taking note of, just breathing you know, but deeper and a bit slower.

So when I stopped for the two days I hadn’t touched the inhalator. I put the patch on and but I’d got through those two days. And then I thought nicotine stays in my system for 24 hours, it was so psychological for me, why was I still feeding myself with the nicotine? I know it’s so different for everybody, but for me, I just thought, why am I doing this. I didn’t want to get to the end of twelve weeks and have another psychological thing where I was thinking “Right I’ve only achieved this because I’ve had a patch on and then I’m going to take a patch off, I know it goes down in strength but I’m still not going to have anything”. And that initial major confidence and ability to stop would have been 12 weeks prior to that. So was I going to get into a position where that in itself could just start me smoking again? So I made an informed decision that I was just going to take it off and I never looked back.


Last reviewed August 2018.
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