The following pointers may act as a guide when deciding on the most appropriate NRT product for an individual.

1. Strength and dose
   Determine how many cigarettes are smoked a day and the time of the first cigarette. If nicotine dependency is high, consider recommending the highest strength NRT products in combination (e.g. a highstrength patch with a highstrength short-acting product) as under-dosing may leave the patient with withdrawal symptoms. A patient can use up to 15 pieces of 4mg gum/lozenge, six inhalator cartridges, 15 oral strips, 40 microtabs, 64 sprays of the mouth or nasal spray a day.
2. Speed of action
   Ask patients on a scale of one to five (where one is low and five is high), how important it is that the product can control cravings quickly. If rated four or five, consider a fast-acting product such as a mouth spray, nasal spray or oral strip, as these are the only licensed products on the market to reach high concentrations within the first 10 minutes.
3. Behavioural/social/sensorial
   Find out on a scale of one to five, how important it is for the patient to have a product that looks like a cigarette. If rated four or five, consider an inhalator in combination with a patch, or an e-cigarette.
4. Technique
   It’s important to offer accurate advice on the use of NRT products and to coach the patient on proper usage since poor technique is one of the main reasons why treatment is stopped. For example:
   Nicotine patch: some people discontinue use immediately if they get any form of skin irritation or redness (this is normal and one of the common side effects)
   Mouth spray: it’s important patients know that they need to dispense a fine mist rather than a jet
   Gum: some users chew it like regular gum, which means the nicotine isn’t absorbed via the buccal route (between the gum and cheek), as required
   Inhalator: many patients draw on an inhalator like a regular cigarette but short shallow puffs are recommended as absorption

Stay the course

Ask the patient how long they think the course of treatment is. If they know it is for a minimum of eight weeks, acknowledge that they are right and stress that staying the course will greatly improve their chances of stopping and staying stopped. If they under-estimate the treatment period, highlight that this is one of the biggest reasons why people go back to smoking as the cravings can hit them when they least expect it.