Health professionals should use the Very Brief Advice (VBA) method to identify and refer smokers appropriately:6,12,13

·      ask and record smoking status.

·      advise on the best way of quitting.

·      act on patient response.

NICE includes VBA in its guideline NG92 ‘Stop smoking interventions and services’ published in March 2018. Other evidence-based stop smoking interventions in NG92 are behavioural support (individual and group), bupropion, NRT and varenicline.12

If pharmacotherapy is being considered, then varenicline and behavioural support or a combination of short-acting and long-acting NRT are likely to be the most effective. Varenicline should normally only be prescribed as part of a programme of behavioural support. Additional support can include text messaging.

Pharmacological interventions should be provided before the smoker stops smoking, preferably with an agreed stop date in place, says NICE. This should be at least one day in advance for NRT but within the first two weeks of bupropion treatment and within the first one to two weeks of varenicline treatment.