In this blog for people who have just stopped smoking Robert Walton, a general practitioner, helps you work out how best to stay smoke-free, looking at the latest Cochrane evidenceCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on relapse prevention.

So you’ve managed to stop smoking – very well done indeed!  Stopping smoking brings a huge benefit in health not just for yourself but also for the rest of your family.

About half of the people who continue to smoke will die because of their habit, but if you stop by the age of 50 you halve that riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent.. And as you might expect, people who stop by the age of 30 are even better off – they avoid almost all the increased riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. to their health arising from smoking in their younger years (https://www.bmj.com/content/328/7455/1519.full.print).

For children of smokers the riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of respiratory illness and ear infections is increased (https://www.ncbi.nlm.nih.gov/pubmed/10092699) and secondhand smoke is a major cause of premature death in people who don’t smoke themselves but who share a house with a smoker (http://ash.org.uk/information-and-resources/secondhand-smoke/ash-research-report-secondhand-smoke/).

But as the old joke goes ‘Stopping smoking is easy – I’ve done it a hundred times!’.  A recent Cochrane Review* of 77 research studies with 67,285 people taking part showed that for every hundred people who stopped smoking about seventy went back to cigarettes over the next 15 months.  So almost all the benefits in health that the people might have gained were lost.

Smoking rates are falling dramatically in the United Kingdom and have dropped by almost a quarter over the last five years. But the latest figures from 2017 show there are 7.4 million people still smoking and it is therefore vitally important to find better ways of helping these people to stop smoking for good.

What does the Cochrane evidence tell us?

This Cochrane Review found several different ways of preventing relapse had been tried in a range of different studies and most looked at the effects of ‘behavioural interventions’. For this kind of treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. people are taught different ways of identifying the triggers that make them smoke and are helped to work out ways of avoiding them.  Rather disappointingly there was no evidence that these interventions made any difference to the numbers people who were going back to cigarettes. Although the effects of the interventions varied considerably from studyAn investigation of a healthcare problem. There are different types of studies used to answer research questions, for example randomised controlled trials or observational studies. to studyAn investigation of a healthcare problem. There are different types of studies used to answer research questions, for example randomised controlled trials or observational studies. so it is possible that some behavioural methods are better than others, although no firm conclusions could be drawn.

The remainder of the studies looked at people who had stopped smoking using a particular drug therapy to see whether extending the treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. could help to prevent the drift back to tobacco.  There was some evidence that extending treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. with varenicline beyond the usual three months duration probably helps to stop people from going back to tobacco.  However the evidence was very limited for extending the duration of treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. with other drugs available in the United Kingdom such as bupropion and nicotine replacement therapy.

The fact that varenicline may help to prevent relapse could potentially link in with the way that the drug works. Varenicline attaches itself to the same receptors in the brain that nicotine uses and so gives some of the same effects.  But varenicline then occupies these receptors, so blocking the action of nicotine and meaning that the pleasurable effects of nicotine are blunted. It is easy to see how this mechanism might help to prevent relapse.

Quitting in pregnancy and beyond

One area where scientific evidence is completely lacking is how best to help women who have managed to stop smoking during their pregnancy to stay clear of tobacco after the birth. Relapse rates are high in these circumstances and this was one of several areas highlighted in a recent NIHR call for research proposals to limit the harm arising from use of tobacco.

Where does this leave you?

Many smokers will not be keen to swap one drug for another, but the best evidence available to date suggests that extending treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. with varenicline which is suggested as an option by NICE will probably help you to remain smoke-free.

*This Cochrane ReviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. was updated in October 2019 with the addition of five new studies. The review’s conclusions have not changed.

Join in the conversation on Twitter with @rtwalton123 @CochraneUK or leave a comment on the blog.

References may be found here.

Declaration of interest:

Dr. Walton reports grants from NIHR Health Technology Asessment, grants from NIHR Programme Grants for Applied Research, other from TTS Pharma,  outside the submitted work;  In addition, Dr. Walton has a patent WALTON R, MCKINNEY E, MARSHALL S, MURPHY M, WELSH K, others. GENETIC INDICATORS OF TOBACCO CONSUMPTION. Patent number: 2001038567. Filed date: 24 Nov 2000. Publication date: 01 Jun 2001  with royalties paid to gNostics.

Page last updated 05 November 2019