ON THE WARDS of Our Lady’s Children’s Hospital, Crumlin last winter, I was asked to review a nine-month-old boy admitted for the fourth time with a respiratory illness. The child’s mother was a regular smoker.

I explained that children exposed to tobacco smoke are at a higher risk of recurrent respiratory illnesses and asked her had she ever tried to quit.

She was aware that smoking around her baby boy was not good for the child’s lungs and told me that she had tried to get off cigarettes on a number of occasions using various methods with little success. What more could she do?

It’s rarely straightforward

Most people who have tried to quit smoking know it is rarely straightforward. A few weeks into 2018 as the best New Year resolutions are being tested my best advice is to find your local quit service through the quit.ie or speak to your general practitioner.

Although smoking rates in Ireland are declining, almost 1 in 5 Irish adults still smoke on a regular basis and smoking-related deaths remain the leading cause of avoidable deaths in this country.

Last year, HIQA published their assessment on best available smoking cessation treatments. This comprehensive document based its recommendations on evidence-based medicine and gives us some guidance on which smoking cessation interventions work best.

Pharmalogical methods

Although all forms of cessation treatments examined were an effective method for quitting compared to doing nothing all, the most effective method was a combination of nicotine replacement therapy (in the form of gums, patches and sprays) and the prescription only medication – Varenicline (trade name Champix).

This medication works as a nicotine receptor partial agonist and helps reduce a smoker’s enjoyment of cigarette smoking in addition to decreasing the withdrawal symptoms.

Using this combination, you are more than three and half times more likely to quit smoking when compared to those who quit without this combination. Of course, these treatments are not suitable for everyone and before starting on any medication, it is important that people consult with their general practitioner.

In addition to pharmacological methods, behavioural interventions such as individual counselling and telephone support were found to aid quitting.

These methods of smoking cessation are particularly pertinent for certain groups such as pregnant mothers for whom medications, such as Varenicline, are not recommended.

Use of e-cigarettes still unsupported

Over one third of Irish adults turn to e-cigarettes or electronic nicotine delivery systems (ENDS) when trying to quit smoking. However, the HIQA report found only two trials of sufficient quality on which to base their conclusions on. High quality data supporting the use of e-cigarettes as a smoking cessation device is lacking.

This is an evolving area of research and we are awaiting the outcome of further trials before we can cast judgment on the role of e-cigarettes in helping people quit smoking.

Evidence suggests that smoking e-cigarettes is less harmful than tobacco smoking. Tobacco smoke contains thousands of chemicals at least 70 of which are known to be carcinogenic.

The levels of chemicals found in e-cigarettes are much lower than that of tobacco cigarettes but we don’t have any data on the long-term health consequences of smoking e-cigarettes.

E-cigarettes aren’t good for you but the argument that enabling people to switch from tobacco cigarettes to e-cigarettes resulting in harm reduction to their health is a strong one. Internationally, conflicting advice is coming from different public health bodies on the subject on whether or not e-cigarettes should be recommended as a smoking cessation tool.

Association doesn’t prove causation

The Royal Society of Public Health (RSPH) in the UK supports their use while the World Health Organisation (WHO) issued more cautious guidelines on their benefits in helping people quit tobacco.

Further concerns surround e-cigarettes include last month’s study from the US demonstrating a worrying association between e-cigarette use among youths and subsequent tobacco smoking. They found that adolescents using e-cigarettes were at a greater risk for future tobacco smoking when compared with those not using e-cigarettes.

E-cigarettes are promoted to the public with many different flavours available making them appealing to the youth market. Association does not prove causation and these aspects have yet to be teased out fully.

Then there is the role of the big tobacco corporations, who are pouring millions into the e-cigarette industry with the promise of developing safer vapour and non-combustible products down the line. I find it difficult to trust the industry that once told us “smoking was good for us”.

We don’t have all the answers yet. More research is needed in this area before we can confidently tell the public what are the best methods for quitting smoking. For the moment, the HIQA guideline provides us with the most up-to-date research in this area.

Never give up trying to give up

In regard to the mother I met on the wards; her smoking was not directly the cause of her child’s respiratory issues but she was fanning the flames and exacerbating his symptoms. Smoking around children is not good for their developing lungs and greater awareness and education for parents is needed in this area.

Many smokers go through numerous quit attempts before they successfully give up. The important thing to tell smokers is to never give up trying to quit smoking.

If you are thinking of quitting smoking this January, find your local quit service through the quit.ie website or speak to your general practitioner.

Dr Des Cox is a Consultant in Paediatric Respiratory Medicine at Our Lady’s Children’s Hospital Crumlin and Chair of the Royal College of Physicians of Ireland’s Policy Group on Tobacco.

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