Many smokers have not succeeded in quitting using a single nicotine replacement mode. An algorithm was developed for clinicians to enhance success rates when recommending nicotine replacement therapy (NRT) to smoking patients. The algorithm is based on clinical experience with chronic smokers with respiratory illnesses attending one-on-one smokers clinics in the Central Sydney Area Health Service. Based on transdermal nicotine therapy (patch) other forms of NRT are added if required for ‘breakout’ smoking for 2 weeks. Outcomes have shown 60% confirmed continuous abstinence at 3 months. Smokers can be safely and successfully treated symptomatically for nicotine withdrawal relief using combination NRT aggressively. This enhances treatment efficacy by minimising relapse in the first few weeks and months of quitting.

Smoking is the major predisposing factor for chronic obstructive pulmonary disease (COPD), yet there has been little understanding of the embodied experience of smoking addiction for the person with chronic breathlessness and their close family members. This interpretive study applies Merleau-Ponty's existential philosophy of the body as a philosophical framework. Heideggerian hermeneutic phenomenology was the mode of inquiry used to gain understanding by engaging 15 people who were admitted to hospital for palliative surgery for emphysema, and 14 close family members in a total of 58 in-depth interviews. People with severe emphysema experienced smoking as a need of their taken-for-granted body. This need was experienced as an intense enjoyment, and as a response to triggers for smoking that were still perceived by the automatic body long after smoking cessation. People with COPD and their families described a link between heavy smoking and exacerbations of breathlessness that created a tension between continued smoking behaviour and awareness of smoking-related illness. Failure to overcome the body's addiction to smoking could lead to the person's denial of the relationship between their need to smoke and their worsening breathlessness. The need to smoke can lead to family anger that is mediated by each family member's personal experience of addiction. Even after cessation, the issue of smoking as part of the situation of COPD was in the foreground for family carers, as it was for the breathless people themselves. This discussion highlights the importance of ‘the right words at the right time’ in assisting a multifaceted approach to smoking cessation.

The Roy Castle Fag Ends Community Stop Smoking Service (RCFE) is commissioned by three primary care trusts (PCTs) to provide the adult smoking-cessation service across Liverpool. The service is not theoretically driven but there are several principles governing RCFE, which maintain the client-led, person-centred philosophy. Unique aspects are that the service is provided by trained lay advisors with a nonmedical background and there is no waiting list — clients can self-refer by calling a helpline or walking into a meeting. At RCFE, clients control their own quit attempt as well as self-regulating attendance at meetings and discharge from the service. Relapsed clients are also welcomed back without fear of criticism or the need for an appointment. Possible reasons for the success of RCFE include the client-led methodology, the community approach that removes doctor–patient barriers that may exist, and the nature of the group meetings, which allows interaction between clients who are at different stages of the quit process. Introducing some of the RCFE principles into other stop-smoking services may help to increase the overall smoking-cessation rate in England.