Use of nicotine replacement therapy for in-patients

1. Use of nicotine replacement therapy for in-patients Nicotine replacement therapy needs to be available in all hospitals as are all essential medication. It is important to consider this medication in a smoke-free hospital.

2. Nicotine replacement therapy can have 4 goals for in-patient use : • Initiate smoking cessation in a nicotine dependant patient, • Maintain in-patient treatment, where smoking cessation had started before hospitalisation • Provide nicotine support for hospitalised nicotine dependant patients and prevent withdrawalsymptoms, • Reduce risks in patients with tobacco related disease.

3. Indicationsfor nicotine replacement use in heavily dependant in-patient smokers with withdrawal symptoms. • Short term substitution is associated with a dramatic decrease of withdrawal symptoms when a smoker is hospitalised. At this time, the patient has other anxieties that increase withdrawal symptoms, particularly when hospitalisation (oxygen, bed-rest..) impairs all possibility of smoking. • Nicotine replacement prevents the dangerous of smoking in hospital and passive smoking. • Short term nicotine replacement can help the patient to review their smoking and nicotine dependence and seriously consider smoking cessation.

4. Risk reduction for in-patient smokers with tobacco related diseases Nicotine replacement therapy is indicated for some hospitalised patients with tobacco related diseases who cannot refrain from smoking. In patients with COPD and Cardiovascular diseases, nicotine replacement therapy decrease risks as compared with that of continued smoking.

5. Risk reduction in cardiac in-patients • In all cases, including acute or unstable coronary disease, nicotine replacement is better in all case than continued smoking (but cessation without nicotine is always better). • Nicotine replacement therapy provides nicotine but no CO, no irritants, no carcinogens and decreases the risk of acute heart disease. • In cardiac patients, in the acute phase of a coronary disease, nicotine replacement therapy is better than continued smoking.

6. Risk reduction in respiratory in-patients • Nicotine replacement therapy has little or no respiratory effect but cigarette are responsible for acute and long term respiratory effects. • Cough and sputum production decrease during nicotine replacement. • Bronchoscopy tolerance is higher if patients do not smoke in the previous 24 hours. • Nicotine replacement therapy provides only a small amount of nicotine as compared to continued smoking, nevertheless smoking cessation should be the goal.