Speaker's Highlight

• Don Sin University of British Columbia, St. Paul Hospital (Canada)
  Kenneth R. Chapman Toronto General Hospital Research Institute (Canada)
• Parameswaran Nair McMaster University (Canada)
  Carolyn Calfee UCSF (U.S.A.)
• Gregory P. Downey University of Colorado School of Medicine (U.S.A.)
  David A. Schwartz University of Colorado School of Medicine (U.S.A.)
• Neil Schluger Tuberculosis Control Branch, California Department of Public Health (U.S.A.)
  Nick Kim Critical Care & Sleep Medicine, University of California San Diego (U.S.A.)
• Nicola Hananiah Baylor College of Medicine (U.S.A.)
  Jae-Joon Yim Seoul National University College of Medicine (Republic of Korea)
• Koichiro Asano Tokai University School of Medicine (Japan)
  Diahn-Warng Perng Taipei Veterans General Hospital (Taiwan)
• Konstantinos Kostikas University of Ioannina (Greece)
  Karin Klooster University Medical Center Groningen (Kingdom of the Netherlands)

• Helping hospital patients quit smoking for lasting health gains

  A hospital admission can create a valuable window for tobacco treatment. Patients may be dealing with pneumonia, chronic obstructive pulmonary disease (COPD), heart disease, cancer or an operation, making the connection between smoking and health especially clear. Brief, well-timed support can begin during admission and continue after discharge.

  For Australian hospitals, cessation care should be practical, respectful and connected to primary care. A patient admitted in Melbourne, Brisbane or Perth may return to a different general practice, while someone from a regional or remote community may face limited pharmacy access. Effective planning must account for these realities rather than treating discharge as the end of treatment.

  Use the admission as a teachable moment

  Hospitalisation often interrupts normal routines. Patients may be unable to smoke because of ward rules, illness or reduced mobility, and this temporary pause can reveal their level of nicotine dependence. Clinicians should use the opportunity to ask about tobacco use, previous quit attempts, vaping, roll-your-own tobacco and exposure to second-hand smoke.

  The conversation works best when it is non-judgemental. A clear statement such as, “Stopping now will help your breathing and reduce the chance of another admission,” links cessation with the patient’s immediate concern. Australian patients may also use local terms such as “durries,” so staff should use language that feels familiar without trivialising the risks.

  Screen dependence and readiness

  A brief assessment should cover cigarettes or other nicotine products used each day, time to the first cigarette, withdrawal symptoms, past medications and the patient’s preferred support. The Fagerström Test can help estimate dependence, but a short clinical conversation is often enough to guide initial treatment.

  Readiness can change quickly during an admission. Someone who is not prepared to quit may still accept nicotine replacement therapy (NRT) to manage withdrawal or agree to a follow-up call. Motivational interviewing techniques—open questions, reflective listening and affirming personal reasons for change—are more productive than pressure or a lecture.

  Treat withdrawal before discharge

  Nicotine withdrawal can cause irritability, anxiety, poor concentration, restlessness and strong cravings. If these symptoms are missed, a patient may leave hospital and immediately resume smoking. NRT should therefore be considered early, particularly for people who smoke soon after waking or report difficult previous quit attempts.

  A nicotine patch provides steady background treatment, while gum, lozenges, inhalators or mouth spray can address breakthrough cravings. Combination NRT is often more effective than a single product for people with substantial dependence. Clinicians must check contraindications, skin sensitivity, oral problems, pregnancy status and interactions with the patient’s broader treatment plan.

  Match medication to the patient

  Varenicline and bupropion may be suitable for selected adults, depending on medical history, mental health, kidney function and current medicines. Treatment decisions should be individualised, with attention to side effects and the patient’s ability to obtain and use the medication after leaving hospital. A pharmacist can explain dosing, what to do after a missed dose and how to handle nausea, sleep disturbance or vivid dreams.

  Cost and access matter in Australia. Patients may obtain cessation products through hospital pharmacies, community pharmacies or the Pharmaceutical Benefits Scheme, depending on eligibility and current arrangements. A discharge prescription is more useful when it is accompanied by a supply plan, clear instructions and confirmation that the local pharmacy can provide the product.

  Build cessation into respiratory care

  Smoking cessation should be part of treatment for COPD, asthma, bronchiectasis, respiratory infections and lung cancer, rather than a separate health-promotion activity. The respiratory team can connect quitting with fewer exacerbations, better exercise tolerance, improved surgical recovery and a slower decline in lung function. For patients being investigated for worsening respiratory symptoms, understanding the wider clinical picture can also support engagement; research on sputum cytology findings illustrates how respiratory assessment may inform conversations about ongoing risk.

  Every admission is different. A person with an acute COPD flare may need an immediate withdrawal plan, inhaler review and pulmonary rehabilitation referral. Someone undergoing thoracic surgery may need a firm perioperative cessation pathway. Written advice should avoid fear-based messaging and explain what benefits can begin within days and weeks of stopping.

  Plan for discharge and relapse prevention

  Before discharge, the team should record smoking status, medication supplied, quit goals and follow-up arrangements. A referral to Quitline services, a general practitioner, Aboriginal Community Controlled Health Service or respiratory nurse can provide continuity. In Australia, Quitline support is available in each state and territory, with telephone coaching that can complement medical treatment.

  Follow-up within the first week is valuable because cravings and uncertainty often peak after patients return home. Staff should ask whether the patient is still abstinent, using NRT correctly and encountering triggers such as alcohol, stress, family smoking or social gatherings. A lapse should be treated as useful information, not failure, with prompt adjustment of the plan.

  Support equity and cultural safety

  Hospital programs should avoid assuming that every patient has stable housing, internet access, transport or a smoke-free household. People discharged to rural New South Wales, remote Western Australia or the Northern Territory may need telephone-based support, mailed resources or coordination with local health workers. Hospital teams in Sydney and other major cities also care for patients who may move between suburbs or temporary accommodation.

  For Aboriginal and Torres Strait Islander patients, culturally safe care includes listening to personal priorities, involving Aboriginal health professionals where available and recognising the effects of stress, disadvantage and tobacco marketing. Interpreters should be used when needed, and written material should be easy to understand. Family involvement can help when the patient consents, particularly where several household members smoke.

  Measure what the service delivers

  A cessation pathway should be evaluated through simple measures: the proportion of smokers identified, the number receiving behavioural support, medication supplied at discharge and follow-up completed within a month. Longer-term outcomes may include self-reported abstinence, reduced cigarette consumption and readmission for smoking-related illness.

  Staff training is essential. Nurses, doctors, pharmacists and allied health professionals should know how to provide a brief intervention, start or arrange NRT and document the plan. Electronic prompts can improve consistency, while audits can reveal whether particular wards, age groups or communities are being missed.

  A reliable hospital approach combines compassion with preparation: identify tobacco use early, control withdrawal, offer evidence-based medication and connect the patient with continuing support. The practical takeaway is simple—before every smoker leaves hospital, ensure they have a treatment plan, a medication pathway and a named service or clinician to contact next.

  Richard Russell Nuffield Department of Clinical Medicine, University of Oxford (United Kingdom)
• Mona Bafadhel King’s College London (United Kingdom)
  David Jackson Guy’s and St Thomas’ Hospital, King’s College London (United Kingdom)
• James Chalmers University of Dundee (United Kingdom)
  David Price University of Aberdeen (United Kingdom)