Position Statements

It is the responsibility of every healthcare professional to treat tobacco dependency holistically, systematically and effectively. People should be offered the most effective and least harmful methods to support a quit attempt including very brief advice (VBA), behavioural support, pharmacological intervention (bupropion, varenicline) and nicotine replacement therapy (NRT). For people wishing to support their quit attempt with NRT, short- and long-acting options should be discussed including lozenges, microtabs, gums, sprays, vapourless nicotine inhalers, inhalators and patches.

Concerns about the environmental impact of the propellant gases used in pressurised metered dose inhalers (pMDIs) and the plastics used in all single-use inhaler devices have made them an important focus for efforts to reduce the environmental impact of the NHS. Patients themselves may also be concerned about the environmental impact of their inhalers and express a preference for alternatives. PCRS do not support ‘blanket switching’ of patients from one inhaler type to another.

PCRS support initiatives to improve air quality and minimise short- and long-term damage to the environment, particularly those with an impact on climate change resulting from greenhouse gases.

PCRS supports the UK National Screening Committee’s recommendation that people at high risk of lung cancer have screening and encourage the committee to ensure that the screening programme maximises opportunities for diagnosis of lung disease beyond lung cancer and to ensure ongoing provision of smoking cessation services.

PCRS have issued a position statement on strategies to care for patients with respiratory disease and frailty in the community setting. Frailty is thought to affect around 10% of those aged over 65 years and up to half of those aged over 85 years. The health and social care needs of these vulnerable patients can be complex and require a holistic approach that should involve confirmation of current diagnoses and review of all medications giving consideration to the goals of treatment, likely benefits and likely side effects.

Healthcare professionals should be prepared to help their patients to quit tobacco smoking and should be knowledgeable about e-cigarettes so they can answer questions if asked or be able to direct people to the most up to date source of information.

PCRS advocate a pragmatic approach to the pharmacological management of patients with COPD guided by the predominance of breathlessness and/or exacerbations and the presence or absence of comorbid asthma. Clinicians must undertake a holistic evaluation for alternative causes of persistent daily symptoms or repeated exacerbations and consider seeking advice from a respiratory specialist before escalating to triple therapy (a respiratory specialist may be a GP/nurse/consultant).

Concerns about the environmental impact of the propellant gases used in pressurised metered dose inhalers (pMDIs) and the plastics used in all single-use inhaler devices have made them an important focus for efforts to reduce the environmental impact of the NHS. Patients themselves may also be concerned about the environmental impact of their inhalers and express a preference for alternatives. PCRS do not support ‘blanket switching’ of patients from one inhaler type to another.