The Royal College of Physicians has produced several reports on the adverse effects of smoking on health in the past 40 years.1-5 Its latest report entitled “Nicotine Addiction in Britain” emphasises the importance and role of nicotine addiction as a major factor in making many smokers unable to stop.6 Recognition of the addictive nature of nicotine has important implications for the way that nicotine products should be regulated in society, and one important conclusion of the report is that tobacco based nicotine products should be subject to the same regulatory control as any other drug delivery device. However, the report also argues that nicotine addiction should become recognised and accepted as a medical problem, much as any other manifestation of drug addiction, and this argument has special relevance to respiratory physicians.

Most people who attempt to stop smoking relapse within a very short time and, in the USA, less than 10% of smokers who stop for one day remain non-smokers at 12 months.7 Nicotine replacement therapy has been shown to improve cessation rates in many controlled randomised studies, …