We read with interest the article by Aveyard et al1 on behavioural support as an intervention for smoking cessation in primary care. There is evidence that behavioural support doubles the likelihood of smoking cessation.2 3 Aveyard et al conducted a random-ised controlled trial and compared basic behavioural support with weekly support as a form of smoking cessation intervention. They have reported a quit rate of 22.4% at 4 weeks for both groups and a quit rate of 7.7% and 6.6% at 52 weeks for basic and weekly support, respectively.

Tobacco smoking is the most common cause of chronic obstructive pulmonary disease (COPD). Smoking cessation is the most significant intervention in patients with COPD as it results in a reduction in lung function decline and improved survival. Behavioural smoking cessation intervention in the group studied by Aveyard et al is important as smoking cessation should be available to smokers in the community who want to give up smoking. We felt, however, that opportunistic smoking cessation should also be offered to patients with COPD who are smokers and who are hospitalised due to exacerbations. Thus, smoking cessation intervention was included in our Hospital at Home (HaH) programme.

We retrospectively analysed 79 patients (39 women) of mean age 65 years (range 51–87) with an exacerbation of COPD who were managed through our HaH programme.4 They had a smoking history of 62.2 pack-years (range 10–228). Smoking cessation intervention was provided by a trained respiratory nurse and included a combination of a verbal 30 min consultation followed by telephone counselling at 1, 3, 6 and 12 months and (in a proportion of patients) nicotine replacement therapy. Our success rates at 4 weeks and 18 months were 51% and 25%, respectively, which was much higher than that reported by Aveyard and colleagues. One of the reasons for this higher success rate in our patients may be related to a possible stronger motivation for smoking cessation resulting from a recent hospital admission. We therefore suggest that smoking cessation intervention is done routinely during an acute exacerbation of COPD as part of the HaH service.