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This indicator relates to patients who are on the disease registers for CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma and mental health who are recorded as current smokers.
Smoking is known to be associated with an increased risk of coronary heart disease.
SIGN Clinical Guideline 97 (2007); European Task Force European Society of Cardiology
European Society of Cardiology. European Guidelines. CVD Prevention in clinical practice.
Peripheral arterial disease is associated with older age and with smoking. Cigarette smoking is a very important contributor to PAD and management of PAD includes smoking cessation
There are few randomised clinical trials of the effects of risk factor modification in the secondary prevention of ischaemic or haemorrhagic stroke. However inferences can be drawn from the findings of primary prevention trials that cessation of cigarette smoking should be advocated.
SIGN clinical guideline 108. Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention 2008..
There is no strong direct link between smoking and blood pressure. However, there is overwhelming evidence of the relationship between smoking and cardiovascular and pulmonary diseases. NICE clinical guideline 127 on hypertension recommends that people who smoke are offered advice and help to stop smoking.
The risk of vascular complications in patients with diabetes is substantially increased. Smoking is an established risk factor for cardiovascular and other diseases.
Smoking cessation is the single most effective - and cost-effective - intervention to reduce the risk of developing COPD and stop its progression.
NICE clinical guideline 101 (2010). Management of chronic obstructive pulmonary disease in adults in primary and secondary care.
Asthma There are a surprisingly small number of studies on smoking related to asthma. Starting smoking as a teenager increases the risk of persisting asthma. One controlled cohort study suggested that exposure to passive smoke at home delayed recovery from an acute attack. Smoking reduces the benefits of inhaled steroids and this adds further justification for recording this outcome. There is also epidemiological evidence that smoking is associated with poor asthma control.See Tomlinson et al. Thorax 2005; 60: 282-7.
There is good evidence from observational studies that people with CKD are at increased cardiovascular risk and hence the rationale for including CKD here.
People with serious mental illness are far more likely to smoke than the general population (61% of people with schizophrenia and 46% of people with bipolar disorder smoke compared to 33% of the general population). Premature death and smoking related diseases, such as respiratory disorders and heart disease, are however, more common among people with serious mental illness who smoke than in the general population of smokers (Seymour L. Not all in the mind: the physical health of mental health service users. Mentality 2003).
See requirements for recording smoking status for further information.
See indicator wording for requirement criteria.
The disease register for the purpose of calculating APDF for SMOK002 and SMOK005 is defined as the sum of the number of patients on the disease registers for each of the conditions listed in the indicator wording. Patients with one or more co-morbidities e.g. diabetes and CHD are only counted once.
Prepared By Jean Keenan