Editorial on primary care respiratory perspective

22 June, 2020

Hi Neil - here's an editorial I cowrote that I hope gives a good overview of the challenges facing primary care in relation to chronic respiratory diseases and tobacco, and where we need to gather more evidence.

https://www.nature.com/articles/s41533-020-0187-x

In particular, please note the points about nicotine replacement therapy - NRT - (particularly as nicotine is a rather hot topic at present). It's shocking that it's on the WHO Essential Medicines List but very few countries at the last count had it on their national formulary, so it's left as an out of pocket expense - and in many countries more expensive than cigarettes.

Here are two excerpts in relation to that:

'COVID-19 presents a powerful reason to quit tobacco. We applaud the WHO's strong stance. Whilst we await evidence, there is concern that waterpipe and cigarette smoking increase the risk of infection. People with a history of tobacco use are also more at risk of respiratory infections and may get worse symptoms if they get COVID-19. Therefore, it is a good time for primary care to support smokers who want to quit, because the evidence is strong about the increased impact of a supported quit attempt 5. We urge primary care pharmacists, GPs and other healthcare workers to actively seek out and support their tobacco-dependent populations to quit. Hypothetical benefits of nicotine in acute COVID-19 does not alter the public health message of the danger of smoking.'

'[We]...must advocate for national investment in the recruitment, teaching and protection of primary care and access to affordable inhaled medicines and spacers, tobacco dependence treatment and rehabilitation. For example, whilst nicotine replacement therapy (NRT) is on the WHO essential medicines list, it is apparently on national formularies in only 17 countries in the world, revealing a significant unmet need that should be addressed whatever the findings of COVID-19 studies ( www.global.essentialmeds.org/dashboard/medicines/1306)."'

I welcome feedback!

Siân

HIFA profile: Sian Williams is Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. sian.health AT gmail.com