Cardiovascular Care

Do you talk to your patients about smoking?

Sylvia McAra, PHD

Sylvia McAra, PhD | Section editor

Podiatrist, clinician & educator

Sylvia has been involved in a number of peer-reviewed publications regarding peripheral vascular assessment. Her doctoral project involved using toe-brachial pressure indices to measure outcomes using transdermal glyceryl trinitrate. Now she provides podiatry services at a large multidisciplinary medical practice in Wodonga, Victoria. She is involved in education for evidence-based best practice in peripheral vascular screening.

While smoking may not immediately come up in conversation between a patient and podiatrist, Dr Sylvia McAra presents some evidence for why it should.

Studies show that people increase their chances to cease smoking by 300% with support of a formal support program.

The current public awareness campaign, ‘Smoking causes sticky blood’ from Quit Australia states: "Within 10 minutes of inhaling cigarette smoke, your blood becomes sticky, increasing your chance of a heart attack.”


As part of this campaign, Professor Nicholas Cox from Western Health shares in this link how he talks to his patients about smoking and quitting.


What is the role of health professionals?

Research shows that:


  • Most adults (70%) want to quit
  • People accessing health services expect to be asked about their smoking
  • One in 33 conversations with a health professional will result in a person quitting.


As part of Quit Victoria, physician Dr Rudi Gasser outlines three simple and evidence-based steps for health professionals in this short video, which are recommended to embed in routine health care.


    1. Ask about people’s smoking
    2. Advise people that:
      a. Giving up smoking is usually the single most helpful thing they can do for their health
      b. It’s most effective to combine pharmacotherapy plus tailored psychological input
    3. Help people to access both pharmacotherapy and psychological support.


Quit Victoria offers free courses for health professionals that help people quit and they include how to connect people with best-practice tobacco dependence treatment. The ‘Essentials’ course takes 30 minutes to complete and is certified so it can be used as Continuing Professional Development.


Clinical case


A 40 year-old mother of an eight year-old girl was consulting her podiatrist, for heel calluses, forefoot and peroneal pain. Her medical issues included smoking, diabetes, obesity and rheumatoid arthritis (RA). Both she and her husband were long term smokers since their teenage years. My input as her podiatrist was to give her the information that her life expectancy is shorter by about 6.6 years from having diabetes, and further reduced by about another 6.5 years as a result of the increased risks of peripheral arterial disease and cardiopulmonary effects from being a smoker. These factors compound each other in combination and with her other health risks.


This information galvanized her into action. She saw that smoking was likely to shorten and impact her family life in preventable ways. She promptly accessed smoking cessation assistance from her GP, and both she and her husband quit using pharmacological aids and GP counselling over the next eight weeks. She thanked me for the information which had empowered her to take action from a perspective of care for her family, and said afterwards that quitting wasn’t as hard as she had imagined.



What’s happening overseas?

In the UK

Studies show that people increase their chances to cease smoking by 300% with support of a formal support program. For example, 10,000 people in the UK’s Hove + Brighton region stopped smoking within four years after accessing interventions such as support groups.


In the US

  • Over 50% of adults who smoke try to quit each year
  • Three in five adults who ever smoked cigarettes have quit
  • Over 40% of adults who smoke do not receive advice to quit from a healthcare professional
  • Fewer than one in three adults who smoke use cessation counselling or FDA-approved medications when trying to quit
  • Fewer than one in 10 US adults successfully quit smoking each year.

The importance of quitting in context of the COVID-19 pandemic has never been greater.

Discuss your successes and failures in triggering effective smoking cessation with your colleagues this month.

Activities to consider