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Dear Colleagues
Today we publish a new paper Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the International Primary Care Respiratory Group (IPCRG), endorsed by WONCA Europe, World Organization of Family Doctors in Europe and applicable to global primary care.

DOI: 10.1038/s41533-017-0039-5
While much recent attention has focused on the impact of air pollution on health, we should never forget that tobacco smoking is the world’s leading cause of premature death and disability.
This paper does not focus on public health measures, but on what to do now for the huge numbers of people who currently smoke, and are therefore at high risk of early death or long term health problems.   It makes it clear that smoking is not “a lifestyle choice” but a highly damaging dependency, for which there are excellent treatments.
“A quarter of the world population still smokes and at least one out of every two smokers will die due to smoking. Primary care physicians are the most important care providers for smoking cessation treatment in many countries in the world. Yet, there many reasons why primary care physicians are hesitant or even reluctant to deliver this care, such as time constraints or a perception of lack of competence. This position statement gives practical guidance to the primary care physician to overcome these constraints. A very brief advice hardly costs any time and saves many lives worldwide when given by a primary care provider.”  said Prof Dr Onno van Schayck, Professor of Preventative Care, Scientific Director Netherlands Research School CaRe, Maastricht University, The Netherlands, first author.
The paper’s authors all work in primary and community settings, and have therefore reviewed the evidence through the lens of real clinical experience.  Two of the authors are part of IPCRG-Global Bridges programmes to teach primary care about treating tobacco dependence in Uganda and in Eastern Europe: framing the problem, rightly, as a clinical problem for which there are evidence-based treatments.   
“New to this paper is the guidance on special populations such as people with long term conditions including TB, HIV, cardiovascular disease and respiratory disease; pregnant women, children and adolescents, and people with serious mental illness. The paper describes trends in the use of e-cigarettes, waterpipes and cannabis smoking and offers guidance to primary care clinicians on what to do faced with uncertain evidence.”  Explained Prof Aziz Sheikh, Editor-in-Chief, npj Primary Care Respiratory Medicine.
Key recommendations of the paper are already being tested globally by IPCRG and colleagues in the Global Bridges and FRESH AIR programmes.  These include a call for clinicians to consider tobacco use as a “vital sign” and act as if smoking - tobacco dependence – is a chronic relapsing-remitting disorder with highly effective and cost effective treatments, deliverable in primary care.  Use Very Brief Advice (Ask, Advise, Act).
The paper calls on the World Health Organization to add more smoking cessation products to its Model List of Essential Medicines.  It also needs national governments to ensure that this list is mirrored nationally, and that the products are available in primary care.  As an illustration, some progress is already being made by colleagues in the Kyrgyz Republic, who have recently lobbied successfully to have the Model List for tobacco dependence replicated nationally.
The paper highly recommends behavioural training for primary care in low, middle and high income countries.  The IPCRG Global Bridges-funded Teach the Teacher programme is testing that now, because achievement of the UN Sustainable Development Goals requires behaviour change, and top of the list should be helping people quit smoking.
More information
The International Primary Care Respiratory Group (IPCRG) is a charity registered in Scotland working internationally (SC No: 035056) and a company limited by guarantee (Company number 256268)
Registered Offices: 4th Floor, 115 George Street, Edinburgh, Scotland, EH2 4JN
Correspondence address: PO Box 11961, Westhill, AB32 9AE, U.K.
Tel: +44 1224 743753
The IPCRG is a not-for-profit clinically-led organisation registered as a charity and company limited by guarantee in Scotland that operates internationally.  It supports primary care to work locally and collaborate globally to improve respiratory health. 

It represents national primary care respiratory groups and facilitates communities of practice and networks across the world to achieve this aim.
Through its network of over 130,000 primary care professionals, the IPCRG initiates, shares, spreads and supports the implementation of evidence in community settings for the prevention, treatment and care of breathing and lung problems such as asthma, chronic obstructive pulmonary disease, tobacco dependence, allergic rhinitis, sleep apnoea and respiratory infection.  It has a long track record of delivering research and education projects funded through public and private funds for example two programmes with Global Bridges Healthcare Alliance for Tobacco Dependence Education to teach tobacco dependence treatment in the community, one in Uganda, and a new Teach the Teacher cascade programme in Bulgaria, FYR Macedonia, Kyrgyzstan and Romania.  See
It is also delivering education on tobacco dependence treatment as an intervention to improve lung health as part of its FRESH AIR programme, funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No. 680997  This operates in Uganda, Kyrgyzstan, Vietnam and Crete.

The IPCRG is the primary care representative on the World Health Organization (WHO)-Global Alliance against chronic Respiratory Diseases (GARD) Planning Executive, the Respiratory Special Interest Group of The World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe and an Organisation in Collaborative Relations with WONCA Global, a member of the European COPD Coalition, and a supporter of the NCD Alliance.  Its peer-reviewed journal, npj Primary Care Respiratory Medicine is published by Springer Nature.
Current Members and active research locations: Australia, Bangladesh, Belgium, Brazil, Bulgaria, Canada, Chile, China, Cyprus, Denmark, France, Georgia, Germany, Greece, India, Ireland, Italy, Kyrgyzstan, Macedonia FYR, Malaysia, New Zealand, Norway, Pakistan, Philippines, Portugal, Romania, Singapore, Spain, Sri Lanka, Sweden, The Netherlands, Turkey, Uganda, UK, Ukraine, USA, Vietnam.
The first edition of the position statement is backed up by online free resources, most of which remain highly relevant:
Opportunities to present your research on implementation of tobacco dependence treatment:
IPCRG 1st South Asian Primary Care Respiratory Conference, 3-5 August 2017, Colombo, Sri Lanka
IPCRG 1st Ibero-American Primary Care Respiratory Conference, and 9th World Conference, Porto, Portugal 31 May-2 June 2018