Nurse-led smoking cessation with cytisinicline in primary care: An intervention study.

Background: Smoking is a major risk factor for several leading causes of death worldwide and is the primary cause of chronic obstructive pulmonary disease. Smoking cessation remains the only effective intervention to halt disease progression. Evidence on smoking cessation outcomes with cytisinicline in primary care programmes remains limited, particularly in nurse-led intervention models. In addition, respiratory diseases are frequently underdiagnosed in smokers, representing an opportunity for early detection in primary care when integrated into smoking cessation support. Objective: To describe smoking cessation outcomes of a comprehensive nurse-led intervention using cytisinicline in primary care and to explore factors associated with relapse and the detection of respiratory disease during follow-up. Desing: Prospective multicentre observational study conducted in primary care. The intervention was based on a structured nursing care model grounded in established behaviour change frameworks, integrating intensive behavioural counselling, pharmacological treatment with cytisinicline, adherence monitoring, structured follow-up, and respiratory assessment using spirometry. Participants were followed for 12 months. An intention-to-treat analysis was performed, with losses to follow-up considered as relapses. Results: A total of 192 participants were included (46.9% women), with a mean age of 50.7 years (standard deviation 12.9). Abstinence rates were 76.6% at 1 month, 58.9% at 3 months, and 47.4% at 6 months. Biochemically verified abstinence at 12 months was 40.1%. The mean time to relapse was 84 days, and the median was 60 days. In multivariable analysis, higher nicotine dependence and greater withdrawal symptoms at the end of treatment were independently associated with an increased risk of relapse, while a diagnosis of asthma during the study was associated with a lower likelihood of relapse. Adverse events were reported by 23.9% of participants and were mostly mild, predominantly gastrointestinal, and well-tolerated. Previously undiagnosed respiratory disease was identified in 28% of participants during the study. Conclusions: A comprehensive nurse-led smoking cessation model in primary care was associated with favourable abstinence outcomes and enabled the identification of previously undiagnosed respiratory disease. Higher nicotine dependence and withdrawal symptoms were associated with an increased risk of relapse, whereas a diagnosis of asthma during the study was associated with a lower likelihood of relapse. We suggest that integrating behavioural, pharmacological, and respiratory assessment components within nurse-led primary care pathways may support smoking cessation in routine practice, although causal inferences cannot be established.