Smoking increases risks of cardiovascular disease, respiratory illness and several cancers. These risks remain relevant for people with schizophrenia and contribute to preventable physical health burden. Existing psychiatric symptoms do not reduce the value of prevention, assessment or treatment of tobacco-related disease.
Smoking is common among people receiving care for schizophrenia, but patterns and reasons vary. Tobacco smoke and nicotine have different pharmacological roles, which matters when discussing medication interactions. Assessment should address dependence, physical health and treatment exposure without assuming that smoking is necessary for cognitive function or that cessation support is unsuitable for people with psychosis.
Care should include discussion of breathing symptoms, exercise tolerance and other concerns as clinically indicated. A person may face barriers to healthcare, including cost, stigma or difficulty organising appointments. Practical support can therefore matter as much as information. Reducing smoking exposure offers potential benefit, while the best plan depends on dependence, preferences and medication considerations. Physical health should be integrated with psychiatric care rather than postponed until symptoms disappear. A respectful discussion avoids blame and focuses on achievable support, recognising that dependence and environmental factors can make change difficult even when the person understands the risks.
Physical symptoms require ordinary clinical attention. Breathlessness or reduced exercise tolerance may reflect tobacco-related illness, another condition or several causes. They should not be attributed automatically to anxiety or low fitness. Integrated care can support assessment and prevention while helping with appointments or communication, recognising that practical access and respectful treatment influence whether health risks are identified and addressed effectively.
Further reading: NICE clinical guideline; NHS Specialist Pharmacy Service.
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