Smoking cessation

Key points
5 As for pts willing to quit
 Ask if pt smokes
 Advise pt to quite
 Assess willingness to quit
 Assit in quit attempt
 Arrange follow up

Assisting pt in developing quit plan (STAR)

 Set quit date
 Tell family + frients (for support)
 Anticipate challenges (withdrawal)
 Remove tobacco related products (ash trays, lighters)

Management
General approach
 Identify tobacco users, elicit smokign habits, prev quit attempts, methods + results
 Make pt aware of withdrawal SXs
o Low mood, insomnia, irritability, anxiety, concentration, restlessness, HR, appetite
 Approach dependent on pt’s stage of change

For pts unwilling to quit

5 Rs for pts unwilling to quit:
 Relevance to pt (health concerns, family/social situations)
o Appeal to their situation to highlight the need to and benefits of quitting (children)
 Risks of smoking
o Short term: SOB, asthma exacerbation, infertility, pregnancy CX, heartburn, URTI, impotence
o Long term: MI, stroke, COPD, lung cancers, other cancers
o Env: risk to children + spouse for lung Ca, asthma, resp infections
 Rewards of quitting
o health, save money, food tastes better, good example to children
 Roadblocks to quitting
o Fear of withdrawal
o Weight gain
o Failure
o Lack of support
 Repetition of motivations intervention at each visit
o Reassure unsuccessful pts that most people try many times before succeeding (7)

For pts willing to quit

 Follow 5 As
 Provide social support + community resources

Pharmacotherapy
 Nicotine replacement Rx
o Bupropion
 MOA: inhibits re-uptake of dopamine/NA
 SE: dry mouth, insomnia
o Varenicline (champix)
 Partial nicotinic R agonist (cravings) + partial competitive nicotinic receptors
antagonist (response to smoked nictoine)
 More effective thatn bupropion
 SE: n/v, constipation, H/A, insomnia, depression, suicidal ideation, psychosis risk

For recent quitters

Higher relapse rate within 3 months of quitting
 Minimal practise: congratulate on success, encourage ongoing abstinence, review benefits + problems
 Prescriptive intervention: address weight gain problem, negative mood, withdrawal + lack of support