SMOKING CESSATIONMustafa Manhal AlWard

Risks of smoking:

• Cancers: Common cancers include: lung (>90% are smokers); lip; mouth; stomach;

colon; bladder

• Cardiovascular disease: CHD, CVA, peripheral vascular disease

• Chronic lung disease: COPD, recurrent chest infection, exacerbation of asthma

• Problems in pregnancy: IUGR, preterm delivery, neonatal and late fetal death

• DM

• Osteoporosis

• Thrombosis

• Dyspepsia and/or gastric ulcers

5 A’S APPROACH

1.ASK2.ADVISE(clear, strong,

personal)

3.ASSESS

4.ASSIST Willing to stop within

30 days?Not willing to stop?

Advice

moreQuit date

Not even a

single puffYour supportExternal

supportNRT

5.ARRANGE

CASE SCENARIO

A 40-year-old executive who smokes three packs of cigarettes a

day comes to your office for his routine health maintenance

assessment. He states that he would like to quit smoking but is

having great difficulty. He has tried three times before, but he says, “Pressures at work mounted up, and I just had to go back to

smoking.”

The patient has a history of mild hypertension. His blood

cholesterol level is normal. He drinks 1 or 2 ounces of alcohol per

week. His family history is significant for premature cardiovascular disease and death.

1.Current evidence suggests that coronary artery disease (CAD) is strongly related

to cigarette smoking. What percentage of deaths from CAD is thought to be directly

related to cigarette smoking?

a.5%

b.10%

c.20%

d.25%

e.30% to 40%

2.Which of the following diseases has (have) been linked to

cigarette smoking?

a.carcinoma of the larynx

b.hypertension

c.abruptio placentae

d.Alzheimer disease

e.all of the above

3.Which of the following statements with respect to passive smoking is false?

a.spouses of patients who smoke are not at increased risk for development of

carcinoma of the lung

b.sidestream smoke contains more carbon monoxide than mainstream smoke

c.infants of mothers who smoke absorb measurable amounts of their mothers’

cigarette smoke

d.children of parents who smoke have an increased prevalence of bronchitis,

asthma, and pneumonia

e.the most common symptom arising from passive smoking is eye irritation

4.Of the following factors listed, which is the most important factor in determining

the success of a smoking cessation program in an individual?

a.the desire of the patient to quit smoking

b.a pharmacologic agent as a part of the smoking cessation program

c.the inclusion of a behavior modification component to the program

d.physician advice to quit smoking

e.repeated office visits

5.Which of the following is (are) now considered a first-line pharmacologic agent(s)

that reliably increase(s) long-term smoking abstinence rates?

a.bupropion SR

b.nicotine gum

c.nicotine inhalers or nasal sprays

d.nicotine patch

e.all of the above

6.Assuming patient interest in smoking cessation, which of the following smoking

cessation methods results in the highest percentage of both short-term and long-term success?

a.Transdermal nicotine

b.a patient education booklet

c.physician counseling and advice

d.a contract for a “quit date”

e.a combination of all of the above

7.One of the best individual targeted smoking cessation programs is the widely

recommended 5 A’s approach (Ask, Advise, Assess, Assist, and Arrange) designed

to identify and help the smoker who is willing to quit. Which of the following is true

about this approach?

a.the approach includes implementation of an officewide system that ensures that

for every patient at every visit, tobacco-use status is queried and documented

b.smokers should be approached intermittently and gently to avoid provoking

anger

c.smokers from households with other smokers present should be advised to change

domiciles

d.the approach fosters self-reliance without the support of any outside organizations

or individuals

e.the use of pharmacotherapy is reserved for counseling failures

8.What is the approximate percentage of patients who relapse after successful cessation of smoking?

a.10%

b.50%

c.75%

d.85%

e.99%

9.What is the most prevalent modifiable risk factor for increased morbidity and

mortality in the United States?

a.hypertension

b.hyperlipidemia

c.cigarette smoking

d.occupational burnout

e.alcohol consumption

10. Nicotine replacement is especially important in which group(s) of patients who smoke cigarettes?

a. those patients who smoke when work-related stressors become unmanageable

b. those patients who smoke more than 20 cigarettes a day

c. those patients who smoke within 30 minutes of awakening

d. those patients who experience withdrawal symptoms

e. all of the above

f. b, c, and d

Nicotine replacement therapy (NRT): Contraindicated immediately post-MI, stroke, or TIA, and for patients witharrhythmia.

Bupropion: Smokers (>18y) start taking the tablets 1–2wk

before intended quit day. Contraindications: epilepsy or i risk of seizures,eating

disorder, bipolar disorder.

Varenicline: Smokers (>18y) start taking the tablets 1wk before intended quit day. If

the patient has stopped smoking after 12wk, consider prescribing a further 12wk

treatment to decrease chance of relapse. Contraindications: caution in psychiatric

illness.

Alternative therapies: Hypnotherapy may be helpful in some casesC.

Drugs for smoking cessation: