1 Provide clear advice (eg):• “It is important that you quit smoking (or using chewing tobacco) now, and I can help you.”
• “Cutting down while you are ill is not enough.”
• “Occasional or light smoking is still dangerous.”
Fiore MC, et al.
Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
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2 Provide strong advice (eg):
• “As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. The clinic staff and I will help you.”
Fiore MC, et al.
Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
PDF
3 Personalize advice: Tie tobacco use to current sx and health concerns, and/or its social and economic costs, and/or the impact of tobacco use on children and others in the household (eg):
• “Continuing to smoke makes your asthma worse, and quitting may dramatically improve your health.”
• “Quitting smoking may reduce the number of ear infections your child has.”
Fiore MC, et al.
Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
PDF
4 Provide supportive clinical environment while encouraging pt in their quit attempt (eg):
• “My office staff and I are available to assist you.”
Fiore MC, et al.
Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
PDF
5 Strategies: Tell family, friends, and coworkers about quitting; review how to cope w/ nicotine w/drawal sx; remove tobacco products from their environment; limit/abstain from alcohol use; ask housemates to not smoke around them. Fiore MC, et al.
Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
PDF
6 Long-acting, steady-state levels: nicotine patch (1/day).
Short-acting for craving relief: nicotine gum, lozenge, inhaler, or nasal spray.
7 Bupropion SR 150: long-acting, non-nicotine pill; nicotine antagonist; contraindicated if on MAO inhibitor or seizure/eating disorder hx.
8 Varenicline: long-acting, non-nicotine pill; nicotine agonist + antagonist; caution in renal impairment/dialysis/serious psychiatric illness.
9 2nd-line options: clonidine and nortriptyline for pts where 1st-line meds are contraindicated/not helpful:
• clonidine: long-acting, pill or transdermal. May start up to 3 days before quit date. Side effects include dry mouth, drowsiness, dizziness. Taper off slowly to avoid rebound hypertension.
• nortriptyline: Start 10-28 days before quit date, caution pt against sudden med d/c to avoid w/drawal sx. Side effects include sedation, dry mouth, blurred vision, urinary retention, lightheadedness, shaky hands.
10 USPSTF recommends clinicians direct pts to other cessation interventions w/ established effectiveness and safety. Siu, A; U.S. Preventive Services Task Force. Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement.
Ann Intern Med. 2015 Oct 20;163(8):622-34.
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11 Options for in-depth, evidence-based tobacco cessation counseling and support include
Tobacco Quitline (800-QUIT-NOW) or clinic, hospital, or community tobacco cessation program.
12 Arrange for f/u contact either in person or via telephone. Begin contact soon after quit date, preferably during the 1st wk, 2nd contact w/in 1st mo, then as needed. During the contact, assess past/present challenges, med use/problems, abstinence; remind about
Tobacco Quitline (800-QUIT-NOW). Fiore MC, et al.
Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
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