![]() I want you to come back to the office next week so we can talk about this more.” ![]() “I think quitting smoking is very important for you because of your asthma. Setting a follow-up appointment specifically to discuss this advice further may increase the patient's uptake of the advice 10 Unambiguous support for smoking cessation should be expressed by the physician, and the benefits of quitting should be discussedĪdvice to patients should be clear (direct expression of the need for smoking cessation), strong (highlighting the importance of cessation), and personalized (linking the patient's health goals to cessation) 4 “Have you ever been a smoker or used other tobacco products? Do you use tobacco now? How much?” Including smoking as a vital sign in patients' charts may remind the physician to address tobacco use Promoting smoking cessation appears to increase patients' satisfaction with their visit, even among smokers not yet motivated to quit 9 Office systems should ensure that all tobacco users are identified smoking status should be documented at every visit Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages. ![]() Nicotine replacement therapies are safe for use in adolescents however, they are less effective than in adults. Varenicline may increase the risk of coronary events. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Using more than one type of nicotine replacement therapy (“patch plus” method) and combining these therapies with bupropion provide additional benefit. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. These messages should be repeated at every opportunity. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. Cigarette smoking causes significant morbidity and mortality in the United States.
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