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Updated: Dec 27 2021

Smoking Cessation

  • Snapshot
    • A 69-year-old male presents with concerns about his declining health. His brother recently died of renal cell carcinoma and he is now concerned about his own health. The patient has a history of type II diabete mellitus, HTN and a 50 pack-year smoking history. He asks you what he can do to improve his health.
  • Introduction
    • Smoking is considered the most important modifiable risk factor in the US for cancer and cardiovascular and pulmonary disease
    • All adults should be screened regularly for tobacco use
    • Smoking cessation should be discussed with all smokers at EVERY clinical contact
      • most likely to reduce mortality
    • Therapies for smoking cessation include:
      • nicotine replacement
      • bupropion
      • varenicline
      • cognitive behavioral therapy (CBT)
      • combination therapy (multiple treatments from above) are the most effective
  • Nicotine Replacement
    • Comes in many forms including:
      • gum
      • inhaler
      • lozenge
      • patch
      • spray
    • Many forms can be purchased over the counter
    • Gums, inhalers, lozenges are excellent for combatting acute cravings
    • Patches ideal for delivering a basal rate of nicotine
  • Bupropion (Zyban)
  • Varenicline (Chantix)
    • Nicotinic receptor partial agnoist
    • Prescription only
      • Therapy should begin 1 week prior to quit date and then continued 4 months after quit date
    • Very effective when combined with nicotine therapy (older sources say NOT to combine them)
    • Side effects:
      • headache
      • nausea
      • insomnia
      • depression/SI
    • Warnings:
      • may cause neuropsychiatric symptoms or increased suicidality
      • avoid in patients with history of unstable psychiatric symptoms or suicidality
      • Cognitive Behavioral Therapy (CBT)
      • CBT is a form of psychotherapy that targets changing maladaptive thinking patterns and the negative behaviors associated with them
      • Not been found to be highly effective when used alone for smoking cessation
      • May be helpful when employed with some of the therapies listed above
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