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An estimated 480,000 Americans die each year from issues associated with smoking cigarettes. According to the CDC, tobacco use is the single largest preventable cause of death in the United States. Even worse, these illnesses cost more than $300 billion each year – $170 billion in medical care and $156 billion lost in productivity.

Quitting reduces the development of atherosclerosis and lowers the incidence of initial and recurrent myocardial infarction, thrombosis, cardiac arrhythmia, and death from cardiovascular causes. Despite these benefits, many struggle to quit because smoking is a complex behavioral activity seldom cured by simple interventions.

Plus, there are some unpleasant withdrawal symptoms that can last up to six weeks. These include cravings, hunger, weight gain, insomnia, dizziness, constipation, chest pains, and irritability. To top things off, the chance of relapse is great, and no single smoking cessation tool is effective for all smokers.

Luckily, there are a number of different ways you can help patients quit, and quit for good.

Physician Intervention + Counseling

Studies have shown that just three minutes of cessation counseling from a physician improves the chances of quitting. Physician intervention begins with routine assessment of smoking status for all patients and includes the 5 A’s for cessation:

  1. Ask the patient about smoking status at every visit.
  2. Advise the patient to stop smoking.
  3. Assess the patient’s willingness to quit.
  4. Assist the patient by setting a date to quit smoking, providing self-help materials, and recommending the use of pharmacologic agents.
  5. Arrange for follow-up visits, preferably within the first week.

For those who aren’t ready to quit just yet, the 5 R’s for motivational intervention are recommended for discussion: Relevance, Risks, Rewards, Roadblocks, and Repetition.

Suggest New Ways to Deal with Stress

During discussions with patients, you may find stress is one of the underlying reasons your patient smokes. Many patients are conscious of the relationship with weight gain and smoking, too. Suggesting alternative ways to deal with stress and to counterbalance weight gain can enable patients to change their behaviors.

Tell Patients Their Lung Age

It’s long been suspected that presenting smokers with evidence of tobacco’s harmful effect on their bodies – biomarkers – might encourage them to stop. In addition to presenting statistics to scare patients straight, a spirometry can be performed on patients who smoke – even if they’re asymptomatic. This will show them their lung age, which is the average age of a nonsmoker with a forced expiratory volume at 1 second (FEV1) equal to theirs.

Anti-depressants

The only FDA- approved anti-depressant to help with smoking cessation is Bupropion, also known as Zyban. Initiated while the patient is still smoking, Bupropion acts as a nicotine antagonist, and is often used to treat major depressive disorder and seasonal affective disorder by increasing brain levels of dopamine and norepinephrine.

In addition, another option is Varenicline (CHANTIX), a partial agonist at the a4ß2 nicotinic acetylcholine receptor, that aids smoking cessation by relieving nicotine withdrawal symptoms. With Varenicline, the patient will need to set a quit date and start Varenicline a week prior.

Nicotine Replacement Therapy (NRT)

Nicotine replacement therapies, such as gum, patches and nasal spray increase quit rates. They reduce withdrawal symptoms by partially replacing nicotine in the blood. However, one is not proven to be better than their counterparts.

As a result, encourage a combination of treatments if the patient is unable to quit using a single form of pharmacotherapy. Furthermore, the choice of which form to use should also reflect patient needs, tolerability and cost considerations.

Bonus: What Not to Do

The use of e-cigarettes is growing in popularity among smokers who want to quit, however, these devices are unregulated, of unknown safety and may not benefit in quitting smoking.

Anxiolytics, silver acetate, Nicobrevin, lobeline, or naltrexone have yet to be proven effective tools for smoking cessation. However, therapies such as acupuncture, hypnosis, print-based educational handouts, and financial incentive-based programs are significantly better than no intervention at all.

About PEPID

To learn more about Smoking Cessation with PEPID, visit the Smoking Cessation monograph in your suite. To learn more about PEPID, visit our home page, watch our overview video, or call us at 602-296-3443.

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