Smoking Cessation

Smoking Cessation

Objectives

Students will be able to list the components of a comprehensive smoking-cessation intervention, as presented in the text and lecture.

Students will document smoking status, recommendations to quit, assistance provided, and follow-up for all smokers seen in the Comprehensive Care Clinic.

Students will be able to elicit information necessary to make a diagnosis of nicotine-dependence in their patients.

Students will be able to prescribe nicotine replacement appropriately for their patients.

Smoking Cessation

Ask patients about smoking at every visit. Document smoking status on the progress note and on the clinic summary sheet.

Assess the patient's willingness to quit.

Advise all smokers to quit, and document this advice in the chart.

Assist the patient in quitting, and document all offers of assistance:

set a quit date
provide self-help material
consider referral for behavioral support
consider nicotine replacement

Arrange follow-up visits.

Anticipatory guidance for adolescents.

Nicotine Replacement (as adjunct to behavioral therapy)

Assess for nicotine dependency:

daily amount >1.5 packs per day

1st cigarette within 30 minutes of waking

trouble in smoke-free environments

smokes if sick in bed

previous withdrawal symptoms (anxiety, irritability, insomnia, decreased concentration, hunger, tremor, sweating, palpitations, headaches, fatigue)

Avoid or use cautiously in:

allergic to nicotine
pregnancy and lactation
unstable or poorly controlled cardiovascular disease and peripheral vascular disease
concurrent smoking
a variety of severe or poorly controlled diseases
dermatitis (patch)/oral or dental problems (polacrilex).

Available products:

Brand	Dose/Schedule			Dispense	Maximum
Habitrol	21mg/24 4-6 wks	14mg/24h* 2-4 wks	7mg/24h 2-4 wks	30/box	3 months
Nicoderm	21mg/24h 4-6 wks	14mg/24h* 2-4 wks	7mg/24h 2-4 wks	14/box	3 months
Nicotrol	15 mg/16h 4-12 wks	10mg/16h 2-4 wks	5mg/16h 2-4 wks	14/box	5 months
Prostep	22mg/24h 4-8 wks	11mg/24h* 2-4 wks		7/box	3 months

*lower dose for cigarette use < 1-1/2ppd (apply to clean, dry, nonhary, noninflamed skin on trunk or upper arm) (advise careful storage and disposal of new and used patches)

Polacrilex	Dose	Usual Pieces Per Day	Maximum Per Day
Nicorette	2mg chew over 30 minutes	9 to 12/day	30
Nicorette DS	4mg chew over 30 minutes	9 to 12/day	20
(withdraw from Polacrilex over 3 months) (advise careful storage and disposal of medication)

Referral Sources:

Respiratory Therapy 5490

Cathy Couvilliion, RN 5647

References:

Husten CG, Manley MW. How to help your patients stop smoking. Am Fam Physician 1990;43(4):1017-26.

J. Hood, MD
updated 8/30/05

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