Overview of smoking cessation management in adults
- Nancy A Rigotti, MD
Nancy A Rigotti, MD
- Professor of Medicine
- Harvard Medical School
- Stephen I Rennard, MD
Stephen I Rennard, MD
- Larson Professor of Medicine
- University of Nebraska Medical Center
- David M Daughton, MS
David M Daughton, MS
- University of Nebraska Medical Center
- Section Editors
- James K Stoller, MD, MS
James K Stoller, MD, MS
- Section Editor — Chronic Obstructive Pulmonary Disease
- Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair
- Cleveland Clinic Lerner College of Medicine
- Chairman, Education Institute, Cleveland Clinic
- Robert H Fletcher, MD, MSc
Robert H Fletcher, MD, MSc
- Editor-in-Chief — Adult Primary Care
- Section Editor — General Medicine
- Professor Emeritus of Population Medicine
- Harvard Medical School
Cigarette smoking is the leading preventable cause of mortality. Smokers who quit smoking reduce their risk of developing and dying from tobacco-related diseases [1,2]. Approximately 70 percent of smokers say that they want to quit, and over 50 percent of smokers report that they tried to quit in the past year [3,4]. However, only 3 to 6 percent of smokers who make an unaided quit attempt are still abstinent one year later. Only 32 percent of smokers who try to quit seek help and even fewer use the most effective treatments [3,5]. With optimal treatment, one-year abstinence rates after a single quit attempt can exceed 30 percent.
This topic provides an overview of smoking cessation management in adults. This includes a discussion of a simple five-step algorithm called the 5 A's (Ask, Advise, Assess, Assist, Arrange) (table 1 and table 2) with suggestions for implementation in primary care practice. Behavioral counseling and pharmacologic treatments for smoking cessation are discussed in more detail separately. (See "Behavioral approaches to smoking cessation" and "Pharmacotherapy for smoking cessation in adults".)
Management of smoking cessation in adolescents and pregnant women are discussed separately. (See "Management of smoking cessation in adolescents" and "Cigarette smoking and pregnancy", section on 'Smoking cessation'.)
ASSESSMENT OF USE AND EXPOSURE
The United States Preventive Health Services guidelines recommend that clinicians ask all patients about tobacco use and provide tobacco cessation interventions for those who use tobacco at every visit . This practice has been shown to increase the likelihood of smoking-related discussions and increase smoking cessation rates [7-9].
For patients who use tobacco, a full assessment includes the frequency of use, the products used, the degree of nicotine dependence, the history of previous quit attempts (including methods used and their effectiveness), and the smokers’ readiness to stop smoking at this time . Dependence on nicotine can be estimated from the duration of smoking history, the number of cigarettes smoked daily, and how soon after waking up the smoker has his or her first morning cigarette. A smoker's degree of nicotine dependence predicts the difficulty that he or she will have in quitting and the intensity of treatment likely to be required. More dependent smokers started smoking early in life, have smoked for many years, smoke more cigarettes daily, and smoke within the first 30 minutes of awakening [10,11].
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- ASSESSMENT OF USE AND EXPOSURE
- ADVISE SMOKING CESSATION
- ASSESS READINESS TO QUIT
- ASSIST SMOKERS READY TO QUIT
- Setting a quit date
- Addressing barriers to quit
- - Nicotine withdrawal syndrome
- - Other barriers
- Treatment options
- - Behavioral counseling
- - Pharmacologic treatments
- - Alternative therapies
- ARRANGE FOLLOW UP
- Difficulty quitting
- Relapse prevention
- ASSIST SMOKERS NOT READY TO QUIT
- ISSUES IN SPECIFIC POPULATIONS
- Psychiatric illness
- Cardiovascular disease
- Hospitalized smokers
- Light smokers
- Preoperative smokers
- IMPLEMENTATION IN PRIMARY CARE PRACTICE
- Team-based approach
- Proactive offer of treatment
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS