SMOKING CESSATION GUIDANCE AND RESOURCES
Date: 01/03/24
January is often when patients make new year resolutions to improve their health. One of those resolutions may be to stop smoking. And they are not alone—in 2015, 68% of adults who smoked wanted to quit smoking.2
Furthermore, 16 million Americans have a disease caused by smoking.1 Smoking can cause heart disease, stroke, cancer, lung disease, diabetes, and chronic obstructive pulmonary disease (COPD). It is a known cause of erectile dysfunction in males. And cigarette smokers on average, die 10 years earlier than non-smokers.1 Encourage your patients that health benefits can be seen 20 minutes after they stop smoking.2
E-cigarettes (also known as vaping, vape pens, or hookah) have increased in popularity. The products do not contain tobacco, but they contain nicotine.4 E-cigarettes heat a liquid that is converted into an aerosol, which is then inhaled into the lungs.4 Besides nicotine, the aerosol also contains polyethylene glycol or glycerin, volatile organic compounds, formaldehyde, and flavoring chemicals.4
During routine office visits, screen your patients for smoking cessation by following the 5 A’s3:
- Ask: Chart all patients who smoke
- Advise: Find a kind but clear and personalized way of recommending that the patient quit
- Assess: Check the patient's readiness to quit
- Assist: Offer help whether the patient is ready or not
- Arrange: Arrange for the patient to follow up with you, or at a smoking cessation clinic
If patients are ready to quit smoking, nicotine replacement therapy (NRT) can be offered to support them, especially if they are significantly dependent on nicotine.
Signs of significant nicotine dependence5:
- Smoking more than 1 pack a day
- Smoking within 5 minutes of waking up
- Smoking while sick
- Waking up at night to smoke
- Smoking to ease symptoms of withdrawal
Available NRT product types include patches, gums, lozenges, sprays, and inhalers. An initial dose depends on the number of cigarettes smoked daily.5 Generally, NRT products should be avoided if the patient has had a myocardial infarction, irregular heart rhythms, or uncontrolled hypertension.
Patches | |||
|---|---|---|---|
Number of cigarettes | Dose | Ideal Patient | Adverse Effects |
Light (<10 cigarettes per day [cpd]) | 14mg | Those that want to apply and “forget about it” | Skin irritation or redness, tachycardia, sleep disturbances, headache |
Moderate (19-21 cpd) | 21mg | ||
Heavy (>29 cpd) | 28mg (21mg +7mg patch) | ||
Oral prescription therapy is also available. See the table below for descriptions.
Drug | Dose | Ideal Patient | Adverse Effects | Notes |
|---|---|---|---|---|
Bupropion (Wellbutrin) | 150mg once per day, increasing to twice a day after 3 days | Those with previous CV history | Dry mouth, insomnia | Start 1 week before quitting date |
Varenicline (Chantix) | Follow manufacturer titration schedule | Those that want the best chance of successful quitting | Headaches, strange dreams, insomnia, depressed mood, increased thoughts of suicide | Start 1 week before quitting date Take with meals |
Please refer to the Meridian PDL (PDF) for preferred smoking cessation products.
References:
1. Disease and Death. Accessed December 15, 2023.
2. I want to quit smoking. Accessed December 15, 2023.
3. Smoking Cessation: Screening. Accessed December 15, 2023.
4. What do we know about e-cigarettes? Accessed December 15, 2023.
5. Nicotine replacement therapy to help you quit tobacco. Accessed December 15, 2023