December 13, 2017

How Can We Help Patients to Quit Smoking?

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Angeline Prabhu, MD; Shivani Naik, MD; Ravi Tej Bommu, MD; and Steven Lippmann, MD

University of Louisville School of Medicine, Kentucky​​


Smoking is a major cause of preventable mortality and morbidity. It leads to detrimental conditions such as coronary artery disease, hypertension, respiratory illness, and neoplasia. Tobacco use causes around 480,000 deaths every year; despite this, many people still smoke. The incidence of tobacco use is more common among men, people between 24 and 44 years old, and those with lower socioeconomic status.

Smoking cessation is crucial to the enhancement of health. According to 2015 CDC data, almost 70% of smokers wanted to quit, and 55% made an attempt to stop during the year, but only about one-third used effective means toward stopping. Evidence-based smoking cessation methods include behavioral interventions and pharmacotherapies. The best results follow from co-prescribing both techniques.Success is directly proportional to the patient’s desire to stop smoking.

Behavioral methods involve individual and/or group psychotherapy, telephone counselling (1-800-QUIT-NOW or 1-800-784-8669), and self-help material, available in clinical and non-clinical settings.

Nicotine replacement therapies (NRTs), varenicline, and bupropion are the most common medicinal strategies. NRTs consist of nicotine patches, gum, lozenges, inhalers, and nasal sprays; many individuals also may utilize e-cigarettes for cessation, but they are not approved for that use. The nicotine patch provides long-term effects (around 24 hours) on smoking desire but does not suppress acute withdrawal symptoms, whereas the other nicotine delivery systems yield more acute and brief relief of withdrawal symptoms and craving. Simultaneously co-prescribing long- and short-duration NRT methods is the most effective strategy.

Varenicline can be administered in combination with NRTs, but bupropion has not been shown to enhance the efficacy of NRTs. The combination of bupropion and varenicline has shown greater efficacy than varenicline monotherapy.

These methods are associated with side effects. NRTs can induce tachycardia, arrhythmias, and/or irritation at the skin site of application.Varenicline may result in suicidal tendencies, especially in people with a personal or a family history predisposing them to affective illness. It can also precipitate cardiovascular complications, nausea, unusual dreams, headache, and insomnia. Bupropion may induce seizures and has a suicidality warning; other side effects might include hypertension, insomnia, headache, dry mouth, and nausea. Neither varenicline nor bupropion should be prescribed during a pregnancy.

In conclusion, smoking cessation is optimized when patients make a determined effort to stop with complete abstinence following a “quit date.” Once the patient commits to therapy, a combination of behavioral techniques and pharmacotherapies is the most successful method.

Financial disclosure:Drs Prabhu, Naik, Bommu, and Lippmann have no relevant personal financial relationships to report.​

Category: Medical Conditions
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One thought on “How Can We Help Patients to Quit Smoking?

  1. Smoking is not the only from of using tobacco. In India and many other south asian countries, chewing and sniffing tobacco in various forms are also a serious threat to public health. We should always try to help these people as well whenever possible.

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