Ask: systems should be established in each clinic that identify the smoking status of each patient and that communicate this status to physicians.
Advise: a personalised, open, and reflective patient-centred discussion should be provided on how smoking cessation can help patients achieve their goals.
Assess: it should be determined whether patients are ready to consider attempting to stop and, if ready, how confident they are about success.
Assist: for those not yet ready to attempt stopping, communication lines should be kept open for motivational messages, to let them know help is available when they are ready. For those who are ready, a menu of available pharmacotherapy and counselling options should be provided. First-line pharmacotherapy doubles the success rate of a stopping attempt.
Arrange follow-up: patients should be connected with a counselling follow-up within a week of their stopping date. This can be with a telephone counselling line, with face-to-face group or individual counselling, or with return clinic visits or telephone calls from the clinic.
Cigarette smoking is the most common cause of preventable death and disease. Physicians and other healthcare professionals should play a central role in motivating and assisting patients who smoke to stop. Physicians are a credible and trusted source of advice to stop, have opportunities to provide this message to most smokers, and can connect patients to cessation counselling and pharmacotherapy. These actions are economical and effective at increasing cessation rates.
History and exam
Franck F. Rahaghi, MD, MHS, FCCP
Pulmonary Education and Rehabilitation
FFR has done research, consulting, and speaking for Boehringer Ingelheim, Shire, CSL Behring, and Grifol.
Felix Hernandez, MD
Pulmonary medicine/Critical Care
FH declares that he has no competing interests.
Dr Franck F. Rahaghi and Dr Felix Hernandez would like to gratefully acknowledge Dr Jose Gonzalez and Dr Theodore W. Marcy, previous contributors to this topic. JG and TWM declare that they have no competing interests.
William Wadland, MD, MS
Professor and Chair
Department of Family Medicine
Associate Dean for Faculty Affairs and Development
College of Human Medicine
Michigan State University
WW declares that he has no competing interests.
Charles J. Bentz, MD, FACP
Tobacco Cessation and Prevention
Providence St. Vincent Hospital and Medical Center
CJB declares that he has no competing interests.
Fei-Ran Guo, MD
Department of Family Medicine
National Taiwan University Hospital
FRG received a grant from Pfizer, the manufacturer of varenicline, for one of the 3rd phase clinical trials of varenicline. FRG has also been reimbursed by Pfizer, Novartis (the manufacturer of nicotine patch), and GSK (the manufacturer of bupropion SR and nicotine lozenge), for attending conferences, and receiving fees for giving speeches on smoking cessation.
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