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
Key diagnostic factors
- number of cigarettes per day
- time to first cigarette (TTFC) ≤30 minutes or >30 minutes
- polysubstance abuse
- smokeless tobacco user
- seizure disorder
- pregnancy or breastfeeding
Other diagnostic factors
- history of depression
- history of schizophrenia
- unstable cardiac disease
- ventricular arrhythmia
- temporomandibular joint or dental disorder
- smokeless tobacco user
1st investigations to order
- no tests required
hospitalised active smokers
active smokers ready to stop: adults (no pregnancy, breastfeeding, depression, or polysubstance abuse)
active smokers ready to stop: pregnant/breastfeeding women, adolescents
active smokers ready to stop: depression and smoking cessation
active smokers ready to stop: polysubstance abuse and smoking cessation
active smokers not ready to stop
smokeless tobacco users
- Polysubstance abuse
- Tobacco: preventing uptake, promoting quitting and treating dependence
- Smoking: supporting people to stop
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