Clinical practice. Treating smokers in the health care setting.
paper
Cited
Public
- Authors
- Fiore, Michael C; Baker, Timothy B
- Year
- 2011
- Journal
- The New England journal of medicine
- PMID
- 21991895
- DOI
- 10.1056/NEJMcp1101512
- PMCID
- PMC4494734
A 45 year-old overweight woman with a history of asthma and depression presents to her primary care physician with her third episode of acute bronchitis in the last 24 months. She began smoking at age 15 and now smokes 10 to 15 cigarettes per day, but every day she starts smoking immediately upon awakening, an indication of severe nicotine dependence. She has made multiple unsuccessful attempts to quit, once briefly using the nicotine patch, but relapsed due to strong urges to smoke and weight gain. She has not used cessation counseling or other medications. She is bothered by the cost of cigarettes, and is worried about smoking’s health effects on her two children and on herself. Importantly, she is reluctant to make a quit attempt now, in part, because she fears she won’t succeed. What would you advise?
5As* Clinical Intervention for Patients Willing to Initiate a Quit Attempt During Clinic Visit*From the 2008 PHS Clinical Practice Guideline3: The 5As: ASK about tobacco use, ADVISE to quit, ASSESS willingness to make a quit attempt, ASSIST in quit attempt, ARRANGE for follow-up.
Clinical Interventions for Patients Unwilling to Initiate a Quit Attempt during the Clinic Visit
| # | Section | Preview |
|---|---|---|
| 20 | Guidelines | The United States Public Health Service (PHS) clinical practice guideline, Treating Tobacco Use and… |
| 21 | Conclusions and Recommendations | At all healthcare visits, smokers such as the woman described in the vignette should be encouraged… |
| 22 | Conclusions and Recommendations | After using the Smoking Reduction+NRT treatment for three months, the patient was willing to make a… |
| 23 | Conclusions and Recommendations | Smoking Reduction+NRT intervention, and NRT has been shown to be safe and effective in persons with… |
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21–24 of 24
| Name | Type |
|---|---|
| 5 Rs counseling local | drug |
| 6-month abstinence | phenotype |
| abstinence | phenotype |
| Adverse events local | phenotype |
| Beta blockers local | drug |
| brain | anatomy |
| Brief advice local | drug |
| bupropion | drug |
| cancer | phenotype |
| Cardiovascular morbidity local | phenotype |
| cessation failure local | phenotype |
| cessation medications local | drug |
| cessation treatments local | drug |
| cigarettes | phenotype |
| clinicians | cohort |
| combination NRT local | drug |
| Combination NRT local | drug |
| COPD | phenotype |
| counseling local | drug |
| cystisine local | drug |
| depression | phenotype |
| depressive symptoms | phenotype |
| Disadvantaged individuals local | cohort |
| excessive alcohol consumption | phenotype |
| fear of gaining weight local | phenotype |
| high nicotine dependence | phenotype |
| Intention to quit local | phenotype |
| living with a smoker local | phenotype |
| Low educational attainment local | cohort |
| Low income | phenotype |
| Low income individuals local | cohort |
| medication | drug |
| medication nonadherence local | phenotype |
| Meta-analysis of 7 placebo controlled trials (N=2767) local | cohort |
| mortality | phenotype |
| Motivational interviewing local | drug |
| myocardial infarction | phenotype |
| Native Americans | cohort |
| Newly abstinent patients local | cohort |
| nicotine | drug |
| nicotine dependence | phenotype |
| nicotine gum | drug |
| nicotine inhaler local | drug |
| Nicotine inhaler local | drug |
| nicotine lozenge local | drug |
| nicotine nasal spray | drug |
| nicotine patch | drug |
| nicotine replacement therapy | drug |
| Nicotine replacement therapy (NRT) local | drug |
| Nicotinic cholinergic receptors local | drug |
| Non-quitters local | cohort |
| NRT | drug |
| NRT medication local | drug |
| Patient acceptance local | phenotype |
| patients | cohort |
| persons with depressive symptoms local | cohort |
| persons with high nicotine dependence local | cohort |
| pharmacologic interventions local | drug |
| pharmacotherapy | drug |
| PHS Guideline local | cohort |
| psychiatric disorders | phenotype |
| Psychiatric drugs local | drug |
| quit attempt local | phenotype |
| quitting | phenotype |
| Reduced smoking local | phenotype |
| relapse | phenotype |
| smoking | phenotype |
| smoking abstinence | phenotype |
| smoking cessation | phenotype |
| Smoking reduction local | phenotype |
| Smoking Reduction+NRT local | drug |
| Study of 1,154 unwilling smokers local | cohort |
| substance abuse | phenotype |
| Successful quitting | phenotype |
| tobacco dependence | phenotype |
| tobacco use | phenotype |
| Treatment acceptance local | phenotype |
| Treatment entry local | phenotype |
| unaided quit attempts local | phenotype |
| Unwilling smokers local | cohort |
| Usual care local | drug |
| varenicline | drug |
| weight control local | phenotype |
| Wound healing | phenotype |
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In this knowledge base
| Title | Year | PMID |
|---|---|---|
| Genetic variation (CHRNA5), medication (combination nicotine replacement therapy vs. varenicline), and smoking cessation. | 2015 | 26142345 |
External
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