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Over 480,000 individuals die prematurely each year in the United States from cigarette use: one out of every five deaths nationwide. Approximately 40% of smokers will die prematurely unless they are able to quit; risks of major diseases caused by cigarette smoking are listed in Table 209-1.

TABLE 209-1Relative Risks for Current Smokers of Cigarettes



All pts should be asked whether they smoke, how much they smoke, how long they have smoked, their past experience with quitting, and whether they are currently interested in quitting; even those who are not interested should be encouraged and motivated to quit. Provide a clear, strong, and personalized message that smoking is an important health concern. A quit date should be negotiated within a few weeks of the visit, and a follow-up contact by office staff around the time of the quit date should be provided. Incorporation of cessation assistance into a practice requires a change of the care delivery infrastructure. Simple changes include:

  • Adding questions about smoking and interest in cessation on pt-intake questionnaires

  • Asking pts whether they smoke as part of the initial vital sign measurements made by office staff

  • Listing smoking as a problem in the medical record

  • Automating follow-up contact with the pt on the quit date


TREATMENT Nicotine Addiction

  • Clinical practice guidelines suggest a variety of pharmacologic and nonpharmacologic interventions to aid in smoking cessation (Table 209-2).

  • Numerous nicotine-replacement products exist, including over-the-counter nicotine patches, gum, and lozenges, as well as nicotine nasal and oral inhalers available by prescription; these products can be used for 3–6 months with a gradual step-down in dosage with increasing duration of abstinence.

  • Prescription medications that have been shown to be effective include antidepressants such as bupropion (300 mg/d in divided doses for up to 6 months) and varenicline, a partial agonist for ...

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