Smoking Cessation

Currently, 16.6 % of australians aged 14 years or older smoke daily. This represents 2.9 millions people in australia, one in two of whom will die prematurely from a smoking related disease if they continue to smoke.

Counseling about cessation of smoking behaviour involves six stages:

• Pre-contemplation
• Contemplation
• Determination
• Action
• Maintenance
• Relapse

The role of a doctor to find out which stages the patients are at and to give information and support to achieve the smoking cessation.

Once the patients are determined to stop smoking, pharmacotherapy should be offered to the nicotine dependent smokers.

Method: The most popular method used is the cold turkey method - quitting abruptly with no medication or assistance.

Only 3 - 5 % of smokers who try to quit without treatment remain abstinent six to 12 months later.

Cut down then stop method is a new strategy for smokers who are not currently willing or able to stop smoking but are prepared to cut down. Smoker gradually cut down their cigarette use and stop smoking completely by six months and then nicotine replacement therapy is ceased by 12 months.

Australian and international guidelines now advise using medication to assist quitting in all smokers who are nicotine
dependent, except where indicated.

To assess the nicotine dependence the patients should be asked:

• Do you usually smoke within 30 minutes of waking?
• Do you smoke between 10 and 15 or more cigarettes per day?
• Have you had cravings or withdrawl symptoms during previous quit attempts?

Nicotine dependence is likely if there is a positive answer to any of these questions.

Nicotine Replacement therapy

• Pre-quit treatment with nicotine patches two weeks before quit day.
• Nicotine patches are then continued for the full course of 10 to 14 weeks after quit day.
• Quick acting forms of NRT such as lozenges and chewing gum are suitable for prompt relief of withdrawl symptoms or cravings as they arise.

Varenicline: reduces cravings and withdrawl symptoms as other treatment do but also reduces satisfaction gained from smoking a cigarette.
Varenicline is taken as a 12 weeks course of 1 mg twice a day after an initial one week titration phase. The patient should quit smoking between seven and 10 days after the first dose.
Side effects include nausea, depression and suicidal ideation.

Bupropion: is an effective first line therapy. There is a one in 1000 risk of seizures in patients taking it and it is contraindicated in patients with predisposing risk factors for seizures.