Fast Facts: Smoking cessation by Robert West, Saul Shiffman

By Robert West, Saul Shiffman

Cigarette smoking is the one greatest preventable explanation for dying and sickness within the commercial international, and debts for 4.9 million deaths all over the world each year. "Fast proof - Smoking Cessation" provides lots of functional recommendation in a transparent and eloquent kind, besides present information regarding the results of smoking at the physique, of smoking cessation and the myths approximately smoking and quitting. The authors, either stated specialists within the box, have produced a concise and engaging instruction manual that would turn out precious to an individual who ever documents smoking as a necessary signal.

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The usual dose is a single 150 mg tablet per day for the first week, increasing to two 150 mg tablets per day by the quit date. The medication is normally © 2007 Health Press Ltd. 5 or 1 mg/day after an initial period of dose escalation Pregnancy Requires a prescription; studies have found superior efficacy to bupropion in unselected patients; reduces both urge to smoke and rewarding effect of a cigarette if a lapse occurs; main side effect is nausea; no serious adverse effects found to date Nicotine patch – 24 h or 16 h Caution on use in pregnancy and immediately following acute cardiac event* Convenient and popular with smokers; available without prescription in some countries; some patches provide different doses for lighter and heavier smokers; most patches provide for a three-dose step-down program to taper nicotine dose over 10–12 weeks Nicotine gum – 2 mg or 4 mg As above Available without prescription; actual dose is much less than nominal dose; 4 mg gum recommended for smokers of 20/25 (UK/USA) or more cigarettes per day; smokers typically use too few pieces of gum, and should be encouraged to use the recommended amounts; in the context of smoking cessation, gum may be used for relief of acute cravings (CONTINUED) 63 © 2007 Health Press Ltd.

1). If not, then the clinician reminds the smoker of how important it is to stop – ideally relating this reminder to the particular smoker’s current condition – and asks whether he or she is interested in making an attempt to stop in the near future. The clinician should also point out that there are now effective methods to help with quitting and encourage the smoker to try one of these. If the smoker is not interested, the clinician simply closes the conversation by inviting the smoker to think about quitting and to get in touch if he or she changes his or her mind.

1). In the absence of an available program of structured behavioral support, medication plus limited behavioral support, such as might be feasible in routine consultations or through the internet, is an important treatment option. 1 Estimated increase in percentage of quit attempts that succeed for at least 6 months associated with particular treatments, both medication and behavioral support (derived from Cochrane reviews of relevant randomized controlled trials). Note that the effect size for varenicline is based on early trials with the medication, whereas the effect sizes for other medications are based on more extensive and more varied trials, including some in clinical practice, conducted over a longer period.

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