Smoking Cessation Counseling

Initial Patient Assessment

  • Patient: 40-year-old male with asthma considering smoking cessation.

  • Goal: Obtain patient history (5 minutes) and counsel on smoking cessation.

  • Approach: Confidentiality, empathy, and open-ended questions.

History Taking

  • Open-Ended Question: "I really appreciate you coming today to discuss how to stop smoking."

  • Smoking History

    • How long have you been smoking?

    • Number of cigarettes smoked per day.

    • Smoking patterns: throughout the day or at specific times?

    • Where do you usually smoke: home, work, or elsewhere?

    • Triggers: friends, stress, alcohol?

    • Do you smoke even when sick?

    • When do you smoke your first cigarette? Within 30 minutes of waking up?

    • Increased smoking to get the same effect (tolerance)?

  • Previous Quit Attempts

    • Have you tried to stop smoking before? What happened?

    • Motivation level: scale of 1 to 10 (1 = least, 10 = most motivated).

    • Have you tried to cut down before?

  • Social Context

    • Do you get angry or annoyed when criticized for smoking?

    • Do you ever feel guilty about smoking?

    • Who do you live with?

    • Stressors at home?

    • Has smoking caused problems at work or home?

    • Is it hard to avoid smoking in non-smoking areas?

  • Physical Symptoms

    • Cough, shortness of breath, chest pain?

  • Psychological Assessment

    • Mood.

    • Sleep.

    • Appetite.

    • Suicidal ideation.

    • Stress levels.

  • Sexual History

    • Any changes?

  • Substance Use

    • Alcohol, drugs, coffee?

  • Medications

    • Any other medications?

Counseling

  • Praise and Acknowledge: Thank the patient for considering quitting; emphasize the significant positive impact on health.

  • Health Benefits: Prevent damage to lungs, heart, and other organs.

  • Social and Financial Benefits: Better relationships and finances.

Quitting Strategy

  • Set a Quit Date: Stop smoking abruptly ("cold turkey").

  • Withdrawal Symptoms: Expect anxiety, irritability, sleep problems, headaches, nausea, vomiting.

Nicotine Replacement Therapy (NRT)

  • Principle: Replace nicotine to reduce withdrawal symptoms.

  • Forms: Patches, gums, lozenges, inhalers, cartridges, sprays.

  • Usage: Sometimes, two forms can be used together.

  • Cost: Some patches are on the PBS scheme (cheaper).

  • Contraindications: Recent heart attack or stroke.

Medications

Varenicline (Champix)

  • Usage: Start while still smoking, stop smoking in the second week.

  • Contraindications: Kidney disease, previous mental health disorder.

  • Side Effects: Nausea.

Bupropion

  • Contraindications: Seizures.

Support and Resources

  • Reading Material: Provide information on options for smoking cessation.

  • Quitline: Counselors, information, education programs, contact line for support.

  • Psychologist: Cognitive behavior therapy to manage stress, cravings, and relapse prevention.

General Advice

  • Lifestyle Modification:

    • Healthy, balanced diet.

    • Exercise.

    • Avoid triggers (alcohol, coffee, friends who encourage smoking).

  • Family Meeting: Arrange a family meeting for support.

  • Other Substances: Cut out other substances.