Smoking Cessation Counseling Notes

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.