Physicians can make a difference with smokers: evidence-based clinical approaches. Presentation given during the Symposium on Smoking Cessation at the 29th World Conference of the IUATLD/UICTMR and Global Congress on Lung Health, Bangkok, Thailand, 23-26 November 1998. International Union Against Tuberculosis and Lung Disease.

Tobacco use poses one of the greatest public health challenges globally. This paper reviews the role of the physician as a key figure in promoting tobacco control and prevention. The physician is in a prime position to assist patients to stop smoking because of the high rate of contact with the general public. His/her efforts can contribute towards stemming the projected increase in smoking prevalence and resulting mortality and morbidity from cigarette-related diseases. However, the doctor is not taking full advantage of this window of opportunity to identify smokers and provide stop smoking advice. Evidence of physicians' and general practitioners' success in advising patients to stop smoking is presented. In general, clinical trials have reported abstinence rates of 5% to 10% for brief advice, and 20% to 36% for more physician involvement in providing advice and counselling. Nicotine replacement therapies (gum and patch) and other pharmacological treatments are useful adjuncts to physicians' advice to quit. Three evidence-based approaches available for the physician to use are described: 'Smokescreen for the 1990s in Australia', 'Smoking Cessation Clinical Practice Guideline' in the USA, and 'Guidelines on Smoking Cessation for General Practitioners and Other Health Professionals' in Europe. The information and resources that we have produced in industrialised countries must be translated, made culturally appropriate and distributed to physicians around the world, particularly in low income countries, so that they can fulfil their vital function of assisting patients to stop smoking.