Nicholas Zwar1. 1. School of Public Health and Community Medicine, University of New South Wales, New South Wales. nicholas.zwar@sswahs.nsw.gov.au
Abstract
BACKGROUND: Prevalence of tobacco smoking in the Australian community has fallen. However, tobacco smoking remains a major cause of illness and death. General practitioners play an important role in assisting their patients to quit smoking. OBJECTIVE: This article describes evidence based approaches to smoking cessation that can be applied in general practice. DISCUSSION: Evidence based approaches to smoking cessation include brief counselling, pharmacotherapy, referral to a specialised service such as Quitline, and follow up. The five As approach--Ask, Assess, Advise, Assist and Arrange follow up--provides a structure for intervention. Smoking cessation pharmacotherapies (nicotine replacement therapy and bupropion) have been shown to double quit rates. A new pharmacotherapy (varenicline) has recently become available which evidence to date suggests is more effective. Clinical suitability, the context of the quit attempt, and patient preference are important considerations in choosing a pharmacotherapy. Active follow up helps to reduce the rate of relapse which is otherwise high in what is commonly a chronic relapsing condition.
BACKGROUND: Prevalence of tobacco smoking in the Australian community has fallen. However, tobacco smoking remains a major cause of illness and death. General practitioners play an important role in assisting their patients to quit smoking. OBJECTIVE: This article describes evidence based approaches to smoking cessation that can be applied in general practice. DISCUSSION: Evidence based approaches to smoking cessation include brief counselling, pharmacotherapy, referral to a specialised service such as Quitline, and follow up. The five As approach--Ask, Assess, Advise, Assist and Arrange follow up--provides a structure for intervention. Smoking cessation pharmacotherapies (nicotine replacement therapy and bupropion) have been shown to double quit rates. A new pharmacotherapy (varenicline) has recently become available which evidence to date suggests is more effective. Clinical suitability, the context of the quit attempt, and patient preference are important considerations in choosing a pharmacotherapy. Active follow up helps to reduce the rate of relapse which is otherwise high in what is commonly a chronic relapsing condition.