Quit smoking

Follow 5 As (Ask, Advise, Assess, Assist, Arrange)

Assessing tobacco use status during healthcare visits increases the likelihood of smoking-related discussions between patients and clinicians, as well as increases smoking cessation rates.
All smokers should be advised to quit smoking. Even brief advice to quit has been shown to increase quit rates.
For smokers who are willing to quit, manage them with combination of behavioral support and pharmacologic therapy
Behavioral intervention generally consists of brief clinician counseling in the office, but smokers should also be referred to a free telephone quit line
Smokers who fail to quit on an adequate trial of first-line pharmacotherapy may benefit from second line pharmacotherapy.
Also attempt to intensify behavioral counseling.
Patients who successfully quit but experience relapse be treated with a pharmacologic agent that previously helped the patient to achieve abstinence and was tolerable
Enhancing treatment by adding another pharmacologic agent or more intensive behavioral support can also be considered.
Smokers can also be advised about the health risks of secondhand smoke exposure to their household members and urged to commit to keeping their home and car smoke-free, especially if children are present.

5As of quitting Smoking

Ask: Implement an office wide system that ensures that, for every patient at every clinic visit, tobacco-use status is queried and documented. Repeated assessment is not necessary in the case of the adult who has never used tobacco or has not used tobacco for many years, and for whom this information is clearly documented in the medical record.

Advise: Strongly urge all tobacco users to quit in a clear, strong, personalized manner. Advice should be clear - "I think it is important for you to quit smoking now and I can help you" "Cutting down while you are ill is not enough" It should be "As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. The clinic staff and I will help you" and it should be personalized. Tie tobacco use to current health/illness, and/or its social and economic costs, motivation level/readiness to quit, and/or the impact of tobacco use on children and others in the household.

Access: Determine the patient's willingness to quit smoking within the next 30 days; If the patient is willing to make a quit attempt at this time, provide assistance; If the patient will participate in an intensive treatment, deliver such a treatment or refer to an intensive intervention; If the patient clearly states he or she is unwilling to make a quit attempt at this time, provide a motivational intervention and If the patient is a member of a special population (adolescent, pregnant smoker), provide additional information specific to that population.

Assist: Provide aid for the person to quit.

Arrange: Schedule follow-up contact, either in person or by telephone. Follow-up contact should occur soon after the quit date, preferably during the first week. A second follow-up contact is recommended within the first month. Schedule further follow-up contacts as indicated.

Congratulate success during each follow-up. If tobacco use has occurred, review circumstances and elicit recommitment to total abstinence. Remind the person that a lapse can be used as a learning experience. Identify problems already encountered and anticipate challenges in the immediate future.