Ask, Advise to quit and Assess are the steps in approaching patients regarding smoking cessation.
All patients should be asked if they use tobacco and should have their tobacco status documented on a regular basis.
Patient with nicotine dependence is characterized by smoking within 30 minutes of waking, consuming >10 cigarettes/day and had withdrawal symptoms in previous attempts of quitting smoking.
Smokers should be strongly urged to quit at every physician encounter. Studies have shown that unplanned efforts to quit is as successful as planned attempts, stressing the benefits in encouraging smokers to quit smoking whenever opportunity arises.
Advice should be clear, personalized, supportive and non-judgmental.
Determine the willingness of smoker to make a quit attempt.
Patient is in action stage when he already stopped smoking within the last 6 months.

Relapse Prevention

  • Smoking relapse usually occurs within the first 3 months of quitting & can occur months to years after the quit date
    • Risks include stress, alcohol consumption, or being with family or friends who smoke
    • May be restarted on the pharmacotherapeutic agent that was previously effective for the patient
  • Physicians need to continually be involved in relapse prevention interventions
  • In patients who have recently quit smoking, the physician should:
    • Reinforce the patient’s decision to quit
    • Review the benefits of quitting
    • Help the patient with any residual problems arising from quitting


  • Smokers should be strongly urged to quit at every physician encounter
    • Studies have shown that unplanned efforts to quit is as successful as planned attempts, stressing the benefit in encouraging smokers to quit smoking whenever opportunity arises
  • Advice should be clear, personalized, supportive & non-judgmental
  • Increasing the number of attempts to quit plays an important role in improving abstinence rates
  • Provide practical problem-solving or skills training that may include total abstinence from smoking, identifying factors that helped in the past quitting experience, anticipating problems that may be encountered, limiting or abstaining from alcohol, & encouraging other household members to also quit smoking
  • Combined counseling & medication is more effective than when either intervention is used alone
    • Both counseling & medication should be offered provided there are no contraindications or evidence of ineffectiveness in particular patient populations
  • Person-to-person treatment (eg individual, group or telephone support) delivered ≥4 sessions are proven effective in increasing abstinence rates

Follow Up

  • The principle for follow-up is to monitor the status of the program that was given to the patient
  • Patient/physician follow-up should be arranged soon after the quit date (within the first week)
  • Second follow-up contact is recommended within the 1st month
  • Points for assessment during follow-up visits:
    • Success of smoking cessation
      • Patient should be congratulated if successful & strongly encouraged to remain abstinent
    • Motivational level
    • Presence of withdrawal symptoms should be discussed & pointers on what to do should be given
    • Discuss problems encountered & challenges that may occur in the future
    • Assess pharmacotherapy use & problems
    • If required, consider specialist referral for more intensive treatment
  • If patient smoked, review circumstances & encourage recommitment to complete abstinence
    • Lapse should be seen as a learning experience
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