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. 
Advice should be clear, personalized, supportive and non-judgmental.
Determine the willingness of smoker to make a quit attempt.

Supportive Therapy

  • There is not enough evidence to support the use of alternative non-pharmacological treatments (eg acupuncture, exercise, hypnotherapy, nutritional supplements) for smoking cessation
  • Electronic cigarettes (e-cigarettes)
    • A device similar to a real cigarette that produces a vapor which does not contain tar and other chemicals found in normal cigarettes and makes use of a replaceable cartridge containing flavoring, additives and sometimes nicotine
    • Though recent evidence suggests it may be of help in quitting smoking, data regarding its efficacy and safety are insufficient; the US Preventive Services Task Force (USPSTF), the American Heart Association (AHA), the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) suggest that clinicians focus more on proven current pharmacotherapeutic agents and interventions
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