Smoking: patient introduction

Welcome to this module on smoking cessation. This week we meet Tracy Wilson, a 28-year-old smoker who wants to quit smoking. There are a range of options available to Tracy. Many of those products contain Nicotine and work by replacing the Nicotine from cigarettes to avoid withdrawal symptoms. Nicotine replacement is available as chewable gum, inhalation, lozenges, patches and tablets to put under the tongue. Nicotine can’t be given as an oral tablet. And in this module we will explore the reasons behind this. We’ll focus on Nicotine patches. And how they are used for smoking cessation.

Tracy presents a very common clinical scenario. There are many health benefits which warrant encouraging and assisting Tracy to stop smoking. And all health care professionals have a role in assisting smokers to quit. Brief interventions and environments that foster a non smoking policy have been shown as important in encouraging patients to quit. Smoking is a chronic condition. It’s a highly addictive habit that could be very difficult to break. Which can mean that irrespective of initial success relapse is common. In spite of relapses, the benefit of stopping smoking however warrant every health professional making persistent and consistent efforts to help smokers quit. However, multiple relapses may occur before the patient stops smoking permanently.

So despite the effort involved, evidence continues to support smoking cessation to be amongst the most cost effective health care interventions. Tobacco smoking harms most organs of the body. It is responsible for the deaths of about 15,500 Australians each year. With 41% of these due to lung cancer. 27% due to emphysema. And 13% related to heart disease. As a 28-year-old woman, Tracy is also in the peak reproductive age group where contraceptive use is common. If she continues to smoke into her late 30s and is also taking an oral contraceptive pill, there is an increased risk of her developing a blood clot.

In addition to this, should she become pregnant and continue to smoke, she exposes herself and her unborn child to potential complications. There are also risks due to secondhand smoke inhalation. Young children can experience increased rates of respiratory and middle ear infections. Higher incidence of meningococcal infection and asthma have also been noted in children whose mothers smoke. So it’s a good thing that Tracy is indicating the desire to quit smoking. From a doctor’s perspective, apart from taking a full and comprehensive medical history, there are a few other important facts that need to be established.

Such as, how long Tracy’s been smoking for, how many cigarettes she smokes each day, whether anyone else in her household or friendship groups smokes, and whether she’s tried to quit previously. If she has attempted to quit before, it’s important to ask what method she’s used. And whether these worked for her. This is part of the highly effective 5A approach to fostering smoking cessation. We’ll see this approach, the 5A approach, in action a little later with Tracy. The 5A approach also gives us the opportunity to determine Tracy’s level of Nicotine dependence, which then guides which medicines may assist her quitting. Currently, there are three main classes of medicine on offer.

Nicotine Replacement Therapy, or NRT, which comes in many different forms in varenicline and bupropion, which are both oral medications. If medication is considered appropriate to assist smoking cessation, the decision will be based on a number of things. Including patient preference, the existence of an underlying medical condition, potential adverse effects, as well as the cost of the medication.

We’ll hear more from Tracy later. And find out about how her local pharmacist is helping her to stop smoking.