Smoking hasn’t decreased despite knowing the fact that ‘smoking is injurious to health.’ Smoking can cause mortality not only in elderly but also in younger populations; moreover, a non-smoker can also be affected by passive smoking. Smoking cessation is an important part of a healthy lifestyle and prevention of diseases; therefore, a physician who advocates lifestyle changes for wellness, can take an active part in encouraging the patients to quit smoking.

Physicians have a wide reach to the general population, and also understand that smoking cessation can reverse the majority of the adverse effects caused due to smoking; therefore, they should ensure a good future for patients who smoke.

Pharmacological treatment of smoking cessation:

Smoking cessation can lead to several withdrawal symptoms that are difficult to tolerate, thereby leading to the failure of smoking cessation. A multitude of symptoms is observed within a day after quitting, which may include restlessness, coughing, anxiety, constipation, and mouth sores. However, these symptoms do last for a week after quitting smoking. If physicians can foresee the symptoms and be prepared, then it is highly unlikely to relapse; for example, patients can initially have difficulties in clearing the pulmonary secretions, which can be treated by short-term use of bronchodilators. However, it is important to note that drug therapy for smoking withdrawal hasn’t seen considerable success.

Nicotine gum is helpful in reducing the withdrawal symptoms in people who are trying to quit smoking.

Proper use of nicotine gum:

Nicotine gum has been proven to be beneficial in individuals with a high dependency on tobacco. Therefore, nicotine gum can be prescribed to patients, and its proper use can help to prevent the relapse. However, nicotine gum should be used as instructed below for optimal benefits:

  • The gum should not be used until smoking is stopped entirely.
  • Caffeine-containing beverages like coffee should be avoided right before or after chewing the gum.
  • Initially, 7-15 gums are required, and each gum should be chewed for about an hour.
  • Saliva generated by the chewing should not be swallowed as it contains nicotine.

Besides advising gum, behavioral therapies and frequent follow-ups are required to encourage smoking cessation.

How can a physician help?

It is important to know that the physician and the patient play equal roles to achieve permanent smoking cessation. Some studies even show that the higher the efforts of a physician, higher are the cessation rate. Therefore, a physician should help by devising a plan/strategy to quit smoking. Below is an intensive program with the use of nicotine gum, it includes the following steps:

  • Identify the habit:
    • Understand the patient’s motivation levels to quit. Enquire about previous attempts in quitting, why the patient decided to quit, brand switch (if any) and withdrawal symptoms.
    • Understand the tobacco-dependency level.
    • Understand the patient’s risk of smoking.
  • Create a plan: Set a quit date for the patient and ask the patient to maintain a diary. Don’t forget to review the diary on their next visit. Anticipate and discuss patient’s withdrawal symptoms.
  • Follow-up: Contact the patient either in the office or by phone and ask if the patient has quit. Set another quit date if the patient hasn’t quit.
  • Use Nicotine gum: Hand over sample nicotine gum to the patient and encourage the user to achieve the goal.

Although many cessation strategies are available, the above-discussed strategy is practical and can be implemented to achieve good cessation rates.

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