Download Smoking

Smoking
Recommend
 Assess smoking status in every patient over 10 years of age [7]
 Consult MO and discuss any patient who is intending to cease smoking and is on Clozapine, for
monitoring of plasma Clozapine levels [6]
 All patients who smoke, regardless of the amount they smoke, should be:

asked about their interest in quitting

assessed whether they are nicotine dependent and if so provide appropriate pharmacotherapy

advised to stop smoking

offered referral to a proactive telephone call-back cessation service such as ‘Quitline’ or ATODS
Health Worker / service if available [7]
Related topics:
 Chronic Obstructive Pulmonary Disease (COPD), page 331
 Acute asthma and Chronic asthma (adult & child) pages 70
Antenatal care, page 389
 Immunisation program 316
Psychotic disorders, page 357
1.
May present with:

Asking for help to quit smoking

As part of a routine consultation or annual Health Check

As part of management of conditions caused by or compounded by smoking (heart disease,
peripheral vascular disease, diabetes, hypertension, hyperlipidaemia, obesity, COPD, asthma and
chest infections)

As part of management of conditions of family or household members with eg. asthma

Pregnant woman
2.
Immediate management – not applicable
3.
Clinical assessment:

Take comprehensive patient history, including previous attempts to stop smoking, identify what
worked and why they started smoking again

Current medications – in particular Clozapine (risk to plasma levels if sudden cessation of smoking)

Perform standard clinical observations + oxygen saturation

Assess if person has strong dependence on nicotine:

smokes more than >15 cigarettes per day

smokes first thing in the morning, within 30minutes of waking

inhales smoke into the lungs

smokes even when they are sick

finds it hard not to smoke in smoke free areas

has experienced withdrawal symptoms on previous attempts to stop

Assess person’s readiness to quit smoking

pre-contemplation – not concerned about drinking

contemplation – actively thinking about change

planning to change – concerned about drinking / ready for change

action – carrying out lifestyle change / drinking behaviour

maintenance – maintaining the change over a long time

relapse – returned to previous drinking or dropped the new healthy behaviour. This is a normal
part of the change process
Management:

In a clear and respectful way, encourage every smoker to quit (non-judgemental enquiry about
smoking is associated with greater patient satisfaction [10, 11]

If the person does not want to stop smoking, ask them to come back if they change their mind or
want more information to help them

Conduct ‘brief intervention’ and ‘motivational interviewing’ according to their stage of change
(discuss the harmful effects of smoking and provide information on how to stop smoking)

Consult MO regarding a need for thorough physical examination and appropriate tests, eg. CXR,
spirometry or the opportunity for medication to assist the patient in stopping smoking
4.
Essential information for person

If a patient (with a condition caused by or compounded by smoking) STOPS SMOKING, no matter
how old they are, the condition will get better or at least not get worse as quickly as if they keep
smoking



Explain that there may be withdrawal symptoms such as mood swings, irritability, anxiety, changed
sleep patterns, headache, aches and pains, feelings of restlessness and difficulty in concentrating,
increased appetite and cravings. People do not get all of these symptoms and they will get better
over time
People worry about putting on weight but weight gain may be less of a risk than still smoking and
weight gain can be controlled by a more active lifestyle and eating better
‘Cutting down' the number of cigarettes or changing to a lower nicotine brand may help people
change their mindset about smoking, but cessation should always be the goal
Tips to STOP smoking

Set a date to stop smoking

Tell family, friends and people at work of the plan to quit and ask for support, like not smoking
around the person at home and work

Get rid of all cigarettes and other things used for smoking such as ashtrays etc

If have tried to quit before, anticipate and avoid what caused problems quitting previously – identify
why and where you smoke and what “triggers” you to smoke

Do not replace cigarettes with high sugar, high fat foods

Drink lots of water and eat more fruit. Do more physical activity

Consider nicotine patches, gum or medication to help you stop – see your doctor for advice

Give pamphlets on the effects of smoking and/or how to stop smoking

Recommend the Quitline on 131 848 for further support, advice and information
5.
Follow up:
 Review in one week and further encourage and support
 Information may be given to person on the harmful effects of smoking and it may be months later
that the patient returns to you and requests assistance to quit
 Interventions will only be successful if the person is receptive to them
 Giving advice on how to stop smoking will not be heard by the person if they are not considering
changing their behaviour at the time
 Encourage immunisation with influenza and pneumococcal vaccines, see Immunisation program.
Smoking is the single most important determinant of risk
6.
Referral / Consultation:
 Consult MO as above
 Consider referral to ATODS Health Worker / Service if available