Winter 2007

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New recommendations for helping smokers quit


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A recent article in the Canadian Medical Association Journal (November 2007) highlights recent updates regarding best practices for helping individuals live healthier tobacco-free.

By Mary Lynn Pender

A recent article in the Canadian Medical Association Journal (November 2007) highlights recent updates regarding best practices for helping individuals live healthier tobacco-free. One of the main recommendations in this paper is that nonpharmacologic interventions (including counseling services and tips on behavior modification techniques provided by a telephone quitline, healthcare provider or group support) should be used in combination with pharmacologic therapies to maximize success in quitting.

The article states that all clinicians should ask about smoking status and offer support in quitting. Research shows that advising patients to quit (even one time) helps to double quit rates. The Newfoundland and Labrador Medical Association in partnership with the Lung Association promotes the Smokers’ Helpline CARE Fax Referral Program as an effective way to link smokers with support to quit. Physicians simply complete the Referral Form with the patient and fax it to the Helpline. A counselor then calls the smokers to provide follow-up counseling and information about the various smoking cessation programs and treatments available in the community. Individuals may receive up to six proactive calls in addition to free self-help materials.

Dr. D.W. Ingram and Dr. M.S. Hall are actively addressing the issue of smoking with patients. They work in different areas of practice, yet smoking cessation is an issue they believe is of critical importance. They are the Smokers’ Helpline’s top-referring physicians (2007).

Dr. Ingram is an internist at St. Clare’s Hospital. He states, “I counsel everyone who smokes. Stopping smoking is the most important advice we can give.” He believes that it is helpful and effective to address the issue of smoking at each visit with patients. Although some smokers may not be motivated to quit initially, when the doctor repeatedly brings up the issue they realize how important quitting smoking really is.

Dr. Hall works at the Janeway Hospital and specializes in pediatrics. He sees the results of secondhand smoke when he examines children. He stresses the importance of quitting smoking with parents and motivates them to quit by educating them on how smoking impacts their health and the health of their children. Smoking triggers symptoms of asthma, causes breathing problems and is linked to increased ear infections in children. He indicates that he has heard positive feedback from individuals he has referred to the Smokers’ Helpline, and he is pleased that these individuals receive ongoing support in quitting once they are referred.

The latest research on pharmacologic therapies for smoking cessation (as recommended by the article in CMAJ):

  • Pharmacotherapy options include nicotine replacement therapy (NRT), bupropion and varenicline.

  • Nicotine replacement therapy comes in a variety of forms (patch, gum, inhaler and lozenge). If a patient does not find these individual products to be effective, they may try combining different forms of NRT or combining NRT with bupropion. When individuals find NRTs to be ineffective it is often due to improper use. Advice from physicians combined with quitline support will ensure that these products are used properly and maximizes efficacy.

  • Heavily addicted smokers may require higher nicotine dosages - it is safe to use 2 patches at the same time (although physicians should advise patients to not start with more than 2 patches simultaneously).

  • NRT appears to be safe for use for individuals who have had a myocardial infarction, for adolescents and for pregnant women. Pregnant women should be advised to first try nonpharmacologic interventions such as behavioral modification before trying NRTs; intermittent-use NRTs such as the gum or inhaler are preferable.

For more information call the Smokers’ Helpline at 1-800-363-5864.

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