Haute Autorité de Santé – Termination of smoking: tools for investigating and sustaining patients
Smoking is the primary cause of death in France. One in two regular smokers die from tobacco related illness. The fight against smoking is a public health priority. It provides treatment methods and tools to help doctors understand patients who are smoking and assist them in quitting smoking. Explanations from Estelle Lavie* from good professional practices at HAS.
What are the benefits of stopping smoking?
By suppressing smoking decreases mortality, especially from cardiovascular disease and bronchopulmonary cancer. The benefit is regardless of age at the time of discontinuation. So for a patient who dies from smoking at 40, life expectancy increases by 7 years, to 50, even better by 4 years… Systematic knowledge of smokers is therefore essential. All patients must be asked about possible tobacco use so that they may receive assistance after giving up.
How does it help out the patient to quit smoking?
As soon as a smoker is noted, it is necessary to urge him to leave. This simple departure plan, given by a health professional, somewhat increases the chances of smoking (see the tool “Examples of Departure Plans”). The patient’s cause was then estimated.
The physician’s attitude toward smoking depends on the patient’s level of ambivalence (see the tool “Recommended medical habits according to the patient’s stage of change”).
It is very important to have regular consultations specially dedicated to the management and planning of smoking cessation.
Social and psychological support are the foundation of care. If the patient is dependent, then nicotine therapy is offered. It calms the symptoms of withdrawal, reduces the urge to smoke, and prevents relapse.
How to estimate the patient’s dependency?
Addiction is defined as the loss of freedom to abstain. The patient is considered dependent if he presents one of the following three criteria:
- attempted to leave
- continues to smoke, although it has tangible consequences on its health (heart attack, COPD, cancer, etc.) or risks to certain conditions (surgery, pregnancy, etc.);
- Always be wary of running out of tobacco. Assessed for level of dependence test (Fagerström).
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computer graphics: Pascal Marseaud
How to assess the cause of the patient’s quit?
- Motivation for example, it can be estimated using the Prochaska and DiClemente model. Lists 5 smokers to go through the paces to rest
- more than the mind smoker: not before departing
- intention he thinks to resist, but is ambiguous;
- decision he makes the decision to retire and to explain the decision when leaving;
- action it turns into a change: it stops smoking;
- maintenance he regained his freedom in the face of a destination, but acknowledges that he must resort to avoiding misfortune.
What methods are offered for smoking cessation?
A smoker will be more likely to quit if he is with a professional: doctor, nurse, psychologist, etc. Based on company-based care and psychological support, attending physicians are key to the process.
For dependent patients, TNS is indicated as first line of treatment.
Other tools to retain effectiveness
- motivational interview (aim to create and sustain motivation for change);
- cognitive behavioral therapies (CBT) (require training testing);
- telephone support (Tobacco info service line: 3989);
- self-help tools (tabac-info-service.fr site).
How to avoid relapse?
When a concession has been initiated, the administration intends to prevent it from falling in with the crowd, because dependency persists after cessation. They can result in an insufficient dose of TNS, anxiety-depressive disorders, weight gain, etc. Strategies are developed to guard against risks. Each condition is resolved by applying a patient to smoke, and the patient is relieved of dramatic de-faux pas and relapse warnings are part of the relapse process.
What? other treatments and methods?
Varenicline and bupropion are second line drugs in the military management reserved for highly dependent subjects.
The benefit of physical activity, acupuncture, or hypnotherapy has not been proven, but these accessories exhibit no danger or are contraindicated. In case of a defect, the patient may contribute to the ways in which the effectiveness has been proven.
Now, we can’t recommend e-cigarettes for cessation smoking because of insufficient information on long-term efficacy and safety.
If a smoker refuses to recommend a nicotine intermediate and chooses to use electronic cigarettes, he has been informed that the treatment is not now being validated, but that the substances it contains are considered less dangerous than those contained in tobacco. Its use is not exhaustive, but accompanies the patient in the process of stopping smoking or decreasing it.
Is there some point in decreasing and stopping temporary consumption?
The reduction can be a middle step for patients who are not ready to retire. Abstinence can help if it is accompanied and associated with it.
Temporary stop justifies specific assistance. It is recommended during pregnancy or surgery to reduce the risk of obstetric or perioperative therapy. This bar can be used for the subsequent stoppage process.
*Interview by Arielle Fontaine – HAS
Article published on 05/11/2017 – Updated on 05/11/2018