• Educate patients about the risks to their health and the many advantages of giving up smoking, and emphasise the improvement in health, longevity, money savings, looks and sexuality.

• The extent of nicotine dependence can be assessed using a questionnaire (based on the Fagerstrom Test) and scoring system. 3

Facts to point out

• Advantages o Food tastes better. o Sense of smell improves. o Exercise tolerance is better. o Sexual pleasure is improved. o Bad breath improves.

o Risk of lung cancer drops: after 10-15 years of quitting it is as low as someone who has never smoked. o Early COAD can be reversed. o Decreases URTIs and bronchitis.

o Chance of premature skin wrinkling and stained teeth is less. o Removes effects of passive smoking on family and friends. o Removes problem of effects on pregnancy.

• If they say no to quitting, give them motivational literature and ask them to reconsider.

• If they say yes, make a contract (example below).

A contract to quit

'I agree to stop smoking on I understand that stopping smoking is the single best thing I can do for my health and that my doctor has strongly encouraged me to quit.'

(Patient's signature)

(Doctor's signature)

• These motivated patients will require educational and behavioural strategies to help them cope with quitting. Ongoing support by their GP is very important.

• Organise joining a support group.

• Arrange follow-up (very important), at least monthly, especially during first 3 months.

• Going 'cold turkey' (stopping completely) is preferable but before making the final break it can be made easier by changing to a lighter brand, inhaling less, stubbing out earlier and reducing the number. Changing to cigars or pipes is best avoided.

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