• Structured Approach / 5A’s
  • Ask
    • Do you smoke?
    • What do you smoke?
    • How many do you currently smoke?
    • When did you start?
    • Why do you continue?
  • Advise to quit, tailoring the delivery to the individual patient
  • Asssess stage of change
    • Maintenance – works to sustain change
    • Action – practices desired behaviour
      • Preparation – intends to take change
    • Contemplation – aware of problem
    • Pre-contemplation
  • Assist
    • Counselling / Psychotherapy
      • Psychologist
      • Hypnotherapist
      • Accupuncture
    • Pharmacotherapy
      • NRT – time to first cigarette and number per day – 9% success
        • Patches
          • 30min to first, 10/day -> 21mg/24hr + add on
          • 30min to first, <10/day -> 21mg/24hr
        • Gum
        • Lozenges
        • Inhaler
        • Spray
      • Varenicline / Champix – 18% success
        • Common side effects (>1%)
          • Nausea/vomiting, dyspepsia, constipation, flatulence, abdo pain, increased appetite, weight increase, insomnia, taste disturbance, headache, abnormal dreams, sleep disorders
        • Use with caution with difficult mental health conditions
      • Buproprion / Zyban
        • Second line – but rarely used
        • Common side effects
          • Insomnia, nightmares, dizziness, agitation, anxiety, remor, headache, fever, rash
          • Contraindicated with MAOI use
          • Contraindicated with seizure history
      • Nortriptyline – third line, almost never used
      • E cigarettes – not recommended
  • Arrange
    • Follow up in 1 week
    • Quit Line – 13 78 48
    • Occupational programs
    • MyQuitBuddy
• Special groups
  • Recent cardiac event – avoid NRT
  • ATSI – Aboriginal Quitline / Koori Quitline, increased PBS subsidy

Baseline vitals;
BP, Pulse, Resp rate, Weight, Height, Temperature, Auscultation of chest/heart