Smoking cessation and the pharmacist-patient relationship
Pharmacists are logical candidates to help patients quit smoking. Here are some of the reasons.
In the United States, approximately 42 million people smoke cigarettes, and more than 16 million Americans suffer from a disease that is known to be caused by smoking.1 Pharmacists can be an integral part of the fight to quit smoking.
One of a pharmacist’s most vital roles is to help patients select the most appropriate prescription or nonprescription treatment and to ensure that they are used correctly. To increase patients’ success rates, pharmacists can also counsel and educate them on the importance of smoking cessation.
For long-term success in smoking cessation, the decision to quit must come from the smoker. The individual should set a day to quit as well as learn ways to deal with withdrawal. Most important, the new abstainer must strive to stay smoke-free.2
The five A’s
To talk to smokers, pharmacists can use a technique known as the “Five A’s approach.” They should:
• Ask patients about their smoking and related habits
• Advise smokers to make a permanent lifestyle change through smoking cessation
• Assess the patients’ readiness to change
• Assist them in the formation of an action plan
• Arrange for a follow-up consultation3
Non-drug treatment options
Nonpharmacologic treatment measures include cognitive behavioral therapy, hypnotherapy, acupuncture, healthcare provider interventions, telephone counseling, and exercise programs.4 Over-the-counter (OTC) nicotine replacement therapies (NRTs), such as nicotine gum, lozenges, and patches, are common aids to smoking cessation.5
Pharmacists can advise patients on selection of the most appropriate product, depending on their lifestyle and smoking habits. Factors to consider include the number of cigarettes used per day, time to first cigarette, and physical habits.
Patients should be advised that treatment with these OTC products may take approximately 12 weeks. NRTs should be used with caution by patients with certain medical conditions, such as gastroesophageal reflux disease, a recent heart attack, or other cardiovascular conditions. The most common side effects of NRTs are skin reactions and vivid dreams (the patch) and nausea and lockjaw (gum or lozenges). Patients should be aware of proper titration and learn how and when nicotine is absorbed.
Rx options and consequences
Prescription products used in smoking cessation include varenicline, bupropion, and nicotine inhalers and nasal sprays. Treatment with Rx products such as NRTs may take 12 weeks or longer. Patients should set a quit date and be counseled on the importance of dose titration to minimize potential adverse events.6,7
Pharmacists should consider the contraindications, such as underlying seizure disorders, specifically with bupropion, and black-box warnings of reactions such as serious neuropsychiatric events, that are associated with some treatments.7
Common side effects that should be monitored are changes in weight, hypertension, and nose and throat irritations from use of inhalers and sprays. Although nicotine-containing products may be very effective, patients should also be warned about the potential for addiction.
E-cigarettes
Many people believe that electronic cigarettes (e-cigarettes) are a healthier alternative to smoking regular cigarettes. E-cigarettes may aid in quitting, but these products are not FDA-regulated; their long-term effects have not been fully studied and it is unknown exactly how much nicotine or what other harmful substances they contain. Until more information about the potential risks and benefits of these products is available, pharmacists need to tell patients that their use raises safety concerns.8
Pharmacists have a special responsibility support patients and to advocate for lifestyle changes that will improve their quality of life and protect those around them. Pharmacists’ knowledge of drug therapy, their accessibility to the public, and their presence at the time that NRT products are purchased make pharmacists suitable guides to smoking cessation.
References
1. 1. Centers for Disease Control and Prevention. Adult cigarette smoking in the United States: Current estimates. Accessed April 23, 2014.
2. 2. American Cancer Society. Guide to quitting smoking. Accessed April 28, 2014.
3. 3. U.S Department of Health and Human Services. Agency for Healthcare Research and Quality. Five major steps to intervention (The "5 A's"). Accessed April 23, 2014.
4. 5. Niaura R. Nonpharmacologic therapy for smoking cessation: Characteristics and efficacy of current approaches. Am J Med. 2008;121(4): S11-19.
5. 5. American Cancer Society. What are the types of nicotine replacement therapy? Accessed April 23, 2014.
6. 6. U.S National Library of Medicine. MedlinePlus Medical Encyclopedia: Nicotine replacement therapy. Accessed April 24, 2014.
7. 7. Varenicline, Bupropion, Nicotrol. In: Lexi-Comp, Inc. (Lexi-Drugs). Lexi-Comp, Inc.; April 23/29, 2014.
8. 8. PL Detail-Document. Electronic cigarettes and hookah pipes: Safety and regulations update. Pharmacist’s Letter/Prescriber’s Letter. June 2014.
Christina Kim and Joan Shim are PharmD candidates at St. John’s University, College of Pharmacy and Health Sciences, Queens, New York, where Carmela Avena-Woods is assistant clinical professor.
