An otolaryngologist can make the connection for the patient that smoking exacerbates all of these conditions. In a best practice paper on the controversy surrounding electronic nicotine device systems (ENDS), Dr. Rahmati and his co-authors wrote, “As physicians primarily involved in the treatment of head and neck malignancies, otolaryngologists have a particular responsibility in guiding patients toward effective methods of tobacco cessation” (Laryngoscope. 2015;125:785-787).
Explore This IssueFebruary 2016
What Works Best?
Smoking cessation largely depends on the efforts and motivation of the patient trying to quit, and there’s no one-size-fits-all approach to helping a patient stop smoking. Practice guidelines suggest practitioners should use the Five A’s: Ask, Assess, Assist, Advise, Arrange.
Follow-ups with a patient who is trying to quit may not happen, because healthcare providers may feel overwhelmed dealing with complex patient populations with medical comorbidities or lower socioeconomic status, said Carla Berg, PhD, associate director of population sciences at Winship Cancer Institute of Emory University in Atlanta and associate professor in the department of behavioral sciences and health education at Emory’s Rollins School of Public Health in Atlanta. “But smoking cessation should be high on the list for all practitioners—and particularly for otolaryngologists. It’s still the number one killer of people in the U.S., and the number two globally,” she added. “We haven’t won the battle just because smoking has gone down.”
Available Methods and Medications
“Most smokers don’t want to stop smoking, or they can come up with a lot of reasons why they don’t want to quit,” said Dr. Berg. There are services and medications that increase a smoker’s odds of success, however.
State-funded quitlines—telephone-based tobacco cessation services—can be very effective. They are free of charge and apply motivational interviewing techniques during which smoking cessation counselors know how to handle a patient’s resistance. “The more convenient you can make them for people, the more likely people are to use the quitline,” said Dr. Berg. In some states, physicians send referrals to have quitlines reach out to their patients who smoke. “If the quitline proactively reaches out to the individual, that removes a lot of barriers,” Dr. Berg said.
Behavioral intervention used in combination with medication increases the odds of successful smoking cessation. Medications for those over the age of 18 include over-the-counter nicotine replacement products such as transdermal nicotine patches, gum, and lozenges, as well as prescription nicotine replacement products such as nasal sprays and oral inhalers. Non-nicotine prescription products include varenicline tartrate and buproprion hydrochloride.