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KMID : 1141720150030020002
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폐쇄성폐질환
2015 Volume.3 No. 2 p.2 ~ p.2
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Kim Yu-Il
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Abstract
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One approach to smoking cessation is the five-step algorithm called the 5 A’s (Ask, Advise, Assess, Assist, Arrange). All smokers should be advised to quit smoking. For smokers who are willing to quit, smokers should be managed with a combination of behavioral counseling support and pharmacologic therapy. For smokers who are not ready to quit, the clinician’s role is to assess the patient’s perspective of the risks and benefits of smoking in order to help the smoker to begin to think about quitting. The first-line pharmacologic therapies for smoking cessation include combination nicotine replacement therapy, varenicline, and bupropion. The choice of pharmacotherapy should be based on patient preference after discussion with a clinician. Pharmacotherapy needs to be tailored for patients with comorbidities (eg, psychiatric illness) or patients in specific populations (eg, light smokers). Smokers who fail to quit with first-line therapy may benefit from adding another of the first-line therapies or second line pharmacotherapy. Smokers who successfully quit but experience relapse can be treated with a pharmacologic agent that previously worked for the patient. Enhancing treatment by adding another pharmacologic agent or more intensive behavioral counseling support can also be considered. There is emerging evidence of benefit in combining varenicline with either nicotine replacement or bupropion, but the safety and efficacy of these combinations should be more evaluated.
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KEYWORD
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Smoking cessation, Counseling, Pharmacotherapy, Combination therapy
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Listed journal information
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