Smoking medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD 
Some general principles including the 5 As (ask, Assess, Advise, Assist and Arrange follow-up), non-pahramcological strategies like nicotine gum and nicotine patch and pharmacological strategies including bupropion, varenicline, inhalers and nasal sprays can be used to help quit smoking.
The 5As are an evidence-based framework for structuring smoking cessation in health care settings. The 5As include: Ask, Assess, Advise, Assist and Arrange follow-up.
First-line pharmacotherapy includes the multiple forms of nicotine replacement therapy (patch, nasal spray, losenge, gum, inhaler), sustained- release bupropion hydrochloride, and varenicline. Second line therapy includes clonidine and nortriptyline and have been found to be efficacious.
The following is a description of the various treatment modalities available:
- Sustained release bupropion hydrochloride:
- Nicotine gum:
- Dose: 1–24 cigarettes/day: 2mg gum (up to 24 pieces/day). ≥ 25 cigarettes/day: 4 mg gum (up to 24 pieces/day).
- Duration: Up to 12 weeks
- Adverse effects: Mouth soreness and dyspepsia
- Nicotine inhaler:
- Dose: 6–16 cartridges/day
- Duration: Up to 6 months
- Adverse effects: Local irritation of mouth and throat
- Nicotine lozenges:
- Nicotine nasal spray:
- Dose: 8–40 doses/day
- Duration: 3–6 months
- Adverse effects: Nasal irritation
- Dose: 0.5 mg/day for 3 days followed by 0.5 mg twice/day for 4 days. Then, 1 mg twice/day
- Duration: 3–6 months
- Adverse effects: Nausea, trouble sleeping, vivid/strange dreams and depressed mood
Effect of Smoking Cessation on various Risks
- Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.
- Within 2 to 5 years after quitting smoking, your risk for stroke may reduce to about that of a nonsmoker’s.
- If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.
- Ten years after you quit smoking, your risk for lung cancer drops by half.
- ↑ 1.0 1.1 "CDC - 2010 Surgeon General's Report - Consumer Booklet - Smoking & Tobacco Use".
- ↑ 2.0 2.1 "QuickStats: Number of Deaths from 10 Leading Causes — National Vital Statistics System, United States, 2010".
- ↑ 3.0 3.1 "CDC - 2014 Surgeon General's Report - Smoking & Tobacco Use".
- ↑ 4.0 4.1 "CDC - Fact Sheet - Current Cigarette Smoking Among Adults in the United States - Smoking & Tobacco Use".
- ↑ 5.0 5.1 WYNDER EL, GRAHAM EA (1951). "Etiologic factors in bronchiogenic carcinoma with special reference to industrial exposures; report of eight hundred fifty-seven proved cases". AMA Arch Ind Hyg Occup Med. 4 (3): 221–35. PMID 14867935.
- ↑ "www.vapremier.com" (PDF).
- ↑ Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff (2008). "A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report". Am J Prev Med. 35 (2): 158–76. doi:10.1016/j.amepre.2008.04.009. PMC 4465757. PMID 18617085.