University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, South Africa; Division of Pulmonology, Department of Medicine, University of Cape Town, South Africa; Chronic Disease Initiative for Africa, University of Cape Town, South Africa.
S Afr Med J. 2013 Sep 30;103(11):869-76. doi: 10.7196/samj.7484.
Tobacco smoking (i.e. cigarettes, rolled tobacco, pipes, etc.) is associated with significant health risks, reduced life expectancy and negative personal and societal economic impact. Smokers have an increased risk of cancer (i.e. lung, throat, bladder), chronic obstructive pulmonary disease (COPD), tuberculosis and cardiovascular disease (i.e. stroke, heart attack). Smoking affects unborn babies, children and others exposed to second hand smoke. Stopping or 'quitting' is not easy. Nicotine is highly addictive and smoking is frequently associated with social activities (e.g. drinking, eating) or psychological factors (e.g. work pressure, concerns about body weight, anxiety or depressed mood). The benefits of quitting, however, are almost immediate, with a rapid lowering of blood pressure and heart rate, improved taste and smell, and a longer-term reduction in risk of cancer, heart attack and COPD. Successful quitting requires attention to both the factors surrounding why an individual smokes (e.g. stress, depression, habit, etc.) and the symptoms associated with nicotine withdrawal. Many smokers are not ready or willing to quit and require frequent motivational input outlining the benefits that would accrue. In addition to an evaluation of nicotine dependence, co-existent medical or psychiatric conditions and barriers to quitting should be identified. A tailored approach encompassing psychological and social support, in addition to appropriate medication to reduce nicotine withdrawal, is likely to provide the best chance of success. Relapse is not uncommon and reasons for failure should be addressed in a positive manner and further attempts initiated when the individual is ready.Key steps in smoking cessation include: (i) identifying all smokers, alerting them to the harms of smoking and benefits of quitting; (ii) assessing readiness to initiate an attempt to quit; (iii) assessing the physical and psychological dependence to nicotine and smoking; (iv) determining the best combination of counselling/support and pharmacological therapy; (v) setting a quit date and provide suitable resources and support; (vi) frequent follow-up as often as possible via text/telephone or in person; (vii) monitoring for side-effects, relapse and on-going cessation; and (viii) if relapse occurs, providing the necessary support and encourage a further attempt when appropriate.
吸烟（如香烟、卷烟草、烟斗等）与重大健康风险、预期寿命缩短以及对个人和社会经济的负面影响有关。吸烟者患癌症（如肺癌、喉癌、膀胱癌）、慢性阻塞性肺疾病（COPD）、肺结核和心血管疾病（如中风、心脏病发作）的风险增加。吸烟会影响未出生的婴儿、儿童和其他接触二手烟的人。戒烟并不容易。尼古丁使人上瘾，吸烟常常与社交活动（如饮酒、进食）或心理因素（如工作压力、对体重的担忧、焦虑或抑郁情绪）有关。然而，戒烟的好处是立竿见影的，血压和心率迅速降低，味觉和嗅觉改善，癌症、心脏病发作和 COPD 的风险长期降低。成功戒烟需要关注个人吸烟的原因（如压力、抑郁、习惯等）和与尼古丁戒断相关的症状。许多吸烟者还没有准备好或不愿意戒烟，需要经常得到戒烟益处的激励。除了评估尼古丁依赖程度外，还应确定并存的医疗或精神疾病状况以及戒烟的障碍。除了适当的药物治疗以减少尼古丁戒断症状外，采用心理和社会支持相结合的个性化方法可能会提供最大的成功机会。复吸并不罕见，应积极解决失败的原因，并在个人准备好时再次尝试。戒烟的关键步骤包括：（i）识别所有吸烟者，提醒他们吸烟的危害和戒烟的益处；（ii）评估开始戒烟的准备情况；（iii）评估对尼古丁和吸烟的生理和心理依赖；（iv）确定咨询/支持和药物治疗的最佳组合；（v）设定戒烟日期并提供合适的资源和支持；（vi）尽可能频繁地通过短信/电话或亲自进行随访；（vii）监测副作用、复吸和持续戒烟；（viii）如果复吸发生，提供必要的支持，并在适当的时候鼓励再次尝试。
