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Smoking cessation
Brief counselling combined with medication — varenicline or combination nicotine replacement — roughly doubles the chance of success, so every smoker is asked, advised and offered help at every visit.
Why it matters in the exam
The exam asks about choosing the drug by comorbidity (seizures, eating disorder, heart disease), explaining withdrawal symptoms and how long they last, and the approach to a patient who is not ready to quit. Other questions deal with calculating pack-years and what they mean for lung cancer and aortic aneurysm screening.
Know that the EAGLES trial found no significant rise in neuropsychiatric events with varenicline or bupropion, and that nicotine replacement is safe in stable heart disease.
Smoking is the most important preventable risk factor, so even a brief conversation of a few minutes, repeated at every visit, measurably raises the number of patients who try to quit and succeed. In Israel the health funds offer cessation workshops and subsidised drugs, and the doctor is the one who refers to them. Further questions deal with a patient after a myocardial infarction or with COPD — for them quitting is the most important treatment.
Key points
- Counselling plus medication doubles the chance of success.
- Varenicline — 12 weeks, with a step-up dose in the first week.
- Nicotine replacement: patch plus a short-acting product; safe in stable heart disease.
- Bupropion starts 1–2 weeks before the quit date; forbidden with seizures and eating disorders.
- Not ready — motivational interviewing and return to the subject at every visit.
Summary table
| Treatment | How it is given | Contraindications and effects | Exam note |
|---|---|---|---|
| Varenicline | 0.5 mg daily for 3 days, 0.5 mg twice daily to day 7, then 1 mg twice daily for 12 weeks | Nausea, vivid dreams; dose adjustment in renal failure | The most effective single agent |
| Combination nicotine replacement | Patch plus a short-acting product (gum, lozenge, inhaler) | Skin irritation, sleep disturbance with a night-time patch | Almost as effective as varenicline; safe in stable heart disease |
| Bupropion | 150 mg once daily for 3 days, then twice daily; start 1–2 weeks before the quit date | Forbidden with seizures, bulimia or anorexia, MAOIs, abrupt alcohol or benzodiazepine withdrawal | Suits a patient who is also depressed; limits weight gain |
| Brief counselling | Ask, advise clearly, assess readiness, assist and arrange follow-up | — | Every doctor, every visit |
| Motivational interviewing | For a patient not ready now | — | Aims to build readiness, not to force quitting |
In the full version for subscribers
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Sources
- US Preventive Services Task Force, 2021 — Interventions for tobacco smoking cessation in adults, including pregnant persons
- Anthenelli RM et al., EAGLES trial, The Lancet, 2016 — Neuropsychiatric safety and efficacy of varenicline, bupropion and nicotine patch
- Israel Ministry of Health, current edition — Smoking cessation services and medicines in the health basket
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.