International Task Force for Prevention of Coronary Heart Disease

International Task Force for Prevention of
Coronary Heart Disease

CORONARY HEART DISEASE: REDUCING THE RISK

In the first instance, simple counselling is offered by the physician or nurse and is often effective in smokers who are already motivated to quit. This need not take more than a few minutes.
Hence the initial step is to inquire how concerned the smoker is to stop. Then the desire should be reinforced (verbally and by providing educational material) by increasing the patient's awareness of

the rapid improvement in well-being after quitting e.g. food tastes better, effort tolerance increases, morning cough subsides, and
the high risk of CHD, peripheral vascular disease, stroke, smoking-related cancers and chronic disabling lung disease if smoking continues, and
the progressive decline in such risks in ex-smokers, however long the habit has continued, and
the financial savings by stopping, not only the cost of smoking materials but also the lower life insurance premiums often available.

Next, the subject is clearly and firmly counselled to stop smoking. This instruction is accompanied by a positive and encouraging attitude; for example the smoker who has quit but relapsed in the past should be told that second or further attempts are often successful. Patients who have suffered an acute coronary event should always be counselled before discharge from hospital. It is important also to identify barriers which may make it more difficult for a person to give up smoking e.g. a spouse who smokes, so that these problems can be addressed. Wherever possible, the support of others in the social environment of the patient should be enlisted.
Smokers should note their personal-triggering factors, e.g. using the telephone, driving a car, entering a smoking environment, completing a meal, or drinking alcohol. Awareness of the trigger lessens its impact. The smoker should know that the doctor intends to maintain contact. Repeated follow-up by consultation and telephone contact is important, to reinforce the determination of the successful quitter and patiently to encourage a further attempt in those who have failed.
For some smokers, the "minimum smoking technique" is helpful. The subject is instructed to ask himself, whenever he feels the urge to smoke, whether he really needs to do so at that moment. If he does, he proceeds to light up. But often he realises that this can be postponed. This strategy is useful for reduction of smoking, as a preliminary to quitting.
For the unsuccessful patient, referral to a smoking cessation programm can be remarkably effective. These may be run by a counsellor or psychologist and may employ behaviour modification techniques including avoidance of trigger factors that lead the person to light a cigarette.
For the persistent smoker or if there are frequent relapses, nicotine dependence should be managed by combining nicotine replacement with the above counselling measures. In patients without cardiovascular disease, this may be effected by the use of nicotine skin patches at progressively-decreasing dosage.