IMPORTANCE FOR THE PATIENT AND ROLE OF THE PHYSICIAN - SMOKING CESSATION

Tobacco is the single most important cause of avoidable morbidity and early mortality in many countries. Smoking cessation is associated wit h a reduction in the prevalence of related symptoms as well as a progr essive decrease in the occurrence of related diseases. Thus, there is a rapid decline in the occurrence of cardiovascular diseases in indivi duals who stop smoking; there is also a decline in the occurrence of l ung cancer, although delayed and with a slower decrease rate. This is an important message for physicians and patients: Physicians should sy stematically offer counselling and information to their patients who s moke. The message should be tailored to the patient's status and must be different for a patient who has already decided to quit than for a patient who is not considering cessation in the near future. To help p atients who have decided to stop and incite other patients who smoke t o quit, physicians should be aware of the mechanisms involved in acqui ring and breaking tobacco dependence (learning pathways, physiological dependence, behavioral analysis). Physicians should be trained to use methods which have proved effective in a physician's practice and to manage difficulties which may arise during cessation (e.g. craving, we ight gain), as well as appropriate use of nicotine skin patches or che wing gum. From a public health standpoint, widespread action by physic ians to promote smoking cessation among their patients could be one of the most effective clinical preventive measures.