Chart 7.1.
Initial evaluation in approach to smoking300
| Anamnesis |
| • Scales: Fagerström (for nicotine dependence)265 - Table 7.2 |
| • Prochaska and DiClementi (for motivation)263 - check the patient's counseling techniques - Table 7.3 |
| • Clinical and/or psychiatric comorbidites (diabetes, hypertension, depression, alcoholism, stroke, convulsion, cancer) |
| • Continuous use medications |
| • Risk factors for CVD (dyslipidemia, uso of oral contraceptives or estrogen) |
| • Pregnancy or breastfeeding |
| • Questions about smoking: |
| - How long have you been smoking |
| - How many cigarettes do you smoke per day |
| - Have you tried to quit smoking and what was the result |
| - Are you interested (or thinking) about quitting smoking? |
| • Questions about smoking cessation: |
| - Are you considering a date to quit smoking and would you like help |
| - If you have tried to quit, if you have succeeded, if you have taken any medication and how long you have been without smoking |
| Physical examination |
| • Monitor BP, especially during bupropion use |
| • Monitor weight: weight gain can be a barrier to starting smoking cessation and a predictor of relapse |
| Complementary examinations |
| • Complete blood count, liver function tests, blood glucose, lipid profile and serum biochemistry |
| • Chest X-ray |
| • Electrocardiogram |
| • Spirometry (not always readily available) |
| • Measurement of COex, if possible. This parameter is directly related to carboxyhemoglobin and cigarettes smoked per day. The cutoff point is 6 ppm |
COex: carbon monoxide; CVD: cardiovascular disease; BP: blood pressure.