World Health Organization Collaborating Centre for Smoking Cessation and Treatment of Tobacco Dependence
Chinese module on treatment of tobacco dependence by counselling and pharmacotherapy targeting the Chinese-speaking population in Southern China and the Western Pacific Region
Case Studies
Case 1
70-year-old woman is referred to you prior to elective abdominal hysterectomy for uterine fibroids. She has mild chronic obstructive lung disease. She has no cardiac history. She smokes immediately upon waking, smokes 30 CPD and has been a smoker for 50 years. She coughs daily producing small amounts of sputum. She has tried multiple times to quit without success. After you advise her to stop smoking, she indicates that she is very interested in making a quit attempt prior to her operation.
Which of the following would likely be the least effective medication choice:
A. Nicotine patch 42 mg per day plus gum 2mg as needed
B. Nicotine patch 42 mg per day plus nicotine lozenge as needed
C. Nicotine patch 14 mg per day
D. Nicotine patch 35 mg per day plus nicotine lozenge as needed
E. Nicotine patch 21 mg per day plus varenicline
Case 2
A 45-year-old man is motivated to quit smoking his usual 20 cigarettes per day and desires your help. He has previously tried to quit unsuccessfully using nicotine gum 2 mg as needed. Which of the following would you advise for treatment?
A. Nicotine lozenge 2 mg to use as needed
B. Nicotine lozenge 2 mg per day
C. Nicotine patch 14 mg per day
D. Varenicline 1 mg twice daily for 12 weeks
E. None of the above
Case 3
A 60-year-old woman with asthma has come to your office for follow-up of the asthma and indicates that she is still smoking 30-40 cigarettes per day and smokes her first one in < 15 minutes after waking. She feels very motivated to stop smoking after seeing a commercial for a new medication to aid in smoking cessation. She tried nicotine patches 2 years ago but developed a blistering patch-site rash on her skin and was unable to stop smoking. She has a past history of major depression but currently denies any symptoms of depression and is on no treatment for this.
Which of the following would you advise as the most appropriate treatment:
A. Nicotine lozenge 4 mg as needed
B. Varenicline 1 mg twice daily
C. Nicotine gum as needed
D. Nicotine patch 14 mg as needed
E. None of the above