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  1. Kate E Koplan, senior medicine resident1,
  2. Sean P David, assistant professor of family medicine2,
  3. Nancy A Rigotti, associate professor of medicine3
  1. 1Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 01225, USA
  2. 2Brown Medical School, Brown University Centre for Primary Care and Prevention, Providence, RI, USA
  3. 3Harvard Medical School, Massachusetts General Hospital, Boston, MA
  1. Correspondence to: K E Koplan kkoplan{at}partners.org
  • Accepted 26 March 2007

A 52 year old man with asthma, hyperlipidaemia, and a family history of early onset heart disease comes to see you because of increased wheezing and dyspnoea. He has smoked a pack per day for 36 years. He tried quitting “cold turkey” but felt irritable and couldn’t concentrate; he tried nicotine gum but it didn’t work. He is willing to try stopping smoking again but wonders if it is too late for him to benefit from quitting and if he ever can quit.

What issues you should cover

The patient’s smoking should be tackled as a standard part of treating his presenting problem, an asthma flare. Tobacco use should be attended to at all patient visits, but respiratory or cardiac symptoms provide a special opportunity. Specific symptoms that can be attributed to tobacco use, rather than risk of future disease, can motivate smokers to change behaviour. In this case, stopping smoking will improve the patient’s asthma control.

What you should do

  • Congratulate the patient on willingness to address tobacco use. Assure him that you can help.

  • Attend to his concerns and elicit any others. Like many long-time smokers, he wonders if it …

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