331 Ch 330. Smoking Cessation and Tobacco Use Disorder

Tobacco use 全球 #1 preventable cause of death (~ 8 million deaths/yr)；diseases caused：lung cancer (top), CV (#1 absolute number), COPD, stroke, atherosclerosis, peripheral vascular, pregnancy complications, oral/throat/esophageal/bladder/kidney cancer；nicotine addiction = neuroplastic disorder, nicotinic acetylcholine receptor up-regulation + dopamine pathway；5A’s = Ask, Advise, Assess, Assist, Arrange；5R’s for unwilling = Relevance, Risks, Rewards, Roadblocks, Repetition；pharmacotherapy first-line：(1) varenicline (Champix/Chantix) — partial nicotinic agonist；(2) nicotine replacement therapy (NRT) — gum, patch, lozenge, inhaler, nasal spray；(3) bupropion — NDRI；combination NRT + varenicline more effective than single；cytisine — partial agonist alternative cheaper；behavioral support essential：CBT, motivational interviewing, telephone counseling, mobile apps；e-cigarettes (vapes)：controversial harm reduction tool；EVALI + lung damage concerns；2024 cytisine FDA approval pending, smoking cessation in lung cancer survivors emphasized；台灣 2020s 政府全民健保 smoking cessation services。