I'm seeing a new patient today.  She is an adult woman, age 54, named Betty Lanister. She just moved to California.  Unfortunately, we have not received her medical record from her previous healthcare provider.  I think we'll spend most of our time going over her preexisting conditions and current treatment regimen.

Ms. Lanister filled out a medical survey while waiting in the lobby, and that was entered into the computer system.

Dr. Tanaka: So Ms. Lanister, could you tell me a little bit about your medical history, and the medications you take now?

Ms. Lanister: Well, about two years ago I reached menopause.  I'm taking estrogen as part of hormone replacement therapy my last doctor started me on.  Otherwise I think I am in fairly good shape.

Dr. Tanaka: So, I see that you had asthma as a child.  Could you tell me a little about that?

Ms. Lanister:  Yes, my asthma started when I was 7 years old. Both my parents were smokers so that didn't help.  As I got older, it seemed to go away for the most part, but I still feel shortness of breath sometimes.  My last doctor prescribed me an inhaler so I have it if I need it.

Dr. Tanaka:  I see you were a smoker too?  Do you still smoke?

I knew the answer.  I could smell the tobacco smoke on her clothes.

Ms. Lanister:  Well, to be honest, occasionally I do smoke.  I took up smoking in high school.  It was cool then.  So I guess I have been smoking for almost 40 years.  In my defense, I've cut down a lot in the last few years.  Now I smoke only around ten cigarettes a day.  

I could see that she was uncomfortable answering that question.  I was thinking that I really need to get her to quit smoking somehow.

Dr. Tanaka: Well, perhaps that does not sound like a lot, but it does affect your heart and lungs. Plus, smokers are more susceptible to respiratory diseases like COVID.  If you stay on this path, you may eventually develop COPD.  

Ms. Lanister: What is COPD exactly? I have heard of it of course but I don't know what it really is all about.

Dr. Tanaka: COPD stands for Chronic Obstructive Pulmonary Disease. It is the name for two major breathing diseases that cause airways in your lungs to become obstructed, or blocked.  They are obstructive chronic bronchitis and emphysema.  It's these serious conditions that I want to make sure you will be able to avoid in the future.  In order to do that, you'll need to make a commitment to stop smoking.

Ms. Lanister: But after 40 years I really don't know if I can quit now.  I've tried, but always came back to smoking.

Dr. Tanaka: Sure, I understand, it is not an easy thing to do.  But let's try some things and see if they work.  First, I'm going to give you some contact info about a few smoking cessation programs that I know of.  According to their literature, they have a good track record of getting people to stop.  They'll give you some more info about support groups.  Please join one of those programs and get involved with a support group too.

Ms. Lanister:  Ok, sounds good.

Dr. Tanaka:  Second, I'd like to see if nicotine replacement therapy patch will help.  You can pick up a package of Nicorette in the hospital pharmacy today.

Ms. Lanister:  I've tried one of those before but obviously it did not work.  I'll give it another try.

Dr. Tanaka:  Third, I am going to prescribe Chantix to help you break your addiction to nicotine.  So this is the plan.  Let's pick a stop smoking date.  How about two weeks from now?

Ms. Lanister: Um, ok I guess.  Yes, let's do it.  Two Wednesdays from today.  

Dr. Tanaka: Good.  So starting today take Chantix for those two weeks leading up to the big day, and continue to take it for the remainder of the dose.  Use the patch daily per the instructions on the package.  And as I mentioned before, get involved with a support group.  Get your family involved.  And reach out to me if you need to talk, or have questions.  Sound good?

Ms. Lanister: Yes doctor, I'll definitely give it a try.  I really don't know if I am up to this, but I will do my best.

Dr. Tanaka:  Sounds great, Betty.  I really think this combination of approaches will work for you.  One last thing.  I've ordered some blood tests and a chest X-RAY for you to establish a baseline.  Please stop into the lab on your way out.  Somebody from Radiology will contact you about an appointment.  Take care, Betty.