A 45-Year-Old Woman Comes to the Office for a Routine

A 45-year-old woman comes to the office for a routine follow-up.  The patient feels well overall but mentions that climbing the last flight of stairs to her 3rd-floor apartment has become harder.  She says, "Sometimes I have to stop at the landing to catch my breath."  Medical history includes cocaine use disorder in remission for the past 4 years; it is otherwise unremarkable.  The patient does not use alcohol or illicit drugs.  She has a 25-pack-year smoking history and has been counseled to quit smoking in the past.  The patient says, "I've tried to quit several times.  I can cut down to a few cigarettes or half a pack for a day or two, but then it's just too difficult."  Which of the following is the most appropriate response by the physician regarding this patient's smoking?

A) "I'm concerned that continuing to smoke is contributing to your breathing problems."
B) "Quitting on your own is difficult and medication can help.  Would you consider this?"
C) "Since you stopped using cocaine, I'm hopeful that you can eventually stop smoking cigarettes."
D) "Stopping smoking will likely improve your breathing and decrease your risk for other conditions."
E) "You were successful in stopping cocaine.  How might your experience help you to quit smoking?"

Correct Answer:

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