Smoking history important to know

Dear Dr. Roach: I have a question that I’d love to see answered in your column sometime. My husband recently had major surgery. Before the surgery, they asked if he ever has smoked. (Husband is 77.) He answered that when he was 9, he smoked a cigarette. He now is in the computer as an ex-smoker, and the nurse told us she is “required by law” to provide him with information on quitting.

When physicians ask, “Have you ever smoked?” do they really want to hear about one cigarette, smoked almost 70 years ago? Is this meaningful information, in medical terms? — S.S.

Answer: There are very important reasons to know a person’s smoking history, especially when someone is about to undergo surgery. Current smokers should know that quitting well before surgery can reduce risks of surgical complications. The anesthesiologist can be extra-vigilant for breathing issues. Some of these points are valid for ex-smokers who have recently quit or who were very heavy smokers.

Of course, one cigarette at age 9 is meaningless, and anytime I hear “required by law” I wonder if it’s really true. In this case, I doubt it: Why give ex-smokers information on quitting? It makes no sense.

Primary care providers like me ask about smoking because a significant history of smoking increases heart disease risk, so I might be more likely to recommend treatment to reduce that risk (for example, in a person with elevated blood pressure or cholesterol who otherwise doesn’t quite meet criteria for drug treatment). Also, people who smoked more than 1 pack per day for 30 years, or the equivalent, should have a discussion about whether screening for lung cancer is appropriate.

Finally, it’s easier to answer if you have never been a smoker. Some people who smoke socially don’t consider themselves smokers but still would benefit from advice to stop.

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