Smoking has been associated with disease activity and overall prognosis for patients with MS . According to a recent comprehensive literature review, smoking seems to affect patients with MS throughout the natural history of the disease, as well as possibly decreasing the efficacy of disease-modifying drugs . Counseling is key in supporting patients before and during smoking cessation .
5A approach for smoking cessation 
- Ask - Identify and document tobacco use status for every patient at every visit.
- Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit.
- Assess - Is the tobacco user willing to make a quit attempt at this time?
- Assist - For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit.
- Arrange - Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date.
- Jakimovski D et al. Neurodegener Dis Manag 2019; 9(3): 149-72. Return to content
- Rosso M, Chitnis T. JAMA Neurol 2020; 77(2): 245-53. Return to content
- Reference: Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/prevention/guidelines/tobacco/5steps.html (accessed August 18, 2021) Return to content