Combine pharmacotherapy and behavior counseling to quit a heated tobacco product: A case report

Introduction: Heated tobacco products (HTPs) are still harmful though harm reduction is claimed. There is a need to quit HTPs but there are no published studies. Methods: Case Presentation: A 41 year old male with underline hypertension, presented to our clinic and asked to quit IQOS. He has smoked 40 cigarettes per day for about 20 years. The score of Fagerström test for nicotine dependence (FTND) was 6. He had an ischemic stroke in Jan, 2019, at the time Moyamoya disease was suspected. He changed to use IQOS and stopped combustible cigarettes afterwards. He smoked 20 sticks of IQOS per day. He had an intracranial hemorrhage in June, 2019. During hospitalization, a smoking cessation counselor was consulted. He was suggested to quit IQOS. He visited an out-patient clinic where 105 tablets of 2mg nicotine gum were prescribed for 7 days. He abstained from using IQOS in this week. After discharge, he visited our clinic again and 210 tablets of nicotine gum were given. During a period of 9 weeks, a total of 6 cessions of behavior counseling were provided. He received operation of Moyamoya disease in Aug, 2019. The post-operation condition was stable. Results: He denied smoking any kind of tobacco product in the telephone follow-up at 3 and 6 months. Conclusion(s): The case had strong willingness to quit HTPs due to recurrent stroke. The long term health effects of HTPs are unknown. Therefore, we suggest to quit all tobacco products. We provide a successful experience of quitting HTPs through the combination of pharmacotherapy and behavior counseling.