A 45-Year-Old Lady Walks in for a Normal Check-Up

A 45-year-old lady walks in for a normal check-up. The patient is doing OK generally, but she adds that climbing the last flight of steps to her third-floor apartment has become more difficult. "Sometimes I have to pause at the landing to regain my breath," she admits. Medical history includes a cocaine use disorder that has been in remission for the past four years; otherwise, it is normal. The patient does not drink alcohol or use illegal substances. She has a 25-pack-year smoking history and has previously been advised to quit smoking. The patient declares, "I've tried countless times to quit. I can reduce down to a few smokes or half a pack for a day or two, but it becomes too tough after that." 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?"