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Smoking is the major risk factor for lung cancer and contributes to risk for heart disease and many other conditions.
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Although the risks of smoking and the benefits of cessation are well recognized, for both generalist and specialist physicians, smoking cessation is often not a priority.
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Cigarette smoking should be regarded as a chronic relapsing disease.
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Optimal treatment requires a long-term approach, combining pharmacologic and nonpharmacologic interventions and close interactions between
Smoking Cessation
Section snippets
Key points
Physiology of smoking
There is a traditional view that regards smoking as a lifestyle choice and a habit. The decision to begin smoking is a choice, and in that context, it is a lifestyle choice. However, almost all smokers begin smoking in adolescence.5 The choice to begin smoking is influenced by numerous social factors, which include not only the behaviors of family and friends but the promotion of smoking through advertising and public image. Smoking behavior is also strongly influenced by other social factors,
Approach to a quit attempt
As noted earlier, smoking should be regarded as a primary addictive disorder.4 Seventy-five percent of Americans wish to quit, but only 3% achieve prolonged abstinence in any year, indicating both the involuntary nature of the established addiction and the substantial need for treatment.25 It is recommended that smoking status and willingness to quit be assessed at every health care visit.4, 26, 27 However, individual readiness to quit (Table 2) is likely variable and may be related to acute
Strategy for the quit attempt
The greatest quit rates are achieved when nonpharmacologic support is combined with pharmacotherapy. The more extensive the support, the greater the success. However, many smokers do not accept referral to a group program. Limited counseling in the office can be provided to these individuals. In addition, telephone quit lines, which have shown efficacy,39 are available toll-free and at no cost in many countries, including the United States and Canada. In the United States, the phone number is
Pharmacotherapy
Three classes of medication are approved as aids to smoking cessation (nicotine replacement, bupropion [Zyban, also sold under the trade name Wellbutrin to treat depression], and varenicline [Chantix]) and 2 others are available off-label (nortryptiline and clonidine), which have documented efficacy and are recommended as alternative therapies in current guidelines.4, 26, 27, 40
Harm reduction
Cigarette smoke contains up to 6000 components, which are generated by the complex chemical processes associated with curing and pyrolysis of the tobacco.80 Nicotine is not among the most important toxic compounds in smoke. This factor has led to the concept that nicotine addiction could be addressed by nicotine replacement using a preparation that does not include the health-compromising toxins. This approach, termed harm reduction, is inherently controversial, because it involves supporting
Summary
Cigarette smoking should be regarded as a chronic relapsing disease. However, it is a disease that can be effectively treated in many cases. Optimal treatment requires a long-term approach combining pharmacologic and nonpharmacologic interventions and close interactions between patient and clinician.
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Cited by (21)
Modelling a budgetary impact analysis for funding drug-based smoking cessation therapies for patients with major depressive disorder in Spain
2017, European PsychiatryCitation Excerpt :Within Spain, smoking accounts for approximately 60,000 deaths per year and, as in other countries, is associated with high healthcare resource utilisation and cost to society [3,4]. Smoking cessation is a medical objective that continues to be pursued by both clinicians and public health authorities alike, particularly in patient populations who are at high risk for developing comorbidity [5–8]. Individuals suffering from major depressive disorder (MDD) are considered to be a vulnerable smoking population due to the greater risk of developing nicotine dependence compared to smokers without comorbid psychiatric disorders [9,10].
Neuroscience of nicotine for addiction medicine: novel targets for smoking cessation medications
2016, Progress in Brain ResearchCitation Excerpt :Nicotine is the major psychoactive component of tobacco smoke (Stolerman and Jarvis, 1995). The effects of nicotine are mediated by neuronal nicotinic acetylcholine receptors (nAChRs) and current first-line Food and Drug Administration (FDA)-approved smoking cessation medications such as varenicline and nicotine replacement therapies target these nAChRs (Nides, 2008; Rennard and Daughton, 2014; see Table 1). However, these FDA-approved medications are not effective in all smokers who express a desire to quit.
Cardiovascular disease in patients with chronic human immunodeficiency virus infection
2014, International Journal of CardiologyCitation Excerpt :A comprehensive smoking cessation program is more likely to achieve higher success rates than individual therapies. Counseling, nicotine replacement therapy (patches, gum and inhaler) and medications (buprorpion and varenicline) are all effective, however, the overall efficacy depends on their integration into an effective management plan and support throughout cycles of remission and relapse [75]. Lipid management to reduce CVD is particularly challenging in patients with HIV.
From planning to action in smoking cessation: Demographic and psychological symptom dimensions related to readiness to quit smoking
2021, International Journal of Mental Health and AddictionCost–benefit analysis of funding smoking cessation before surgery
2020, British Journal of Surgery
Disclosures: Since 2010, S.I. Rennard has consulted with Pfizer on the topic of smoking cessation and conducted clinical trials sponsored by Pfizer. He has also consulted on other topics for GlaxoSmithKline which has smoking cessation products.