Summary
Definition
History and exam
Key diagnostic factors
- number of cigarettes per day
- time to first cigarette (TTFC) ≤30 minutes or >30 minutes
- use of alternative tobacco and nicotine delivery products
- history of substance use disorder (SUD)
- pregnancy or breastfeeding
Other diagnostic factors
- history of depression
- history of schizophrenia
- seizure disorder
- hypertension
- unstable cardiac disease
- ventricular arrhythmia
- asthma
- temporomandibular joint or dental disorder
Risk factors
- tobacco smoker
- use of alternative tobacco and nicotine delivery products
Diagnostic investigations
1st investigations to order
- self-report of smoking status
- cotinine level
Treatment algorithm
hospitalised active smokers
active smokers ready to stop: adults (no pregnancy, breastfeeding, depression, or substance use disorder)
active smokers ready to stop: pregnant/breastfeeding women, adolescents
active smokers ready to stop: depression and smoking cessation
active smokers ready to stop: substance use disorder and smoking cessation
active smokers not ready to stop
smokeless tobacco users
Contributors
Authors
Franck F. Rahaghi, MD, MHS, FCCP
Chairman
Pulmonary Department
Director
Pulmonary Education and Rehabilitation
Cleveland Clinic
Weston
FL
Disclosures
FFR is a consultant and speaker for Bayer, United Therapeutics, Janssen-PH, Merck, Boehringer Ingleheim, Takeda, and Talecris. He is involved in industry-sponsored research with Bayer, Janssen-PH, Gossamer Bio, and Bellerophon.
Samuel Gurevich, MD, FCCP
Pulmonary Department
Director
Respiratory Therapy
Cleveland Clinic
Weston
FL
Disclosures
SG declares that he has no competing interests.
Acknowledgements
Dr Franck F. Rahaghi and Dr Samuael Gurevich would like to gratefully acknowledge Dr Felix Hernandez, Dr Jose Gonzalez, and Dr Theodore W. Marcy, previous contributors to this topic.
Disclosures
FH, JG, and TWM declare that they have no competing interests.
Peer reviewers
William Wadland, MD, MS
Professor and Chair
Department of Family Medicine
Associate Dean for Faculty Affairs and Development
College of Human Medicine
Michigan State University
East Lansing
MI
Disclosures
WW declares that he has no competing interests.
Charles J. Bentz, MD, FACP
Medical Director
Tobacco Cessation and Prevention
Providence St. Vincent Hospital and Medical Center
Portland
OR
Disclosures
CJB declares that he has no competing interests.
Fei-Ran Guo, MD
Department of Family Medicine
National Taiwan University Hospital
Taipei
Taiwan
Disclosures
FRG received a grant from Pfizer, the manufacturer of varenicline, for one of the 3rd phase clinical trials of varenicline. FRG has also been reimbursed by Pfizer, Novartis (the manufacturer of nicotine patch), and GSK (the manufacturer of bupropion SR and nicotine lozenge), for attending conferences, and receiving fees for giving speeches on smoking cessation.
Differentials
- Substance use disorder
More DifferentialsGuidelines
- Tobacco: preventing uptake, promoting quitting and treating dependence
- Clinical practice guidelines in oncology: smoking cessation
More GuidelinesPatient information
Stopping smoking
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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