Summary
Definition
History and exam
Key diagnostic factors
- number of cigarettes per day
- time to first cigarette (TTFC) ≤30 minutes or >30 minutes
- polysubstance abuse
- smokeless tobacco user
- seizure disorder
- pregnancy or breastfeeding
Other diagnostic factors
- history of depression
- history of schizophrenia
- hypertension
- unstable cardiac disease
- ventricular arrhythmia
- asthma
- temporomandibular joint or dental disorder
Risk factors
- smoker
- smokeless tobacco user
Diagnostic investigations
1st investigations to order
- no tests required
Treatment algorithm
hospitalised active smokers
active smokers ready to stop: adults (no pregnancy, breastfeeding, depression, or polysubstance abuse)
active smokers ready to stop: pregnant/breastfeeding women, adolescents
active smokers ready to stop: depression and smoking cessation
active smokers ready to stop: polysubstance abuse 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 has done research, consulting, and speaking for Boehringer Ingelheim, Shire, CSL Behring, and Grifol.
Felix Hernandez, MD
Fellow
Pulmonary medicine/Critical Care
Cleveland Clinic
Weston
FL
Disclosures
FH declares that he has no competing interests.
Acknowledgements
Dr Franck F. Rahaghi and Dr Felix Hernandez would like to gratefully acknowledge Dr Jose Gonzalez and Dr Theodore W. Marcy, previous contributors to this topic. 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
- Polysubstance abuse
More DifferentialsGuidelines
- Smoking: supporting people to stop
- NCCN clinical practice guidelines in oncology: smoking cessation
More GuidelinesPatient leaflets
Stopping smoking
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