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Smoking cessation

Last reviewed: 21 Oct 2024
Last updated: 09 Apr 2024

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
Full details

Other diagnostic factors

  • history of depression
  • history of schizophrenia
  • seizure disorder
  • hypertension
  • unstable cardiac disease
  • ventricular arrhythmia
  • asthma
  • temporomandibular joint or dental disorder
Full details

Risk factors

  • tobacco smoker
  • use of alternative tobacco and nicotine delivery products
Full details

Diagnostic investigations

1st investigations to order

  • self-report of smoking status
  • cotinine level
Full details

Treatment algorithm

ACUTE

hospitalised active smokers

ONGOING

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.

  • Smoking cessation images
  • Differentials

    • Substance use disorder
    More Differentials
  • Guidelines

    • Tobacco: preventing uptake, promoting quitting and treating dependence
    • Clinical practice guidelines in oncology: smoking cessation
    More Guidelines
  • Patient information

    Stopping smoking

    More Patient information
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