Smoking cessation

Last reviewed: 19 Apr 2022
Last updated: 30 Oct 2018

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
More key diagnostic factors

Other diagnostic factors

  • history of depression
  • history of schizophrenia
  • hypertension
  • unstable cardiac disease
  • ventricular arrhythmia
  • asthma
  • temporomandibular joint or dental disorder
Other diagnostic factors

Risk factors

  • smoker
  • smokeless tobacco user
More risk factors

Diagnostic investigations

1st investigations to order

  • no tests required
More 1st investigations to order

Treatment algorithm

ACUTE

hospitalised active smokers

ONGOING

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.

  • Smoking cessation images
  • Differentials

    • Polysubstance abuse
    More Differentials
  • Guidelines

    • Smoking: supporting people to stop
    • NCCN clinical practice guidelines in oncology: smoking cessation
    More Guidelines
  • Patient leaflets

    Stopping smoking

    More Patient leaflets
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