Smoking cessation

Last reviewed: 29 Dec 2022
Last updated: 16 Dec 2022

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
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • tobacco smoker
  • use of alternative tobacco and nicotine delivery products
More risk factors

Diagnostic investigations

1st investigations to order

  • self-report of smoking status
  • cotinine level
More 1st investigations to order

Treatment algorithm

ACUTE

hospitalized active smokers

ONGOING

active smokers ready to quit: adults (no pregnancy, breastfeeding, depression, or substance use disorder)

active smokers ready to quit: pregnant/breastfeeding women, adolescents

active smokers ready to quit: depression and smoking cessation

active smokers ready to quit: substance use disorder and smoking cessation

active smokers not ready to quit

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

    • NCCN clinical practice guidelines in oncology: smoking cessation
    • Tobacco smoking cessation in adults, including pregnant women: interventions
    More Guidelines
  • Patient leaflets

    Quitting smoking

    More Patient leaflets
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