Tobacco Treatment [2012 update]

Description: Smoking-related deaths account for a fourth of all deaths in this country. Approximately 25% of American men and women continue to smoke. Of these, approximately 70% see a physician each year. A great majority of smokers report a desire to quit smoking and cite physician advice as an important motivator for making a quit attempt. Lack of time, lack of knowledge about counseling and lack of familiarity with current pharmacologic therapies may all contribute to inadequate intervention being done by clinicians. Every clinician should become comfortable and knowledgeable in an approach to assist patients with smoking cessation. This educational guideline helps clinicians understand assessment and treatment in promoting smoking cessation and how to implement this care in their practice. Some of the key points are:

Clinicians should:

• Advise all tobacco users to consider making a serious quit attempt.
• Assess all tobacco users for their readiness to quit.
• Refer those interested in quitting to a tobacco treatment specialist or tobacco treatment program.
• Tobacco use status should be routinely asked at each visit and documented for all patients in the medical record.
• Document attempts at tobacco counseling for all current users in the medical record.

Clinic sites should have a system to monitor and manage smoking cessation.

• Tobacco status should be routinely asked and documented for all patients.
• A tobacco treatment coordinator and procedures should be in place to provide patient education materials, follow-up on quit dates, and referrals to treatment counseling.

New in this update:

• Electronic cigarettes (E-cigarettes) are reviewed and not recommended for tobacco cessation.
• Combination nicotine replacement therapy has been shown to be an effective treatment option.
• Studies reconfirm that treatment (nicotine or bupropion) and modality (patch, gum, inhaler, spray, pill) should be based on patient preference and prior experience.
• Drug costs have been updated in Table 4 along with Black Box warnings for bupropion and varenicline.
• Information has been updated and added for special populations: pregnant smokers, hospitalized patients, and pre-operative patients.