Treatment
Box 1. Foundations of Tobacco-Dependence Treatment
1. All patients should be screened for tobacco use, and the potential
diagnosis of tobacco dependence should be assessed.
2. The diagnosis of tobacco dependence, as well as the toxic effects
of tobacco exposure, should be incorporated into the patient's
problem list.
3. Simply encouraging patients to stop smoking is insufficient. All
patients who use tobacco should be provided with evidence-based
treatment, including pharmacotherapy, to help them stop.
4. Tobacco-dependence interventions require longitudinal follow-
up, akin to the longitudinal evaluation and management of other
chronic illnesses.
➤ For tobacco-dependent adults in whom treatment is
being initiated, we recommend varenicline over a nicotine
patch (strong recommendation, moderate certainty in the
estimated effects).
Remarks: To promote adherence to pharmacologic therapy, providers should be
prepared to counsel patients about the relative safety and efficacy of varenicline
treatment compared with a nicotine patch.
➤ For tobacco-dependent adults in whom treatment is being
initiated, we recommend varenicline over bupropion (strong
recommendation, moderate certainty in the estimated
effects).
➤ For tobacco-dependent adults in whom treatment is being
initiated, we suggest varenicline plus a nicotine patch over
varenicline alone (conditional recommendation, low certainty
in the estimated effects).
