Pharmacological Approach to Smoking Cessation: An Updated Review for Daily Clinical Practice

Abstract

Tobacco use is one of the major public health concerns and it is the most preventable cause of morbidity and mortality worldwide. Smoking cessation reduces subsequent cardiovascular events and mortality. Smoking is a real chronic disorder characterized by the development of an addiction status mainly due to nicotine. This condition makes the smokers generally unable to quit smoking without help. Different strategies are available to treat smoking dependence that include both non-pharmacological (behavioral counselling) and pharmacological therapies. Currently, it is well accepted that smoking cessation drugs are effective and safe in real-world settings. Nicotine replacement therapy (NRT), varenicline, bupropion and cytisine are the main pharmacological strategies available for smoking cessation. Their efficacy and safety have been proved even in patients with chronic cardiovascular disease. Each of these drugs has peculiar characteristics and the clinician should customize the smoking cessation strategy based on currently available scientific evidence and patient's preference, paying particular attention to those patients having specific cardiovascular and psychiatric comorbidities. The present document aims to summarize the current viable pharmacological strategies for smoking cessation, also discussing the controversial issue regarding the use of alternative tobacco products, in order to provide useful practical indications to all physicians, mainly to those involved in cardiovascular prevention.

When primary care providers and smokers meet: a systematic review and metasynthesis

“…PCPs workload and increasing number of patients impose them very often to reduce the time of their appointments 67 . Addiction medicine is not mandatory in GPs—and other PCPs—training and when integrated, only a little time in the curriculum is devoted to substance use disorders and addictions 68 . As for specific training regarding tobacco use addiction, many models, tools and theories have been developed and can be applied in PCPs daily practice, for instance, the 5As and 5Rs—to both assist smokers willing to quit (5As) and implement interventions designed to increase future attempts with patients unwilling to quit at the time of the visit (5Rs) 69 , or the transtheoretical model by Prochaska and DiClemente 70 , the label “teachable moment” 2 , 71 and “opportunistic smoking cessation interventions” 72 , such as the “ flashcard for a motivational-based intervention” tool, taking only 30 s to 3 min to use 73 .…”

Ten things to know about ten cardiovascular disease risk factors

“…Clinicians should be aware of the dosing, precautions, and inform the patient of potential side effects of these therapies. [ 293 , 294] The aerosol from e-cigarettes typically does not contain all the contaminants in tobacco smoke. Short-term use of e-cigarettes in healthy individuals may not adversely affect vascular function.…”

“…Clinicians should be aware of the dosing, precautions, and inform the patient of potential side effects of these therapies. [ 293 , 294] …”

The smoking-dyslipidaemia dyad: A potent synergistic risk for atherosclerotic coronary artery disease

“…There are different approaches to smoking cessation for patients with CVD, including a number of pharmacological agents such as varenicline, nicotine replacement therapy, bupropion SR which may be used as single or dual therapy. 38 …”