that has been made in this area, even in a short period of time. Tobacco dependence is increasingly acknowledged as a chronic condition that can require multiple interventions. In addition, recent evidence supports the critical role of counseling, in individual and group interventions, as well as in conjunction with pharmacological treatment.The evidence-based selection method was applied in order to identify appropriate references in the specialized litera-
IntroductionThis update represents the strong commitment of the Brazilian Thoracic Association to smoking cessation. It provides health professionals with a comprehensive instrument to deal with the principal aspects of tobacco dependence. It includes new and effective clinical treatments and highlights changes in procedures in certain situations.The comparison between this content and that of the previous guidelines shows the significant scientific progress The use of the strength of recommendation associated with the bibliographic citations in the text has as the following principal objectives: to clarify the information source; to stimulate the search for stronger scientific evidence; and to introduce a didactic and simple way to aid in the critical evaluation on the part of the reader, who is the one responsible for making the decisions concerning the patient being treated.
Diagnostic approach
Clinical evaluationThe smoker should be submitted to clinical evaluation upon admission to the smoking cessation program. The objective is to identify functional alterations in the lungs, the existence of smoking related diseases (SRDs), possible contraindications and drug interactions during the pharmacological treatment of the dependence. The profile of the smoker, the level of nicotine dependence and the motivation to stop smoking are also evaluated at this time.This evaluation (Chart 1) should include accurate clinical history, complete physical examination, and some complementary tests, depending on local diagnostic resources.Chest X-ray is an essential tool during the treatment. A good physician-patient relationship, together with professional sensitivity and observation skills, will indicate the most appropriate time. Some people are afraid of what they might find, avoiding treatment so that they do not have to face the situation. ture. This was followed by critical review by pairs, who ultimately presented their recommendations.The decision to adopt any of these guidelines should be made by the professional, taking into consideration the resources available in the locale and the specific circumstances of the patient. Although this document describes the principal recommendations in each situation, there is limited space for publishing. Therefore, additional references are provided to those interested in broadening their scientific knowledge on this subject.These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, in public or private health care clinics. This is the role of the government and the public poli...