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. 2020 Jul 15;202(2):e5-e31.
doi: 10.1164/rccm.202005-1982ST.

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline

Frank T Leone, Yuqing Zhang, Sarah Evers-Casey, A Eden Evins, Michelle N Eakin, Joelle Fathi, Kathleen Fennig, Patricia Folan, Panagis Galiatsatos, Hyma Gogineni, Stephen Kantrow, Hasmeena Kathuria, Thomas Lamphere, Enid Neptune, Manuel C Pacheco, Smita Pakhale, David Prezant, David P L Sachs, Benjamin Toll, Dona Upson, Dan Xiao, Luciane Cruz-Lopes, Izabela Fulone, Rachael L Murray, Kelly K O'Brien, Sureka Pavalagantharajah, Stephanie Ross, Yuan Zhang, Meng Zhu, Harold J Farber

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline

Frank T Leone et al. Am J Respir Crit Care Med. .

Abstract

Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

Keywords: dependence; pharmacotherapy; smoking; tobacco; treatment.

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Figures

Figure 1.
Figure 1.
Logic model for identification of important clinical questions and translation into evaluable PICO-formatted questions. NRT = nicotine-replacement therapy; PICO = Population, Intervention, Comparator, and Outcome.
See this image and copyright information in PMC

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