July 6, 2021
Kristin Walter, MD, MS1
Author
Affiliations Article Information JAMA. 2021;326(1):96. doi:10.1001/jama.2021.7239
Tobacco
smoking is the leading cause of preventable death, disease, and disability in
the US.
Quitting
smoking reduces the risk of developing lung cancer, chronic obstructive lung
disease, heart disease, and many other chronic illnesses. Because of the highly
addictive nature of nicotine, quit rates are very low without treatment.
Although behavioral counseling and medications can both increase quit rates,
combining these treatments provides the highest success rates for smoking
cessation.
Recommended
Behavioral Interventions
Effective
behavioral techniques to help people quit smoking include advice from a doctor,
nurse, or smoking cessation specialist, either individually or in a group
session. Counseling can also be done by telephone or through other mobile or
app-based interventions. Some resources include:
·
Telephone-based
resources
o
Free quit help:
1-800-QUIT-NOW
o
In Spanish:
1-855-DÉJELO-YA
·
Web-based support (see
the For More Information box)
·
Text messaging
programs, such as available at smokefree.gov/tools-tips/text-programs
·
Smartphone app
support, such as the National Cancer Institute’s quitSTART app
Recommended
Medications for Smoking Cessation in Nonpregnant Adults
Three
medications have US Food and Drug Administration (FDA) approval for treatment
of smoking dependence: (1) varenicline (taken orally); (2) nicotine replacement
therapy (transdermal patch, gum, lozenge, inhaler, or nasal spray); and (3)
sustained-release bupropion hydrochloride (taken orally).
The
standard treatment duration with smoking cessation medications is 6 to 12
weeks, but use of tobacco cessation medications for longer than 12 weeks can
improve quit rates.
Choice
of Initial Medication Regimen for Smoking Cessation
Choice
of medication is based on patient preference, underlying medical conditions,
and allergy or intolerance to medications. In the general population,
varenicline appears more effective compared with nicotine replacement therapy
or bupropion. Varenicline and a nicotine patch used together may increase
smoking cessation. The combination of a long-acting nicotine replacement
therapy (nicotine patch) with a short-acting form (gum, lozenge, inhaler, or
nasal spray) is more effective than either used alone.
Potential
Side Effects of Smoking Cessation Medications
Patients
taking nicotine replacement therapy may experience nausea, vomiting, and
insomnia. The nicotine patch may also cause local skin irritation. Side effects
of varenicline may include nausea, headache, fatigue, insomnia, and abnormal
dreams. Bupropion should be avoided in patients with a history of seizures..
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Article
Information
Conflict
of Interest Disclosures: None
reported.
Sources: US Preventive Services Task Force.
Interventions for tobacco smoking cessation in adults, including pregnant
persons. JAMA. 2021;325(3):265-279. doi:10.1001/jama.2020.25019
Leone
FT, Zhang Y, Evers-Casey S, et al. Initiating pharmacologic treatment in
tobacco-dependent adults. Am J Respir Crit Care Med.
2020;202(2):e5-e31. doi:10.1164/rccm.202005-1982ST
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