Smoking cessation

Healthcare professionals play a central role in motivating and assisting people to stop smoking.

Smoking cessation benefits all people who smoke regardless of age, comorbidities, or current health problems.

The 5 A's is a five-step treatment framework to guide smoking cessation that is used across the world in many treatment settings; abbreviated variants (e.g., Very brief advice) are also available, increasing in usage, and preferentially recommended in some countries and within certain treatment settings.

The combination of behavioural support plus an evidence-based pharmacotherapy for smoking cessation has the best evidence for smoking cessation. Of the available pharmacological options, nicotine replacement therapy (NRT) in combination with varenicline have amassed the greatest volume of data demonstrating safety and efficacy.

The use of e-cigarettes for smoking cessation remains a topic of ongoing debate and research; professional medical bodies in different countries have varying stances on e-cigarettes based on the available evidence and public health considerations.

Cigarette smoking is the leading cause of preventable disease, disability, and death.[1]United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking cessation: a report of the Surgeon General. 2020 [internet publication]. https://www.ncbi.nlm.nih.gov/books/NBK555591 http://www.ncbi.nlm.nih.gov/pubmed/32255575?tool=bestpractice.com Physicians and other healthcare professionals play a central role in motivating and assisting people who smoke to stop.[2]Tobacco Use and Dependence Guideline Panel, US Department of Health and Human Services. Treating tobacco use and dependence: 2008 update. Rockville (MD): US Department of Health and Human Services; 2008. https://www.ncbi.nlm.nih.gov/books/NBK63952 Physicians are a credible and trusted source of advice to stop, have opportunities to provide this message to most smokers, and can connect people to behavioural support and pharmacotherapy. These actions are effective at increasing cessation rates.[3]Maciosek MV, LaFrance AB, Dehmer SP, et al. Updated priorities among effective clinical preventive services. Ann Fam Med. 2017 Jan;15(1):14-22. https://www.annfammed.org/content/15/1/14 http://www.ncbi.nlm.nih.gov/pubmed/28376457?tool=bestpractice.com

According to the Centers for Disease Control and Prevention (CDC), an adult's smoking status at any given point in time may be defined as one of the following:[4]Cornelius ME, Loretan CG, Jamal A, et al. Tobacco product use among adults - United States, 2021. MMWR Morb Mortal Wkly Rep. 2023 May 5;72(18):475-83. https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a1.htm http://www.ncbi.nlm.nih.gov/pubmed/37141154?tool=bestpractice.com ​​

• Current smoker: an adult who has smoked 100 cigarettes in his or her lifetime, and who currently smokes cigarettes

• Former smoker: an adult who has smoked 100 cigarettes in his or her lifetime, but who has quit smoking at the time of the interview.

The goal of smoking cessation is to assist the person in changing their behaviour to help them achieve abstinence from smoking or other tobacco use. Sustained or prolonged abstinence from cigarette smoking and other tobacco use may be defined in a number of ways; the most rigorous definition typically used within clinical trials involves avoidance of all tobacco use from the stop day until the time the assessment is made. This definition occasionally allows for lapses.[5]Cochrane Tobacco Addiction Group. Glossary. 2024 [internet publication]. https://tobacco.cochrane.org/resources/glossary

Note that this topic covers smoking cessation rather than nicotine eradication; cessation of nicotine e-cigarettes (vaping) is not specifically covered. Nicotine e-cigarette cessation has its own separate and emerging evidence base. A key clinical priority for healthcare professionals who are supporting a person who wishes to stop using nicotine e-cigarettes is to ensure that they do not start (or return to) using combustible tobacco products (i.e., conventional smoking) as an alternative.