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

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.

Diretrizes Brasileiras de Hipertensão Arterial – 2020

“…Independentemente, deve ser enfatizada a cessação, devido ao risco CV e de neoplasias. 403 Os medicamentos para a cessação (como bupropiona de liberação sustentada, vareniclina, goma de nicotina, pastilha, spray nasal e adesivos) são eficazes para ajudar os fumantes a parar com o tabagismo 404 (GR: IIa, NE: B).…”

Manejo de la cesación tabáquica entre residentes de cardiología de Iberoamérica

“…Nuestro estudio entre residentes de cardiología de cinco países de Latinoamérica y España demuestra que a pesar de que el tabaquismo es un problema relevante y reconocido, es muchas veces soslayado durante la formación de estos. De esta forma, un elevado número de residentes manifestó no sentirse capacitados para asistir a sus pacientes en el cese de esta adicción, especialmente en lo que respecta a prescripción de fármacos con probada eficacia para este fin 13 .…”

“…Los pacientes que fuman y sufren eventos cardiovasculares se encuentran más receptivos a recibir intervenciones antitabaco 11 , y los cardiólogos asistimos continuamente a individuos que sufren perjuicios por esta adicción 1 . Por ello, nuestras acciones resultan claves para aconsejar y acompañar a los fumadores en el proceso del cese tabáquico 12 , práctica recomendada en la atención de nuestros pacientes, siendo incluso un marcador de calidad 13,14 . Sin embargo, y paradójicamente, el abordaje de esta patología no se encuentra específicamente contemplado en los programas de formación de la especialidad.…”

Lung Damage among Individuals with Biomass Smoke Exposure Characterized by CT Features and Changes in Pulmonary Function

“…CSE is the most common cause of COPD. The harmfulness of smoking is well-known among members of the public, especially because of social media campaigns and the development of smoking cessation clinics [14,15,28,29]. In contrast, the risks of BSE are not well-known among the public and healthrelated investments regarding BSE are insu cient.…”