ABSTRACT
Introduction: There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. Material and methods: 12 PICO questions are formulated from a GLOBAL PICO question: Efficacy and safety of pharmacological treatment of tobacco dependence. A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. Results: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. Conclusions: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence. (AU)
Subject(s)
Humans , Female , Pregnancy , Adolescent , Pulmonary Medicine , Smoking Cessation , Thoracic Surgery , Tobacco Use Disorder/therapy , Bupropion/therapeutic use , Nicotinic Agonists/therapeutic use , Tobacco Use Cessation Devices , Varenicline/therapeutic useABSTRACT
INTRODUCTION: There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. MATERIAL AND METHODS: 12 PICO questions are formulated from a GLOBAL PICO question: "Efficacy and safety of pharmacological treatment of tobacco dependence". A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. RESULTS: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. CONCLUSIONS: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence.
Subject(s)
Alcoholism , Pulmonary Medicine , Smoking Cessation , Thoracic Surgery , Tobacco Use Disorder , Pregnancy , Female , Humans , Adolescent , Tobacco Use Disorder/drug therapy , Varenicline/therapeutic use , Nicotinic Agonists/therapeutic use , Tobacco Use Cessation Devices , Bupropion/therapeutic useSubject(s)
Humans , Male , Female , Middle Aged , Aged , Smoking Cessation , Alkaloids , Cross-Sectional Studies , Spain/epidemiology , Patient SatisfactionSubject(s)
Alkaloids , Smoking Cessation , Humans , Patient Satisfaction , Spain/epidemiology , Cross-Sectional StudiesABSTRACT
In the last decade, the appearance of electronic cigarettes and new tobacco products (heated tobacco or smokeless tobacco) has generated a growing interest in harm reduction methods that are defined as mechanisms that seek to reduce the harmful consequences of tobacco without give up the pleasant effects of it by replacing it with these new electronic devices. However, these products are addictive and not safe as they contain nicotine. Harm reduction is a false solution as it represents a commercial strategy of the tobacco industry to increase its sales, making it difficult to control smoking, since it keeps smokers from consuming tobacco and prevents them from making serious attempts to quit. In addition, these products are a gateway to adolescents in tobacco.
ABSTRACT
No disponible
Subject(s)
Humans , Vaping/adverse effects , Lung Diseases/etiology , Electronic Nicotine Delivery SystemsABSTRACT
No disponible
Subject(s)
Humans , Tobacco Use Disorder/prevention & control , Tobacco Use Cessation/methods , Smoking Prevention/methods , Spain/epidemiology , Patient Care BundlesABSTRACT
Entre el 15 y el 27% de los pacientes que ingresan en los hospitales españoles son consumidores de tabaco. La hospitalización es un momento idóneo para que el fumador se plantee el abandono del tabaco. Se ha realizado una búsqueda bibliográfica en MEDLINE entre el 1 de enero de 2002 y el 30 de septiembre de 2015, de estudios, controlados y aleatorizados u observacionales, relacionados con la ayuda para dejar de fumar a pacientes ingresados en el hospital. Basándose en los resultados de dichos estudios se han emitido unas recomendaciones para el tratamiento del tabaquismo en pacientes hospitalizados. Las recomendaciones han sido formuladas de acuerdo con el sistema GRADE. Ofrecer al fumador asesoramiento psicológico más tratamiento farmacológico mientras está ingresado en el hospital y prolongar el seguimiento durante al menos 4 semanas después del alta es la recomendación más efectiva para ayudar a dejar de fumar a los pacientes ingresados (AU)
Between 15 and 27% of patients admitted to Spanish hospitals are smokers. Hospitalization is an ideal time for a smoker to decide to quit. We performed a MEDLINE search of controlled, randomized or observational studies associated with helping hospitalized patients quit smoking, published between January 1, 2002 and September 30, 2015. On the basis of the results of those studies, we have issued some recommendations for the treatment of smoking in hospitalized patients. The recommendations were drawn up according to the GRADE system. Offering the smoker psychological counselling and prolonging follow-up for at least 4 weeks after discharge is the most effective recommendation for helping hospitalized patients to quit (AU)
Subject(s)
Humans , Smoking/therapy , Smoking Cessation/methods , Tobacco Use Cessation Devices , Psychotherapy/methods , Smoking Prevention , Hospitalization , Comprehensive Health Care/trends , Practice Patterns, Physicians'ABSTRACT
Between 15 and 27% of patients admitted to Spanish hospitals are smokers. Hospitalization is an ideal time for a smoker to decide to quit. We performed a MEDLINE search of controlled, randomized or observational studies associated with helping hospitalized patients quit smoking, published between January 1, 2002 and September 30, 2015. On the basis of the results of those studies, we have issued some recommendations for the treatment of smoking in hospitalized patients. The recommendations were drawn up according to the GRADE system. Offering the smoker psychological counselling and prolonging follow-up for at least 4 weeks after discharge is the most effective recommendation for helping hospitalized patients to quit.
Subject(s)
Inpatients , Smoking Cessation , Smoking/therapy , Bupropion/therapeutic use , Clinical Trials as Topic , Comorbidity , Counseling/economics , Evidence-Based Medicine , Humans , Meta-Analysis as Topic , Motivation , Practice Guidelines as Topic , Smoking/epidemiology , Smoking Cessation/economics , Spain , Tobacco Use Cessation Devices , Varenicline/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/complications , Smoking/drug therapy , Bupropion/therapeutic use , Cholinergic Agents/therapeutic use , Nicotine/therapeutic useSubject(s)
Pulmonary Disease, Chronic Obstructive/complications , Smoking/therapy , Benzazepines/therapeutic use , Bupropion/therapeutic use , Clinical Trials as Topic/statistics & numerical data , Cognitive Behavioral Therapy , Combined Modality Therapy , Double-Blind Method , Follow-Up Studies , Humans , Motivation , Multicenter Studies as Topic/statistics & numerical data , Program Evaluation , Quinoxalines/therapeutic use , Randomized Controlled Trials as Topic , Reward , Severity of Illness Index , Smoking/psychology , Smoking Cessation , Spain , Surveys and Questionnaires , Tobacco Use Cessation Devices , Tobacco Use Disorder/diagnosis , Tobacco Use Disorder/drug therapy , Tobacco Use Disorder/psychology , Tobacco Use Disorder/therapy , VareniclineABSTRACT
No disponible
