Abstract
Smoking remains a widespread intractable behaviour and is a significant cause of morbidity and mortality worldwide. Effective approaches to smoking cessation include behavioural intervention and pharmacotherapy, in particular nicotine replacement therapy (NRT) and sustained-release bupropion (bupropion SR). Pharmacotherapy remains a popular choice of smoking cessation intervention for many smokers, and both NRT and bupropion SR, combined with behavioural interventions, achieve 1.5- to >2-fold increases in smoking cessation rates. Various national and international smoking cessation guidelines have been published recommending effective implementation of smoking cessation strategies. Recommendations include the systematic identification of smokers, assessment of their willingness to quit smoking, provision of advice promoting a cessation attempt, and administration of approved first-line therapies.
Similar content being viewed by others
Notes
Tradenames are used for identification purposes only and do not imply endorsement.
References
Eckert T, Junker C. Motivation for smoking cessation: what role do doctors play? Swiss Med Wkly 2001; 131: 521–6
Rigotti NA. Treatment of tobacco use and dependence. N Engl J Med 2000; 346(7): 506–12
Raw M, McNeill A, West R. Smoking cessation guidelines for health professionals: a guide to effective smoking cessation interventions for the healthcare system. Thorax 1998; 53 Suppl 5(Pt 1): S1–19
Lawrence WF, Smith SS, Baker TB, et al. Does over-the-counter nicotine replacement therapy improve smokers’ life expectancy? Tob Control 1998; 7: 364–8
American College of Chest Physicians, American Thoracic Society, Asia Pacific Society of Respirology, et al. Smoking and health: physician responsibility. Chest 1995; 108(4): 1118–21
Silagy C, Formica N. Place of bupropion in smoking-cessation therapy. Lancet 2001; 357: 1550
Hughes JR, Gulliver SB, Fenwick JW, et al. Smoking cessation among self-quitters. Health Psychol 1992; 11(5): 331–5
Rennard SI, Daughton DM. Smoking cessation. Chest 2000; 117(5): 360S–4S
Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence: clinical practice guidelines. Rockville (MD): US Department of Health and Human Services. Public Health Service, 2000 Jun
West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Thorax 2000; 55: 987–99
Fiore MC, Pierce PJ, Remington PL, et al. Cigarette smoking: the clinician’s role in cessation, prevention, and public health. Dis Mon 1990; 36(4): 181–242
Russell MAH, Wilson C, Taylor C, et al. Effects of general practitioners’ advice against smoking. BMJ 1979; 2(6184): 231–5
Emmons KM. Smoking cessation and tobacco control: an overview. Chest 1999; 116: 490S–2S
Fiore MC, Jorenby DE, Schensky AE, et al. Smoking status as a new vital sign: effects on assessment and intervention in patients who smoke. Mayo Clin Proc 1995; 70(3): 209–13
Coleman T. Smoking cessation: integrating recent advances into clinical practice. Thorax 2001; 56: 579–82
Lancaster T, Stead L, Silagy C, et al. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ 2000; 321(5): 355–8
Silagy C, Stead LF. Physician advice for smoking cessation (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 1. Oxford: Update Software, 2002
Rice VH, Stead LF. Nursing interventions for smoking cessation (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 1. Oxford: Update Software, 2002
World Health Organisation (WHO). European partnership to reduce tobacco dependence: WHO evidence based recommendations on the treatment of tobacco dependence. Geneva: WHO, 2001 Jun
Butler CC, Pill R, Stott NCH. Qualitative study of patients’ perception of doctors advice to quit smoking: implications for opportunistic health promotion. BMJ 1998; 316: 1878–81
Prochazka AV. New developments in smoking cessation. Chest 2000; 117(4): 169S–75S
Coleman T, Wilson A. Managing smoking cessation: implementing new guidelines in primary care presents a challenge. BMJ 1999; 318: 138–9
Fiore MC, Jorenby DE, Baker TB. Smoking cessation: principles and practice based upon the AHCPR Guidelines, 1996. Ann Behav Med 1997; 19(3): 213–9
McEwen A, West R, Owen L. General practitioners’ views on the provision of nicotine replacement therapy and bupropion. BMC Fam Pract 2001;2: 6
Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 1. Oxford: Update Software, 2002
Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 1. Oxford: Update Software, 2002
The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence. A US Public Health Service Report. JAMA 2000; 283(24): 3244–54
Raw M, McNeill A, West R. Smoking cessation: evidence based recommendations for healthcare systems. BMJ 1999; 318: 182–5
Lancaster T, Stead LF. Self-help interventions for smoking cessation (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 1. Oxford: Update Software, 2002
McElnay JC, Maguire TA, Drummond A, et al. Smoking cessation: the contribution of community pharmacy. Drugs 2000; 8(3): 147–58
Friedman RH, Stollerman JE, Mahoney DM, et al. The virtual visit: using telecommunications technology to take care of patients. J Am Med Inform Assoc 1997; 4(6): 413–25
Platt S, Tannahill A, Watson J, et al. Effectiveness of antismoking telephone helpline: follow up survey. BMJ 1997; 314(7091): 1371–5
Borland R, Segan CJ, Livingston PM, et al. The effectiveness of callback counselling for smoking cessation: a randomized trial. Addiction 2001; 96(6): 881–9
Deagle EA, Berigan TR. Adding behavioral therapy to medication for smoking cessation. JAMA 1999; 281(21): 1983–9
Jorenby DE. Smoking cessation strategies for the 21st century. Circulation 2001; 104: 51–2
Lennox AS, Osman LM, Reiter E, et al. Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled trial. BMJ 2001; 322: 1–7
Bock BC, Marcus BH, King TK, et al. Exercise effects on withdrawal and mood among women attempting smoking cessation. Addict Behav 1999; 24(3): 399–410
Ussher MH, Taylor AH, West R, et al. Does exercise aid smoking cessation?: a systematic review. Addiction 2000; 95(2): 199–208
White AR, Resch KL, Erns E. A meta-analysis of acupuncture techniques for smoking cessation. Tob Control 1999;8: 393–7
Okuyemi KS, Ahluwalia JS, Harris KJ. Pharmacotherapy of smoking cessation. Arch Fam Med 2000; 9: 270–81
Henningfield JE, Fant RV, Gitchell J, et al. Tobacco dependence: global public health potential for new medications development and indications. Ann NY Acad Sci 2000; 909: 247–56
Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 1. Oxford: Update Software, 2002
Bohadana A, Nilsson F, Rasmussen T, et al. Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial. Arch Intern Med 2000; 160(20): 3128–34
Hughes JR, Goldstein MG, Hurt RD, et al. Recent advances in the pharmacotherapy of smoking. JAMA 1999; 281(1): 72–6
Abelin T, Ehrsam R, Buhler-Reichert A, et al. Effectiveness of a transdermal nicotine system in smoking cessation studies. Methods Find Exp Clin Pharmacol 1989; 11(3): 201–14
Bolliger CT, Zellweger JP, Danielsson T, et al. Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety. BMJ 2000; 321: 329–33
Fiore MC, Smith SS, Jorenby DE, et al. The effectiveness of the nicotine patch for smoking cessation: a meta-analysis. JAMA 1994; 271(24): 1940–7
Gourlay SG, Forbes A, Marriner T, et al. Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation. BMJ 1994; 309: 842–6
Schneider NG, Olmstead R, Nilsson F, et al. Efficacy of a nicotine inhaler in smoking cessation: a double-blind, placebocontrolled trial. Addiction 1996; 91(9): 1293–306
National Institute for Clinical Excellence (NICE). Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. National Institute for Clinical Excellence Technology Appraisal Guidance No. 39, 2002 Apr. Available from URL: www.nice.org.uk
Daughton DM, Heatley SA, Prendergast JJ, et al. Effects of transdermal nicotine delivery as an adjunct to low intervention smoking cessation therapy: a randomized, placebo-controlled, double-blind study. Arch Intern Med 1991; 151(4): 749–52
Herrera N, Franco R, Herrera L, et al. Nicotine Gum, 2 and 4mg, for nicotine dependence: a double-blind placebo-controlled trial within a behavior modification support program. Chest 1995; 108(2): 447–51
Hurt RD, Dale LC, Fredrickson PA, et al. Nicotine patch therapy for smoking cessation combined with physician advice and nurse follow-up: one-year outcome and percentage of nicotine replacement. JAMA 1994; 271(8): 595–600
Britton J, Jarvis MJ. Bupropion: a new treatment for smokers. Nicotine replacement treatment should also be available on the NHS. BMJ 2000; 321: 65–6
Blondal T, Gudmundsson LJ, Olafsdottir I, et al. Nicotine nasal spray with nicotine patch for smoking cessation: randomized trial with six yearfollow up. BMJ 1999; 318: 285–9
Kornitzer M, Boutsen M, Dramaix M, et al. Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial. Prev Med 1995; 24(1): 41–7
Anda RF, Williamson DF, Escobedo LG, et al. Depression and the dynamics of smoking. JAMA 1990; 264(12): 1541–6
Breslau N, Kilbey MM, Andreski P. Nicotine withdrawal symptoms and psychiatric disorders: findings from an epidemiologic study of young adults. Am J Psychiatry 1992; 149(4): 464–9
Breslau N, Kilbey MM, Andreski P. Nicotine dependence and major depression: new evidence from a prospective investigation. Arch Gen Psychiatry 1993; 50(1): 31–5
Benowitz NL, Wilson Peng M. Non-nicotine pharmacotherapy for smoking cessation. Mechanisms and prospects. CNS Drugs 2000; 13(4): 265–85
Barchas JD, Marzuk PM. General psychiatry. JAMA 1998; 280(11): 961–2
Gambassi G, Bernabei R. Antidepressants and smoking cessation. Arch Intern Med 1999; 159: 1257–8
Hurt RD, Sachs DPL, Glover ED, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997; 337(17): 1195–202
Covey LS, Sullivan MA, Johnston JA, et al. Advances in nonnicotine pharmacotherapy for smoking cessation. Drugs 2000; 59(1): 17–31
Ferry LH, Burchette RJ. Efficacy of bupropion for smoking cessation in non-depressed smokers. J. Addict Dis 1994; 13: 249
Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340(9): 685–91
Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 1. Oxford: Update Software,2002
Jarvis MJ, Powell S, Marsh H, et al. A meta-analysis of clinical studies confirms the effectiveness of bupropion SR (Zyban™) in smoking cessation [abstract]. Presented at the 7th Annual Conference of the Society for Research on Tobacco and Nicotine; 2001 Mar 23–25; Seattle (WA)
Hays JT, Hurt RD, Rigotti NA, et al. Sustained-release bupropion for pharmacological relapse prevention after smoking cessation: a randomized, controlled trial. Ann Intern Med 2001; 135(6): 423–33
Hertzberg MA, Moore SD, Feldman ME, et al. A preliminary study of bupropion sustained-release for smoking cessation in patients with chronic posttraumatic stress disorder. J Clin Psychopharmacol 2001; 21(1): 94–8
Tashkin DP, Kanner R, Bailey W, et al. Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial. Lancet 2001; 357: 1571–5
Coleman T, West R. Newly available treatments for nicotine addiction: smokers wanting help to stop smoking now have effective treatment options. BMJ 2001; 322: 1076–7
Ascher JA, Cole JO, Colin JN, et al. Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry 1995; 56: 395–401
Holm KJ, Spencer CM. Bupropion: a review of its use in the management of smoking cessation. Drugs 2000; 59(4): 1007–24
Rose JE, Behm FM, Westman EC. Nicotine-mecamylamine treatment for smoking cessation: the role of pre-cessation therapy. Exp Clin Psychopharmacol 1998; 6(3): 331–43
Rose JE, Behm FM, Westman EC, et al. Mecamylamine combined with nicotine skin patch facilitates smoking cessation beyond nicotine patch treatment alone. Clin Pharmacol Ther 1994; 56(1): 86–99
Glassman AH, Covey LS, Dalack GW, et al. Smoking cessation, clonidine, and vulnerability to nicotine among dependent smokers. Clin Pharmacol Ther 1993; 54(6): 670–9
Glassman AH, Stetner F, Walsh BT, et al. Heavy smokers, smoking cessation, and clonidine: results of a double-blind, randomized trial. JAMA 1988; 259(19): 2863–6
Hilleman DE, Mohiuddin SM, Delcore MG, et al. Randomized, controlled trial of transdermal clonidine for smoking cessation. Ann Pharmacother 1993; 27(9): 1025–8
Sutherland G, Stapleton J, Russell MAH, et al. Naltrexone, smoking behaviour and cigarette withdrawal. Psychopharmacology 1995; 120(4): 418–25
Dwoskin LP, Crooks PA. A novel mechanism of action and potential use for lobeline as a treatment for psychostimulant abuse. Biochem Pharmacol 2002; 63(2): 89–98
Hymowitz N, Eckholdt H. Effects of a 2.5-mg silver acetate lozenge on initial and long-term smoking cessation. Prev Med 1996; 25(5): 537–46
West R, Willis N. Double-blind placebo controlled trial of dextrose tablets and nicotine patch in smoking cessation. Psychopharmacology 1998; 136(2): 201–4
West R, Courts S, Beharry S, et al. Acute effect of glucose tablets on desire to smoke. Psychopharmacology 1999; 147(3): 319–21
West R. Glucose for smoking cessation: does it have a role? CNS Drugs 2001; 15(4): 261–5
Woolf SH, Grol R, Hutchinson A, et al. Potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318: 527–30
Fiore MC, Bailey WC, Cohen SJ, et al. Smoking cessation: clinical practice guidelines No 18. Rockville (MD): US Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research, 1996. AHCPR publication no.: 96-0692
Practice guidelines for the treatment of patients with nicotine dependence. American Psychiatry Association. Available from URL: http//www.psych.org/clin_res/pg_nicotine.cfm [Accessed]
Smoking Kills. A White Paper on Tobacco. Available from URL: http://archive.oficial.document.co.uk/document/cm41/4177.htm
Silagy CA, Stead LF, Lancaster T. Use of systematic reviews in clinical practice guidelines: case study of smoking cessation. BMJ 2001 Oct; 323(7317): 833–6
Anderson JE, Jorneby DE, Scott WJ, et al. Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. Chest 2002; 121(3): 932–41
Foulds J. Effectiveness of smoking cessation initiatives. BMJ 2002; 324: 608–9
Acknowledgements
G. Sutherland has received travel funds from, and undertaken research and consultancy for, manufacturers of nicotine replacement therapy and bupropion.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sutherland, G. Current Approaches to the Management of Smoking Cessation. Drugs 62 (Suppl 2), 53–61 (2002). https://doi.org/10.2165/00003495-200262002-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-200262002-00006