medigraphic.com
ISSN 2594-1526 (Electronic)
Antes Revista del Instituto Nacional de Enfermedades Respiratorias

 Ver anteriores al 2010

2024, Number 2

<< Back Next >>

Neumol Cir Torax 2024; 83 (2)

A therapeutic approach proposal for smoking cessation during hospitalization

Bedolla-Tinoco, Alan1; Ortíz-González, Yari G1; García-Peña, Luis E1; Thirión-Romero, Ireri1; Robles-Hernández, Robinson1; Hernández-Pérez, Andrea1; García-Gómez, Leonor1; Osio-Echanove, Jennifer1; Pérez-Padilla, Rogelio1

Language: English/Spanish [Versi?n en espa?ol]
References: 56
Page: 134-142
PDF size: 346.53 Kb.


ABSTRACT

Smoking is a major public health issue stemming from nicotine addiction and the multi-organ damage caused by the toxic substances released during tobacco combustion. It has been described that during hospitalization, patients are more receptive to initiating smoking cessation treatment, taking advantage of the enforced abstinence due to the smoking ban in hospitals, with even greater effectiveness compared to standard treatment. Quitting smoking in hospitalized patients reduces the risk of infections, surgical wound bleeding, hospital stay length in patients diagnosed with pneumonia, the number of exacerbations in COPD patients, as well as acute coronary events. This review aims to formulate a management algorithm and provide recommendations based on the most up-to-date evidence regarding the treatment of tobacco addiction in the inpatient setting in our country. The initial evaluation involves assessing smoking consumption, level of motivation, nicotine dependence, and withdrawal symptoms. For patients with more than 6 months of abstinence, management is limited to verifying continued abstinence and preventing relapse. In contrast, those with less than 6 months of abstinence should be evaluated for withdrawal symptoms and receive both pharmacological treatment and brief counseling. Follow-up after discharge presents the main challenge, as many patients may experience immediate relapse or fail to return for further care. Therefore, healthcare services must have an established plan in place.



ABBREVIATION:

  • TAPS = the tobacco, alcohol, prescription medication and other substances use tool.



INTRODUCTION

It is well known that the tobacco consumption is one of the main health problems worldwide, it is associated with approximately 8 million death every year.1 In Mexico, according to the Global Adult Tobacco Survey (GATS) 2023, 15.6% of the population actively consumes tobacco, which reflects the public health problem we face.2 In addition, there are economic damages because of the decrease in the labor productivity and the increase in health care costs because of the increase in hospitalizations and complications of chronic-degenerative diseases.3,4

In a survey made of 81 patients hospitalized at the National Institute for Respiratory Diseases Ismael Cosío Villegas (INER), it was found that 78.2% of smokers presented symptoms associated with withdrawal syndrome. The main symptoms were tension (44.4%), hypersomnia (41.9%), depression (40.7%), anxiety (38.2%). The average time in the hospital for smokers was 9.9 ± 4 days; among the main diagnoses of smokers were the chronic obstructive pulmonary disease (COPD), asthma and lung cancer with 22.2%, 13.6 and 12.3% respectively.5 As it is shown in this report, withdrawal symptoms are frequent and show the opportunity area to achieve effective interventions in the health care system.

Quitting smoking in preparation for hospitalization is known to have multiple benefits. For example, it decreases the post surgical complication rate, it improves wound healing and tissue proliferation, and in patients hospitalized for other diseases attenuates inflammation mechanisms; resulting in fewer complications and reduced hospital stay.6-8

The objective of this document is to propose recommendations based on evidence and an algorithm on the tobacco treatment in the in-hospital context, space and time conducive to smoking cessation.



INPATIENT INTERVENTION

Among the main objectives in hospitalized smokers are: 1) taking advantage of the hospital stay as an ideal time for intervention; 2) individualizing treatment, taking into account the intensity of the withdrawal symptoms, comorbidities and patient preference for ease of use, cost and accessibility; 3) give a follow up plan and treatment after hospital discharge; 4) promoting the training of all health personnel to give brief advice and make referrals to clinics to stop smoking; 5) decreasing the direct and indirect complications of tobacco use.

We divided the intervention in hospitalized smokers into two parts: a diagnostic and a therapeutic one.



DIAGNOSTIC EVALUATION

In general, evaluation is based on analyzing the history and patterns of tobacco consumption. It includes the quantification of their consumption, analysis of the degree of motivation to quit smoking, the degree of physical and psychological dependence on nicotine, exploring of previous attempts to quit and if they were accompanied by pharmacological treatment, as well as the measurement of exhale carbon dioxide (CO) or measurement of continine (Table 1).

Therapeutic intervention includes pharmacological and no pharmacological as a whole.9 In Figure 1, we present a proposal algorithm for the evaluation and treatment of tobacco consumption in the in-hospital context.



QUANTIFICATION OF CUMULATIVE TOBACCO CONSUMPTION

The packet-year index is calculated, establishing the average number of cigarettes consumed per day in the years that they have smoked multiplied by the number of years divided by 20 (cigarettes per packet); as well as the number of daily cigarettes consumed before admission, since they allow to guide the nicotine replacement treatment.10 The patients can be categorized as:9,11,12

  • 1. Active smoker if their last consumption is less than three months.
  • 2. Non-active smoker if their last consumption is more than three months, but less than six months.
  • 3. Ex-smoker if their last consumption is more than six months.
  • 4. Non-smoker if there is no consumption or if the total consumption has been less than 100 cigarettes.

In addition, it is important to question about passive exposure to tobacco in places such as home or work, to assess relapse and general health risks.



DEGREE OF MOTIVATION ANALYSIS

A strong association with abstinence success has not been demonstrated; however, some tests could be considered to predict the adherence to treatment.13 Motivation can be measured by visual analog scales, the Richmond test, the Smoking Abstinence Questionnaire (SAQ), and the Henri Mondor Paris or Khimji Watt test.14 The Richmond test is the most widely used and classifies the degree of motivation as: 0-5 weak motivation, 6-8 medium motivation and > 9 strong motivation.



ANALYSIS OF THE DEGREE OF PHYSICAL AND PSYCHOLOGICAL DEPENDENCE ON NICOTINE

The Dependence Nicotine Questionnaire of Fagerström is the world standard for the assessment of physical dependence on nicotine,15 it has six items that asses the amount of consumption, compulsion and dependence. Reagents from 0 to 1 and the multiple choice items from 0 to 3 are scored. These are added together for a total score of 0 to 10. The higher it is, the more intense the physical dependence on nicotine. The scores obtained allow to classify the dependence into five levels: very low (0 to 2 points); low (3 to 4 points); moderate (5 points); high (6 to 7 points); and very high (8 to 10 points). Measuring dependence has been used primarily for dose selection in drug therapy.16

Currently, it is recognized that tobacco dependence it is a multidimensional behavioral phenomenon that involves psychological, social and physical components, such as the number of cigarettes consumed. Therefore, the characterization of the patient is relevant for the diagnosis, and according to the consumption pattern in Mexico, which is mostly as occasional consumption, it is suggested to integrate evaluations such as the psychological dependence on tobacco assessment scale (TAPS).17 Others can be mentioned, such as the Heavy Smoking Index (HSI) or the Nicotine Dependence Syndrome Scale (NDSS) that predict the craving to smoke, the withdrawal syndrome and cessation success.15



CRAVING AND WITHDRAWAL SYNDROME

The absence or decrease in the intensity of craving and withdrawal syndrome have been used as secondary treatment goals as well as smoking cessation; currently they are also used for the decision of the type and dose of pharmaceutical treatment, mainly nicotine replacement therapy in its various presentations. The evaluation can be done using various questionnaires, such as the nicotine craving questionnaire (CCN),18 or the Questionnaire on Smoking Urges (QSU) that allow to discriminate stable and the high intensity aspects of the need to smoke.19 It is recommended to select a short questionnaire that contains the desire to quit smoking and the withdrawal symptoms referred to by the Diagnostic and Statistical Manual of Mental Disorders (DSM), including cravings.20



ANALYSIS OF PREVIOUS ATTEMPTS OF CESSATION

The number of attempts will be investigated, how long he remained smoke-free in those attempts, the treatments that were used and above all, the withdrawal syndrome, since these can predict the success of abstinence or the relapse.21 Abstinence for at least 24 hours has predicted the following cessation, that is why this cut-off point is taken into account to define previous attempts.22,23



BIOCHEMICAL VERIFICATION OF SMOKING CESSATION

Different tools can be used such as the measurement of nicotine and cotinine in saliva, urine or blood and/or exhaled carbon monoxide (CO); the latter being the simplest, innocuous, cheapest and very useful to corroborate abstinence.11,24-26 Levels of CO are expressed in ppm (1-6 = non-smoker, 7-10 = light smoker, 11-20 = smoker, > 20 = heavy smoker).9



TREATMENT

The interventions that can be performed are similar to those of outpatient treatment, which consists of non-pharmacological and pharmacological measures. Psychological counseling can be used in its various forms after hospital discharge,11,27,28 and brief advice is essential during hospitalization. The effectiveness of therapeutic interventions in patients with respiratory diagnoses is less clear, in part because there are few studies in this subgroup.29



NON-PHARMACOLOGICAL TREATMENT

Types of hospital non-pharmacological interventions include brief advice and self-help materials. In the outpatient context, the greater the intensity of the behavioral intervention, the greater the effectiveness, but in the hospital context it is necessary to limit and systematize it in a brief and accessible way. Rigotti et al. showed that brief counseling initiated during a hospitalization and continued with non-pharmacological measures for at least one month after discharge increased smoking cessation rates (OR 1.37; 95% CI, 1.27-1.48).30 The short advice to quit smoking is the most recommended type of advice, as well as being simple it can be given by any health worker. It includes three steps:

  • 1. "Asking" about tobacco use,
  • 2. "Advise" that the best method to quit smoking is with a combination of medication and behavioral support, and
  • 3. "Act" guiding to establish a plan with the available means. It is critical to clearly explain the benefits of quitting, highlight the risks, and congratulate the decision to quit.27,28,30

Training on how to give brief advice should be implemented through educational programs for health personnel, including advice on treatment to quit smoking, as they have shown a 41% increase in counseling and the prescription of treatments at discharge up to 31%29 (Table 2).



NON-PHARMACOLOGICAL MEASURES AT DISCHARGE

Some measures such as personal contacts between the healthcare professional and the patient, sending SMS, email, proactive telephone contact, etc.,31-34 have shown their usefulness in increasing the effectiveness of the interventions offered during the hospital period.



PHARMACOLOGICAL TREATMENT

The four first-line smoking cessation drugs are: bupropion, varenicline, cytisine, and nicotine replacement therapy.35 Drug therapy during the hospital stay can attenuate withdrawal symptoms and increase withdrawal success. The characteristics of each of the pharmacological alternatives are described below:



1. NICOTINE REPLACEMENT THERAPY (NRT)

The use of any presentation is recommended (chewing gum, tablets, mouth spray or patches). It is useful to help manage withdrawal symptoms acutely.26 In the in-hospital context they increase effectiveness by 54% compared to counseling alone36 (Table 3).

Adverse effects and drug interactions: the mostcommonly reported include singulum, gastrointestinal symptoms, headache, jaw and orodental pain. Few interactions have been reported with other drugs, including adenosine (tachycardia), cimetidine (increased nicotine concentration), and memantine (increased toxicity to nicotine).37 There are few contraindications for these types of drugs such as nicotine hypersensitivity, and lactating women. Traditionally, its prescription was contraindicated in patients with coronary heart disease (CHD), however, there is evidence demonstrating efficacy and safety in this type of patient.38

Choice of NRT scheme: it is currently based on three characteristics: 1) the degree of the patient's nicotine dependence, 2) the number of daily cigarettes consumed, 3) the latency time between awakening and the first cigarette smoked. The nicotine patch is the simplest presentation to use; despite not acting as quickly to decrease acute withdrawal, it is an excellent maintenance therapy.39 For patients with moderate to high dependence, long-acting NRT (patches) plus immediate-acting NRT (gum, tablets, etc.) have been recommended in patients who smoke > 10 cigarettes a day. For patients with low dependence the NRT can be used with either 2 mg ad lib chewing gum or patches in their dosages of 14 or 21 mg/day depending on cigarette consumption.40,41

Duration of treatment: in most studies a total duration of 10-12 weeks is established. The American Thoracic Society (ATS) Clinical Practice Guideline recommends an extended regimen of at least 12 weeks.42



2. VARENICLINE

It is currently the most effective medication for smoking cessation, recommending its use over nicotine and bupropion patches.42 The treatment is effective regardless of nicotine dependence and can be combined with other drugs to increase success41 (Table 3).

Adverse effects and interactions: the main symptoms are nausea (24-29%), but the dose can be adjusted to 50% to reduce these symptoms without affecting their effectiveness; others are constipation (5-8%), less frequent insomnia, vivid dreams and headache (< 5%). It requires dose adjustments in liver or kidney failure.43 Varenicline is safe in patients with a history of acute coronary syndrome (ACS).41 It has previously been associated with increased anxiety, depression, and even suicidal ideation; however, this was ruled out by a meta-analysis in 2018 [ABT1].44,45 It has few interactions with other drugs,43 being ideal in patients with polypharmacy.

Contraindications: hypersensitivity to varenicline, and caution during lactation.43

Disadvantages: its main drawback in hospitalized patients lies in the need to use it for a week before it reaches its efficacy 10 so it must be combined with a fast-acting nicotine replacement treatment. In addition, it is the most expensive pharmacological treatment related to smoking cessation. It was recently reincorporated by the FDA, still unavailable in our country, considerably hindering access to medicines, although it is likely to be reincorporated into the therapeutic armamentarium.



3. BUPROPION

Its recommendation for use in the in-hospital context is unclear, as its effectiveness in achieving abstinence is lower compared to NRT or varenicline.46

Adverse effects: Among the most common are tachycardia (11%), weight loss (14-19%), xerostomia (17-26%), headache (25-34%) and insomnia (11-20%). Serious adverse effects that have been reported are complete atrioventricular block, hypertension (2-6%), decreased seizure threshold, and psychiatric disturbances such as hostile behavior (6%), requires adjustment in renal failure and not recommended in hepatic failure.47 No association with suicidal ideation has been demonstrated.45

Contraindications: use of alcohol, benzodiazepines, barbiturates, linezolid, methylene blue, anticoagulants, or antiepileptic drugs; concomitant use of monoamine oxidase inhibitors or within 14 days of discontinuation; current or previous diagnosis of bulimia or anorexia nervosa; hypersensitivity to bupropion; or history of uncontrolled seizures and liver failure.47,48

Disadvantages: it requires a period of 7 to 14 days to reach therapeutic concentrations, so in the hospital context it must be combined with nicotine substitutes and can be associated with important interactions with other drugs.47 It requires a meticulous assessment of drug interactions.



4. CYTISINE

Cytisine is an alkaloid purified from the seeds of Cytisus laburnum and has been used for decades to quit smoking in regions such as Eastern Europe.49 Cytisine, like varenicline, competes with great affinity for nicotinic cholinergic receptors in the brain.50 It has been shown to be as effective as varenicline,51 being the best cost-effective therapy for the treatment of smoking, especially in the absence of varenicline on the market. One of its great advantages has been its low cost, especially in Eastern European countries,49,52 although at the time it is marketed in the United States, procedures already started, it could raise the cost substantially and gets closer to varenicline.

Adverse effects: mainly abnormal dreams (16.6%), nausea (10.9%), sleep disturbance (18.6%) and headache (9.2%).51

Disadvantages: its main limitation are the treatment schemes that suggest an initial consumption every two hours; however, it has been found that fixed doses of every eight hours or every six hours seem to be equally effective.53 This drug is not available in Mexico.



INTERVENTIONS IN HOSPITALIZED EX-SMOKERS

Cessation less than six months

The following measures are recommended:

  • 1. Avoid relapses: the greatest risk is during the first six months of abstinence, so it is advisable to offer follow-up.9
  • 2. Reinforce and recognize achievements.9,12
  • 3. Offer of Support: The ex-smoker should be offered assistance in initiating and maintaining abstinence during their hospital stay.9
  • 4. Assessment of abstinence syndrome and corroboration of abstinence: if the patient has been abstinent for less than three months, it is still possible for the patient to develop abstinence syndrome.54
  • 5. Assess symptoms of depression and refer if they are present to the psychiatrist.54
  • 6. Advice from a nutritionist since he can present weight gain.55



CESSATION GREATER THAN SIX MONTHS

In this group of patients, they will simply recognize their achievements, reinforce their maintenance and offer help in case of relapse.9



FOLLOW-UP ON HOSPITAL DISCHARGE

Perhaps this is the main challenge, since many of the patients may have immediate relapses, or do not come to receive care upon discharge. Health services must have a follow-up plan at discharge. Pharmacotherapy is not consistently covered by health systems and toll-free smoking cessation hotlines are poorly linked to health care systems.32 A referral to a smoking cessation clinic is recommended for follow-up days after discharge.56



CONCLUSIONS

Scientific evidence is consistent regarding increases in smoking cessation rates when implementing cessation interventions in hospitalized patients, accompanied by timely monitoring of discharge. It is necessary to document and characterize consumption at each clinical visit, train health personnel to provide brief counseling and pharmacological treatment. In addition, it is essential to promote policies for the health system at the national level to support and provide smoking cessation treatments and counseling during a hospitalization.


REFERENCES

  1. He H, Pan Z, Wu J, Hu C, Bai L, Lyu J. Health effects of tobacco at the global, regional, and national levels: results from the 2019 global burden of disease study. Nicotine Tob Res. 2022;24(6):864-870. Available in: https://pubmed.ncbi.nlm.nih.gov/34928373/

  2. INPRFM Psiquiatría IN de. Encodat Tabaco. Secretaría de Salud [Internet]. 2017, 489. Disponible en: https://www.gob.mx/salud%7Cconadic/acciones-y-programas/encuesta-nacional-de-consumo-de-drogas-alcohol-y-tabaco-encodat-2016-2017-136758

  3. Wendy M. The financial impact of smoking on health-related costs: a review of the literature. Am J Health Promot. 2001;15(5):321-331. Available in: https://pubmed.ncbi.nlm.nih.gov/11502013/

  4. Sari AA, Rezaei S, Arab M, Matin BK, Majdzadeh R. Does smoking status affect cost of hospitalization? Evidence from three main diseases associated with smoking in Iran. Med J Islam Repub Iran. 2017;31(1):63. Available in: https://pmc.ncbi.nlm.nih.gov/articles/PMC5804450/

  5. García-Gomez L, Robles-Hernández R, Hernández-Pérez A, Ossio-Echanove J, Thirion-Romero I, Pérez-Padilla R. Reporte breve sobre los síntomas de abstinencia a la nicotina y las características clínicas de los fumadores hospitalizados en un centro de referencia de tercer nivel. Ciudad de México; 2024. Disponible en: https://zenodo.org/records/10959803

  6. Khullar D, Maa J. The impact of smoking on surgical outcomes. J Am Coll Surg. 2012;215(3):418-426. Available in: https://journals.lww.com/journalacs/Fulltext/2012/09000/The_Impact_of_Smoking_on_Surgical_Outcomes.14.aspx

  7. Sørensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012;147(4):373-383. Available in: https://pubmed.ncbi.nlm.nih.gov/22508785/

  8. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154. Available in: https://pubmed.ncbi.nlm.nih.gov/21295194/

  9. Jiménez RCA, de Granda OJI, Solano RS, Riesco MJA, de Higes ME, Pascual LJF, et al. Normativa sobre tratamiento del tabaquismo en pacientes hospitalizados. Arch Bronconeumol. 2017;53(7):387-394. Disponible en: https://www.archbronconeumol.org/en-normativa-sobre-tratamiento-del-tabaquismo-articulo-S0300289616303258

  10. Pleasants RA, Rivera MP, Tilley SL, Bhatt SP. Both duration and pack-years of tobacco smoking should be used for clinical practice and research. Ann Am Thorac Soc. 2020;17(7):804-806. Available in: articles/PMC7405110/

  11. Rigotti NA, Munafo MR, Stead LF. smoking cessation interventions for hospitalized smokers: a systematic review. Arch Intern Med. 2008;168(18):1950. Available in: /pmc/articles/PMC4500120/

  12. A clinical practice guideline for treating tobacco use and dependence: 2008 Update. A U.S. Public Health Service Report. Am J Prev Med. 2008;35(2):158-176. https://doi.org/10.1016/j.amepre.2008.04.009

  13. de Granda-Orive JI, Pascual-Lledó JF, Asensio-Sánchez S, Solano-Reina S, García-Rueda M, Martínez-Muñiz M, et al. Is the motivation to quit smoking a predictor of abstinence maintenance? Tob Prev Cessat. 2021;30(7):48. Available in: http://www.tobaccopreventioncessation.com/Is-the-motivation-to-quit-smoking-a-predictor-of-abstinence-maintenance-,136506,0,2.html

  14. Hendricks PS, Wood SB, Baker MR, Delucchi KL, Hall SM. The smoking abstinence questionnaire: measurement of smokers' abstinence-related expectancies. Addiction. 2011;106(4):716-728. Available in: /pmc/articles/PMC3348861/

  15. Shiffman S, Waters AJ, Hickcox M. The nicotine dependence syndrome scale: A multidimensional measure of nicotine dependence. Nicotine Tob Res. 2004;6(2):327-348. https://doi.org/10.1080/1462220042000202481

  16. Sharma MK, Sharma P. Need for validation of Fagerstrom test for nicotine dependence in Indian context: implications for nicotine replacement therapy. Indian J Psychol Med. 2016;38(2):105. Available in: /pmc/articles/PMC4820547

  17. Paz-Ballesteros WC, Zavala-Arciniega L, Gutiérrez-Torres DS, Ponciano-Rodríguez G, Reynales-Shigematsu LM. Evaluación de la dependencia física y psicológica al tabaco en fumadores mexicanos adultos, Encodat 2016. Salud Publica Mex. 2019;61(2):136-146. Disponible en: https://doi.org/10.21149/9858

  18. Villalobos-Gallegos L, Marín-Navarrete R, Templos-Nuñez L, Rosendo-Robles A. Nicotine craving questionnaire (CCN): psychometric properties on Mexican population. Salud Ment. 2012;35(4):273-277. Available in: http://www.scielo.org.mx/scielo.php?script=sci_abstract&pid=S0185-33252012000400002&lng=es&nrm=iso&tlng=en

  19. Germeroth LJ, Wray JM, Gass JC, Tiffany ST. Diagnostic utility of craving in predicting nicotine dependence: impact of craving content and item stability. Nicotine Tob Res. 2013;15(12):1988-1995. Available in: /pmc/articles/PMC3819973/

  20. Baker TB, Breslau N, Covey L, Shiffman S. DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5. Addiction (Abingdon, England). 2012;107(2):263. Available in: /pmc/articles/PMC3246568/

  21. Roberts C. The implications of noncompliance for randomized trials with partial nesting due to group treatment. Stat Med. 2020;40(2):349-368. https://doi.org/10.1002/sim.8778

  22. Balmford J, Borland R, Burney S. The role of prior quitting experience in the prediction of smoking cessation. Psychol Health. 2010;25(8):911-924. Available in: https://www.tandfonline.com/doi/abs/10.1080/08870440902866878

  23. Bailey SR, Bryson SW, Killen JD. Predicting successful 24-Hr quit attempt in a smoking cessation intervention. Nicotine & Tobacco Research. 2011;13(11):1092-1097. Available in: https://dx.doi.org/10.1093/ntr/ntr151

  24. García-Gómez L, Hernández-Pérez A, Noe-Díaz V, Riesco-Miranda JA, Jiménez-Ruiz C. Smoking cessation treatments: current psychological and pharmacological options. Rev Invest Clin. 2019;71(1):7-16. Available in: https://doi.org/10.24875/ric.18002629

  25. Cahill K, Lindson-Hawley N, Thomas KH, Fanshawe TR, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2016;2016(5):CD006103. Available in: https://pubmed.ncbi.nlm.nih.gov/27158893/

  26. Rigotti NA, Tindle HA, Regan S, Levy DE, Chang Y, Carpenter KM, et al. A post-discharge smoking-cessation intervention for hospital patients: helping hand 2 randomized clinical trial. Am J Prev Med. 2016;51(4):597-608. https://doi.org/10.1016/j.amepre.2016.04.005

  27. Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev. 2017;3(3):CD001292. Available in: https://pubmed.ncbi.nlm.nih.gov/28361496/

  28. Ross L. Never give up encouraging patients to give up smoking. Guidelines in Practice [Internet]. 2022. Available in: https://www.guidelinesinpractice.co.uk/smoking-cessation/very-brief-advice-can-be-effective-in-encouraging-smokers-to-quit/337163.article

  29. Asif A, Dailey H, Sheth HS, Petroulakis M. Enhancing hospitalists smoking cessation counseling and billing compliance by education intervention: a quality improvement project. J Community Hosp Intern Med Perspect. 2021;11(5):612-618. Available in: https://www.tandfonline.com/doi/abs/10.1080/20009666.2021.1961380

  30. Rigotti NA, Clair C, Munafò MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012;5(5):CD001837. Available in: https://pubmed.ncbi.nlm.nih.gov/22592676/

  31. Sood A, Andoh J, Verhulst S, Ganesh M, Edson B, Hopkins-Price P. "Real-world" effectiveness of reactive telephone counseling for smoking cessation: a randomized controlled trial. Chest. 2009;136(5):1229-1236. Available in: https://pubmed.ncbi.nlm.nih.gov/19225061/

  32. Rutten LJF, Davis K, Squiers L, Augustson E, Blake K. Physician awareness and referral to national smoking cessation quitlines and web-based resources. J Cancer Educ. 2011;26(1):79. Available in: /pmc/articles/PMC3043326/

  33. Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2019;5(5):CD002850. Available in: https://pubmed.ncbi.nlm.nih.gov/31045250/

  34. Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database Syst Rev. 2019;10(10):CD006611. Available in: https://pubmed.ncbi.nlm.nih.gov/31638271/

  35. Rábade-Castedo C, de Granda-Orive JI, Riesco-Miranda JA, De Higes-Martínez E, Ramos-Pinedo Á, Cabrera-César E, et al. Clinical practice guideline of spanish society of pneumology and thoracic surgery (SEPAR) on pharmacological treatment of tobacco dependence 2023. Arch Bronconeumol. 2023;59(10):651-661. https://doi.org/10.1016/j.arbres.2023.07.024

  36. Rigotti NA, Regan S, Levy DE, Japuntich S, Chang Y, Park ER, et al. Sustained care intervention and postdischarge smoking cessation among hospitalized adults: a randomized clinical trial. JAMA. 2014;312(7):719-728. Available in: https://pubmed.ncbi.nlm.nih.gov/25138333/

  37. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 2018;2018(5):CD000146. Available in: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000146.pub5/full

  38. Mohiuddin SM, Mooss AN, Hunter CB, Grollmes TL, Cloutier DA, Hilleman DE. Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease. Chest. 2007;131(2):446-452. Available in: https://pubmed.ncbi.nlm.nih.gov/17296646/

  39. Theodoulou A, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J, Livingstone-Banks J, Hajizadeh A, Lindson N. What is the best way to use nicotine replacement therapy to quit smoking? Cochrane data base [Internet]. Cochrane Data Base. 2023;6:CD013308. Available in: https://www.cochrane.org/CD013308/TOBACCO_what-best-way-use-nicotine-replacement-therapy-quit-smoking

  40. Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019;4(4):CD013308. Available in: https://doi.org/10.1002/14651858.cd013308

  41. Suissa K, Larivière J, Eisenberg MJ, Eberg M, Gore GC, Grad R, et al. Efficacy and safety of smoking cessation interventions in patients with cardiovascular disease: a network meta-analysis of randomized controlled trials. Circ Cardiovasc Qual Outcomes. 2017;10(1):e002458. Available in: https://pubmed.ncbi.nlm.nih.gov/28093398/

  42. Farber HJ, Leone FT, Cruz-Lopes L, EakiN MN, Evins AE, Evers-Casey S, et al. Initiating pharmacologic treatment in tobacco-dependent adults. an official american thoracic society clinical practice guideline. Am J Respir Crit Care Med. 2020;202(2):e5-e31. Available in: http://www.atsjournals.org/doi/suppl/10.1164/rccm.202005-1982ST

  43. Chantix® (varenicline tartrate) Adverse Reactions | Pfizer Medical Information - US [Internet]. Available in: https://www.pfizermedicalinformation.com/chantix/adverse-reactions

  44. Raich A, Ballbe M, Nieva G, Cano M, Fernandez T, Bruguera E, et al. Safety of varenicline for smoking cessation in psychiatric and addicts patients. Subst Use Misuse. 2016;51(5):649-657. Available in: https://pubmed.ncbi.nlm.nih.gov/27050328/

  45. Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, Lawrence D, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016;387(10037):2507-2520. Available in: https://pubmed.ncbi.nlm.nih.gov/27116918/

  46. Simon JA, Duncan C, Huggins J, Solkowitz S, Carmody TP. Sustained-release bupropion for hospital-based smoking cessation: a randomized trial. Nicotine Tob Res. 2009;11(6):663-669. https://doi.org/10.1093/ntr/ntp047

  47. Richmond R, Zwar N. Review of bupropion for smoking cessation. Drug Alcohol Rev. 2003;22(2):203-220. Available in: https://onlinelibrary.wiley.com/doi/full/10.1080/09595230100100642

  48. Kinalp C, Kurultak I, Ceri M, Keskinel I. Serum creatinine elevation caused by bupropion. Wien Klin Wochenschr. 2009;126(3-4):138-139. https://doi.org/10.1007/s00508-013-0466-4

  49. Rigotti NA. Cytisine--a tobacco treatment hiding in plain sight. N Engl J Med. 2014;371(25):2429-2430. Available in: https://pubmed.ncbi.nlm.nih.gov/25517710/

  50. Jeong SH. Cytisine Pharmacokinetics and Dose Response (C-DRAKS 3 and C-DRAKS 4) - Full Text View - ClinicalTrials.gov [Internet]. 2019;49(11):1332-1337. Available in: https://clinicaltrials.gov/ct2/show/NCT02585024

  51. Courtney RJ, McRobbie H, Tutka P, Weaver NA, Petrie D, Mendelsohn CP, et al. Effect of cytisine vs varenicline on smoking cessation: a randomized clinical trial. JAMA. 2021;326(1):56-64. Available in: https://jamanetwork.com/journals/jama/fullarticle/2781643

  52. Karnieg T, Wang X. Cytisine for smoking cessation. CMAJ. 2018;190(19):e596. Available in: /pmc/articles/PMC5953578/

  53. Jeong SH, Sheridan J, Bullen C, Newcombe D, Walker N, Tingle M. Ascending single dose pharmacokinetics of cytisine in healthy adult smokers. Xenobiotica. 2018;49(11):1332-1337. Available in: https://www.tandfonline.com/doi/abs/10.1080/00498254.2018.1557760

  54. Manual 32. Manejo diagnóstico y tratamiento del tabaquismo en la práctica clínica diaria by SEPAR - Issuu [Internet]. 2015. Disponible en: https://issuu.com/separ/docs/manual_32

  55. Tian J, Venn A, Otahal P, Gall S. The association between quitting smoking and weight gain: a systematic review and meta-analysis of prospective cohort studies. Obes Rev. 2015;16(10):883-901. Available in: https://pubmed.ncbi.nlm.nih.gov/26114839/

  56. Japuntich SJ, Regan S, Viana J, Tymoszczuk J, Reyen M, Levy DE, et al. Comparative effectiveness of post-discharge interventions for hospitalized smokers: study protocol for a randomized controlled trial. Trials. 2012;13(1):1-13. Available in: https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-13-124



AFFILIATIONS

1Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico.



Conflict of interests: the authors declare no conflict of interests.



CORRESPONDENCE

Alan Bedolla-Tinoco, MD. E-mail: alan.bedolla@hotmail.com




Received: IX-08-2024; accepted: X-22-2024.

2020     |     www.medigraphic.com