Pharmacological Approach to Smoking Cessation: An Updated Review for Daily Clinical Practice
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REVIEW ARTICLE
Pharmacological Approach to Smoking Cessation: An Updated Review for Daily Clinical Practice Federico Giulietti1,2 · Andrea Filipponi1,2 · Giulia Rosettani1,2 · Piero Giordano1 · Corrado Iacoacci1 · Francesco Spannella1,2 · Riccardo Sarzani1,2 Received: 24 May 2020 / Accepted: 13 June 2020 © The Author(s) 2020
Abstract Tobacco use is one of the major public health concerns and it is the most preventable cause of morbidity and mortality worldwide. Smoking cessation reduces subsequent cardiovascular events and mortality. Smoking is a real chronic disorder characterized by the development of an addiction status mainly due to nicotine. This condition makes the smokers generally unable to quit smoking without help. Different strategies are available to treat smoking dependence that include both non-pharmacological (behavioral counselling) and pharmacological therapies. Currently, it is well accepted that smoking cessation drugs are effective and safe in real-world settings. Nicotine replacement therapy (NRT), varenicline, bupropion and cytisine are the main pharmacological strategies available for smoking cessation. Their efficacy and safety have been proved even in patients with chronic cardiovascular disease. Each of these drugs has peculiar characteristics and the clinician should customize the smoking cessation strategy based on currently available scientific evidence and patient’s preference, paying particular attention to those patients having specific cardiovascular and psychiatric comorbidities. The present document aims to summarize the current viable pharmacological strategies for smoking cessation, also discussing the controversial issue regarding the use of alternative tobacco products, in order to provide useful practical indications to all physicians, mainly to those involved in cardiovascular prevention. Keywords Smoking cessation · Nicotine addiction · Nicotine replacement therapy · Varenicline · Bupropion · Alternative tobacco products
1 Introduction Tobacco use is one of the major public health concerns and it is the most preventable cause of morbidity and mortality worldwide. It is estimated that 16 million adults are currently living with a smoking-related disease in the United States [1]. Cigarette smoking is the main source of tobacco consumption and it is also the most dangerous one. Every year, more than 700,000 people die because of smoke-related diseases in Europe. More than one-quarter of Europeans smoke * Riccardo Sarzani [email protected] 1
Internal Medicine and Geriatrics, “Hypertension Excellence Centre” of the European Society of Hypertension, Pulmonology and Respiratory Medicine Clinic, Centre for Smoking Cessation, IRCCS INRCA, Ancona, Italy
Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
2
and one-third of smokers are 25–39 years of age [2]. There are nearly 12 million smokers in Italy, mostly men, although female smokers increased by over a million in 2016 [3]. It is known that smokers’ life expectancy
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