Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023

Abstract

tIntroduction: There are multiple systematic reviews and meta-analyses on the efficacy and safety ofpharmacological treatments against nicotine dependence. However, there are few guidelines to answerfrequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitatethe treatment of tobacco addiction.Material and methods: 12 PICO questions are formulated from a GLOBAL PICO question: “Efficacy andsafety of pharmacological treatment of tobacco dependence”. A systematic review was carried out toanswer each of the questions and recommendations were made. The GRADE (Grading of Recommenda-tions, Assessment, Development and Evaluation) system was used to grade the certainty of the estimatedeffects and the strength of the recommendations.Results: Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective thanplacebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers withhigh dependence, a combination of drugs is recommended, being more effective those associations con-taining varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, theduration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospi-talized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. Thefinancing of smoking cessation treatments increases the number of smokers who quit smoking. There isno 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 forthe pharmacological treatment of tobacco dependence.