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

• Carlos Rábade-Castedo ^[7] ; José Ignacio de Granda-Orive ^[1] ; Juan Antonio Riesco-Miranda ^[8] ; Eva De Higes-Martínez ^[2] ; Ángela Ramos-Pinedo ^[2] ; Eva Cabrera-César ^[3] ; Jaime Signes-Costa Miñana ^[4] ; Marcos García Rueda ^[9] ; Esther Pastor-Esplá ^[5] ; Carlos A. Jiménez-Ruiz ^[6]
  1. [1] Hospital Universitario 12 de Octubre

     Hospital Universitario 12 de Octubre

     Madrid, España

     
  2. [2] Fundación Hospital Alcorcón

     Fundación Hospital Alcorcón

     Alcorcón, España

     
  3. [3] Hospital Universitario Virgen de la Victoria

     Hospital Universitario Virgen de la Victoria

     Málaga, España

     
  4. [4] Hospital Clinico Universitario de Valencia

     Hospital Clinico Universitario de Valencia

     Valencia, España

     
  5. [5] Hospital Universitario San Juan de Alicante

     Hospital Universitario San Juan de Alicante

     Alicante, España

     
  6. [6] Hospital Clínico San Carlos de Madrid

     Hospital Clínico San Carlos de Madrid

     Madrid, España

     
  7. [7] Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
  8. [8] Servicio de Neumología, Hospital Universitario de Cáceres, Cáceres, España
  9. [9] Servicio de Neumología, Hospital Carlos Haya de Málaga, Málaga, España

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 59, Nº. 10 (October), 2023, págs. 651-661
• Idioma: inglés
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• Resumen

  • 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.