@article{a86d0ae9383d4fd0b1fbdb5f75f92d1b,
title = "Initiating pharmacologic treatment in tobacco-dependent adults an official American thoracic society clinical practice guideline",
abstract = "Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.",
keywords = "Dependence, Pharmacotherapy, Smoking, Tobacco, Treatment",
author = "Farber, {Harold J.} and Leone, {Frank T.} and Luciane Cruz-Lopes and EakiN, {Michelle N.} and Evins, {A. Eden} and Sarah Evers-Casey and Joelle Fathi and Kathleen Fennig and Patricia Folan and Izabela Fulone and Panagis Galiatsatos and Hyma Gogineni and Stephen Kantrow and Hasmeena Kathuria and Thomas Lamphere and Murray, {Rachael L.} and Enid Neptune and O'brien, {Kelly K.} and Pacheco, {Manuel C.} and Smita Pakhale and Sureka Pavalagantharajah and David Prezant and Stephanie Ross and Sachs, {David P.L.} and Benjamin Toll and Dona Upson and Dan Xiao and Yuan Zhang and Yuqing Zhang and Meng Zhu",
note = "Funding Information: Author Disclosures: A.E.E. received research support and served on an advisory committee for Pfizer; received support from the National Cancer Institute for a study on testing an organizational change model to address smoking in mental healthcare; received research support from the National Institute on Mental Health for a trial on integrated smoking cessation, exercise, and weight management in serious mental illness (Achieve); received research support from Patient-Centered Outcomes Research Institute for a study of facilitators and barriers to implementation of integrated smoking cessation treatment for smokers with serious mental illness; and received a Career Award from the National Institute on Drug Abuse for mentoring in addiction treatment research. H.G. received research support from Western University of Health Sciences for a study on pharmacists{\textquoteright} knowledge and attitudes about electronic cigarettes. S. Pakhale received research support from the Canadian Institute of Health Research for a study on nicotine reduction therapy and e-cigarettes, using the marketed e-cigarette NJOY as a study instrument. D.P. reported potential 2020 Research Support from the CDC/National Institute for Occupational Safety and Health for a study on tobacco cessation in firefighters, using varenicline as a study instrument. D.P.L.S. served on an advisory committee for Pfizer; and has noncommercialized intellectual property—U.S. patent 6,602,892—Methods for Nicotine Replacement Dosage Determination. B.T. served on an advisory committee for Pfizer; testifies on behalf of plaintiffs on litigation filed against the tobacco companies; and received research support from the National Cancer Institute. H.J.F., F.T.L., L.C.-L., M.N.E., S.E.-C., J.F., K.F., P.F., I.F., P.G., S.K., H.K., T.L., R.L.M., E.N., K.K.O{\textquoteright}B., M.C.P., S. Pavalagantharajah, S.R., D.U., D.X., Yuan Zhang, Yuqing Zhang, and M.Z. reported no relevant commercial relationships. Publisher Copyright: {\textcopyright} 2020 by the American Thoracic Society.",
year = "2020",
month = jul,
day = "15",
doi = "10.1164/rccm.202005-1982ST",
language = "English (US)",
volume = "202",
pages = "E5--E31",
journal = "American journal of respiratory and critical care medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "2",
}