Initiating pharmacologic treatment in tobacco-dependent adults an official American thoracic society clinical practice guideline

Harold J. Farber, Frank T. Leone, Luciane Cruz-Lopes, Michelle N. EakiN, A. Eden Evins, Sarah Evers-Casey, Joelle Fathi, Kathleen Fennig, Patricia Folan, Izabela Fulone, Panagis Galiatsatos, Hyma Gogineni, Stephen Kantrow, Hasmeena Kathuria, Thomas Lamphere, Rachael L. Murray, Enid Neptune, Kelly K. O'brien, Manuel C. Pacheco, Smita PakhaleSureka Pavalagantharajah, David Prezant, Stephanie Ross, David P.L. Sachs, Benjamin Toll, Dona Upson, Dan Xiao, Yuan Zhang, Yuqing Zhang, Meng Zhu

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)E5-E31
JournalAmerican journal of respiratory and critical care medicine
Issue number2
StatePublished - Jul 15 2020


  • Dependence
  • Pharmacotherapy
  • Smoking
  • Tobacco
  • Treatment

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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