Strategies for smoking cessation

Cigarette smoking is the leading preventable cause of death in the United States, accounting for more than 400,000 deaths annually. Recent advances in the treatment of smoking cessation and prevention of relapse offer promise to many smokers, especially vulnerable smokers such as those with coronary heart disease and other cardiovascular disease. Varenicline, a newly approved medication for smoking cessation, is a welcome addition to the clinician’s treatment arsenal. Other options for treatment include new uses of traditional nicotine replacement therapy (NRT), such as the simultaneous use of two forms of NRT or starting NRT prior to the quit-smoking date. A combination of pharmacologic and nonpharmacologic strategies is appropriate for most smokers and effectively doubles quit rates compared with rates in smokers who try to quit without the help of a clinician. Drawing appropriately from existing therapeutic options, the clinician should aim to treat smokers at all levels of interest in quitting.