Tobacco is the leading preventable cause of mortality in the world. In the United States, great strides have been taken in reducing the prevalence of cigarette smoking since 1964. Yet, nearly 500,000 people still die yearly from complications caused mainly by smoking or exposure to secondhand smoke.
Approximately 50% of chronic smokers die prematurely from cardiovascular diseases, chronic obstructive lung disease, or various cancers, particularly lung cancers. The preferred strategy is to counsel smokers regarding abstinence. Smoking cessation is facilitated by the use of various drugs in the motivated smoker. However, experience indicates that tobacco use can never be completely eliminated because many individuals find smoking, tobacco, and nicotine products pleasurable and, thus, are unable or unwilling to quit. Cigarette smoking is a chronic, relapsing substance disorder requiring multiple modalities to manage.
Although the major focus of strategies to reduce mortality from tobacco use and exposure must be to prevent initial access, this is an updated review of cessation therapies as well as an attempt to identify and possibly treat the high-risk chronic person who smokes. We will focus in the United States on cigarette smoking because it represents the main cause of tobacco-related disability.
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-John A. Ambrose, MD, Amir Najafi, DO, Vipul Jain, MD, James E. Muller, MD, Sagar Ranka, MD, Rajat S. Barua, MD, PhD
This article originally appeared in the April 2020 issue of The American Journal of Medicine
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