Cigarette smoking is estimated to be responsible for nearly five million premature deaths worldwide, said Dr. KK Aggarwal, President, Heart Care Foundation of India. The most important causes of smoking-related mortality include atherosclerotic cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD).

Smoking cessation is associated with health benefits for both male and female smokers of all ages. All smokers should be managed with a combination of behavioral interventions and pharmacologic therapy. Combination therapy is clearly superior to behavioral interventions alone, and combination therapy is probably also superior to pharmacologic therapy alone. Most smokers should be treated with varenicline as first-line pharmacologic therapy. Bupropion or nicotine replacement therapy are reasonable alternatives.

Patients who do not tolerate a pharmacologic agent can be switched to an alternate agent. Patients who fail to quit should also be switched to an alternate agent. An alternative in such patients is to combine nicotine replacement therapy with bupropion, and/or use multiple formulations of nicotine replacement therapy.  For individuals who fail this, clonidine or nortriptyline can be tried. Patients who successfully quit but experience a late relapse should be treated with the pharmacologic agent that previously worked for the patient.