Facultad de Medicina Tijuana, Universidad Autónoma de Baja California.
Postgrad Med. 2010 Mar;122(2):74-82. doi: 10.3810/pgm.2010.03.2124.
Cigarette smoking represents the most important source of preventable morbidity and premature mortality worldwide. Approximately 100 million deaths were caused by tobacco use in the 20th century. There are >1 billion smokers worldwide, and globally the use of tobacco products is increasing, with the epidemic shifting to the developing world. Tobacco dependence is a chronic condition that often requires repeated intervention for success. Just informing a patient about health risks, although necessary, is usually not sufficient for a decision to change. Smokers should be provided with counseling when attempting to quit. Pharmacologic smoking cessation aids are recommended for all smokers who are trying to quit, unless contraindicated. Evidence-based guidelines recommend nicotine replacement therapy, bupropion SR, and varenicline as effective alternatives for smoking cessation therapy, especially when combined with behavioral interventions. Combination pharmacotherapy is indicated for highly nicotine-dependent smokers, patients who have failed with monotherapy, and patients with breakthrough cravings. An additional form of nicotine replacement therapy or an addition of a non-nicotine replacement therapy oral medication (bupropion or varenicline) may be helpful. The rate of successful smoking cessation at 1 year is 3% to 5% when the patient simply tries to stop, 7% to 16% if the smoker undergoes behavioral intervention, and up to 24% when receiving pharmacological treatment and behavioral support.
吸烟是全世界可预防的发病和早逝的最重要原因。在 20 世纪，约有 1 亿人死于烟草使用。目前全球有超过 10 亿烟民，而且烟草制品的使用在全球范围内呈上升趋势，这一流行病正在向发展中国家转移。烟草依赖是一种慢性疾病，通常需要反复干预才能成功。仅仅告知患者健康风险虽然是必要的，但通常不足以促使其做出改变。在试图戒烟时，应该为吸烟者提供咨询。建议所有试图戒烟的吸烟者使用药物戒烟辅助剂，除非有禁忌证。循证指南推荐尼古丁替代疗法、安非他酮缓释剂和伐尼克兰作为戒烟治疗的有效替代方法，尤其是与行为干预联合使用时。联合药物治疗适用于尼古丁依赖程度高的吸烟者、单药治疗失败的患者以及出现突破性渴求的患者。额外使用尼古丁替代疗法或添加非尼古丁替代疗法的口服药物（安非他酮或伐尼克兰）可能会有所帮助。如果患者只是试图停止吸烟，那么 1 年内成功戒烟的比例为 3%至 5%；如果吸烟者接受行为干预，这一比例为 7%至 16%；而接受药物治疗和行为支持的比例则高达 24%。
