Pharmacotherapy of smoking cessation

Tobacco use is the number one cause of preventable diseases in the United S tates. Smoking accounts for more than 400 000 deaths yearly and 30% of all cancer deaths. Primary care physicians have access to 70% of smokers, appro ximately 60% of whom are perceived to be in excellent health. Recent advanc es in the pharmacotherapy of nicotine addiction, including nicotine nasal s pray, nicotine inhaler, bupropion hydrochloride, and over-the-counter trans dermal nicotine patches, have increased the treatment options physicians ca n offer to smokers. Physicians, especially those in primary care specialtie s, should familiarize themselves with these products to improve efforts to help their patients stop smoking. This article reviews scientific data on t he efficacy of approved medications, benefits, adverse effects, and appropr iate use of these products. We also discuss nicotine addiction and treatmen t for special populations, including women, ethnic minorities, light smoker s, and patients with cardiovascular and pulmonary diseases.