由吸烟导致的疾病及过早死亡是可预防的。20世纪，有约1亿人死于吸烟导致的疾病。目前，全世界有超过10亿名吸烟者，而且烟草使用量呈现逐年上升趋势，发展中国家的吸烟量也在不断增加。烟草依赖是一种慢性疾病，需采取相关干预措施。虽然对吸烟者进行健康风险教育是必须的，但仅此教育一般不足以促使戒烟。当吸烟者有戒烟意向时，可向吸烟者提供咨询。对于愿意戒烟的人群，除非对药物使用存在禁忌，可推荐采用药物戒烟。循证指南推荐，可采用尼古丁替代治疗、安非他酮缓释剂及伐尼克兰进行戒烟，特别是联合行为干预治疗。对于存在高度尼古丁依赖吸烟者、单个药物戒烟失败者、强烈戒烟欲望者，可采用联合药物治疗。其他形式的尼古丁替代治疗或非尼古丁（安非他酮或伐尼克兰）替代治疗的口服给药也有助于戒烟。当仅患者愿意戒烟时，第1年的戒断成功率为3～5％，当采取行为干预后，戒断率为7～16％，若采用药物和行为干预戒烟，则戒断率可达24％。

Laniado-Laborín R, et al. Postgrad Med. 2010 Mar;122(2):74-82.

Smoking cessation intervention: an evidence-based approach.

Laniado-Laborín R.

Facultad de Medicina Tijuana, Universidad Autónoma de Baja California. rafaellaniado@gmail.com

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.