Intended for healthcare professionals

Clinical Review

Supporting smoking cessation

BMJ 2014; 348 doi: (Published 14 January 2014) Cite this as: BMJ 2014;348:f7535
  1. Nicholas A Zwar, professor of general practice1,
  2. Colin P Mendelsohn, tobacco treatment specialist2,
  3. Robyn L Richmond, professor of public health1
  1. 1School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia
  2. 2Brain and Mind Research Institute, University of Sydney, Level 2, Camperdown, NSW 2050, Australia
  1. Correspondence to: N Zwar n.zwar{at}

Summary points

  • Throughout the world tobacco smoking is the leading cause of preventable death and illness

  • As smoking rates in the general population fall in developed countries, a greater proportion of smokers have coexisting problems such as mental illness

  • Cessation support from doctors and other health professionals increases quit rates

  • Tobacco dependence is most effectively treated with a comprehensive approach involving behavioural support and pharmacotherapy

  • Effective medicines include nicotine replacement therapy, varenicline, bupropion, nortriptyline, and cytisine. The availability and registration of these medicines varies between countries

Despite the decrease in prevalence of tobacco use in developed countries, smoking remains the most common preventable cause of disease and death in the world today.

Advice on smoking cessation from doctors and other health professionals has been shown to improve quit rates and is highly cost effective.1 Given the importance to health of tobacco use and the benefits of cessation, every doctor should encourage attempts to stop, be able to provide brief smoking cessation intervention, and be aware of referral options (see box 1).

Over the past decade there have been advances in the science and practice of smoking cessation support. These include new medicines to treat nicotine dependence, new ways of using existing medicines, and increasing use of technology to support behavioural change. This review provides an update on evidence based approaches to maximise the effectiveness of the treatment of tobacco dependence.

Sources and selection criteria

This review is based on evidence synthesis from relevant Cochrane systematic reviews; review and distillation of clinical practice guidelines from Australia, the United States, and New Zealand; information from UK National Centre for Smoking Cessation and Training (; and other evidence from the authors’ personal libraries. We have focused on developments since the review by Aveyard and West in 2007.2

Who smokes?

The prevalence of tobacco use varies around the world. Of …

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