Editorial
The Most Important Learnings from the new Official American Thoracic Society (ATS) Clinical Practice Guidelines: Initiating Pharmacologic Treatment in Tobacco Dependent Adults
Los aprendizajes más importantes de la nueva guía de práctica clínica de la American Thoracic Society: Inicio del tratamiento farmacológico en adultos dependientes del tabaco
Harold J. Farber1
Pulmonary Section, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
Read
1912
Timeswas read the article
814
Total PDF
1098
Total HTML
Share statistics
array:23 [ "pii" => "S1579212921003979" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.04.018" "estado" => "S300" "fechaPublicacion" => "2021-12-01" "aid" => "2815" "copyright" => "SEPAR" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Arch Bronconeumol. 2021;57:737-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S1579212921003967" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.04.017" "estado" => "S300" "fechaPublicacion" => "2021-12-01" "aid" => "2826" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Arch Bronconeumol. 2021;57:739-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Bronchiectasis as a Long-Term Consequence of SARS-COVID-19 Pneumonia: Future Studies are Needed" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "739" "paginaFinal" => "740" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bronquiectasias como secuela crónica de la neumonía por SARS-COVID-19: son necesarios estudios" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 572 "Ancho" => 1005 "Tamanyo" => 74175 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Radiological bronchiectasis (white arrows) in the acute infectious disease (pneumonia) and, (B) radiological bronchiectasis in the fibrotic phase of the infection (free access from Refs. <a class="elsevierStyleCrossRefs" href="#bib0070">5 and 6</a>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Angel Martinez-Garcia, Timothy R. Aksamit, Stefano Aliberti" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Miguel Angel" "apellidos" => "Martinez-Garcia" ] 1 => array:2 [ "nombre" => "Timothy R." "apellidos" => "Aksamit" ] 2 => array:2 [ "nombre" => "Stefano" "apellidos" => "Aliberti" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921003967?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000012/v3_202201080532/S1579212921003967/v3_202201080532/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212921003852" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.10.011" "estado" => "S300" "fechaPublicacion" => "2021-12-01" "aid" => "2803" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Arch Bronconeumol. 2021;57:735-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "On the new post COVID-19 condition" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "735" "paginaFinal" => "736" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sobre la nueva condición post COVID-19" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joan B. Soriano, Julio Ancochea" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Joan B." "apellidos" => "Soriano" ] 1 => array:2 [ "nombre" => "Julio" "apellidos" => "Ancochea" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289621001198" "doi" => "10.1016/j.arbres.2021.04.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621001198?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921003852?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000012/v3_202201080532/S1579212921003852/v3_202201080532/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The Most Important Learnings from the new Official American Thoracic Society (ATS) Clinical Practice Guidelines: Initiating Pharmacologic Treatment in Tobacco Dependent Adults" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "737" "paginaFinal" => "738" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Harold J. Farber" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Harold J." "apellidos" => "Farber" "email" => array:1 [ 0 => "hjfarber@texaschildrens.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pulmonary Section, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los aprendizajes más importantes de la nueva guía de práctica clínica de la American Thoracic Society: Inicio del tratamiento farmacológico en adultos dependientes del tabaco" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tobacco dependence is one of the most important non-infectious causes of premature death and disability. Although commonly viewed as a bad habit, it is now known to be a severe treatable chronic illness. Nicotine withdrawal can lead to a variety of neuropsychiatric symptoms which can be severe, including anger, irritability, depression, difficulty feeling pleasure, and difficulty concentrating in addition to the cravings of compulsion to use nicotine. Pharmacotherapy of tobacco dependence focuses on treating these withdrawal symptoms so that the patient can feel normal when not using tobacco products.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The American Thoracic Society (ATS) Clinical Practice Guideline for Initiating Pharmacologic Treatment in Tobacco-Dependent Adults documents that varenicline is more effective than nicotine patch or bupropion for pharmacotherapy of tobacco dependence. Varenicline does not increase psychiatric adverse effects and is more effective than nicotine patch for patients with psychiatric co-morbidities. The combination of varenicline and nicotine patch is more effective than varenicline alone. Extended duration pharmacotherapy (>12 weeks) is more effective than standard duration (6–12 weeks). Varenicline can be initiated for a patient who is ready to intiate pharmacotherapy but is not yet ready to stop smoking.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although strong recommendations were made favoring varenicline compared to other FDA (US Food and Drug Administration) approved tobacco dependence treatment medications, if a patient does not wish to use varenicline, it is reasonable for the provider to prescribe or recommend another FDA approved tobacco dependence treatment medication such as nicotine patch and/or bupropion.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The ATS guideline was developed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The methodology was developed to reduce risk for bias and develop “guidelines you can trust”.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Evidence is condensed to estimates of effect size derived from pooled data from the randomized clinical trials and assessment of quality of the evidence. Evidence from outside of randomized clinical trials is excluded. Strong recommendations can only be made when supported by high quality evidence from randomized clinical trials. When high quality evidence exists and there are not other conflicting findings, that approach can work well. When there is important conflicting data from laboratory and observational research, that approach can be problematic.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The limitation of GRADE methodology was evident in evaluating electronic cigarettes versus varenicline. The evidence synthesis included data from two open label trials comparing electronic cigarettes to nicotine patch and eleven randomized controlled clinical trials comparing varenicline to nicotine patch. As the evidence was of very low quality, a conditional recommendation against e-cigarettes and in favor of varenicline was made. Extensive evidence from observational and laboratory studies raising concern of lack of efficacy and significant harms from electronic cigarettes was excluded from the evidence synthesis. Six committee members (myself included) dissented from the conditional recommendation asserting that, based on evidence excluded from the evidence synthesis, a strong recommendation against electronic cigarettes should have been made.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Acute harms from electronic cigarettes include injuries from product explosions, nicotine poisoning, and severe lung diseases. Electronic cigarette use is associated with increased risk for cardiovascular disease, chronic obstructive lung disease, and cancer. There is a decreased rate of smoking cessation and an increased rate of relapse to smoking among electronic cigarette users.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> An open label clinical trial of electronic cigarettes vs. nicotine patch found that 80% of the subjects who stopped smoking with the electronic cigarette were not able to stop electronic cigarette use. Many of the smokers who used electronic cigarettes remained dual users of combustible tobacco and electronic cigarettes.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Dual use of electronic cigarettes and combustible tobacco may be more harmful than combustible tobacco alone.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The World Health Organization advises, “Unlike the tried and tested nicotine and non-nicotine pharmacotherapies that are known to help people quit tobacco use, WHO does not endorse e-cigarettes as cessation aids”.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> The Ibero-Latino-American respiratory scientific societies states, “Health professionals should never recommend the use of this type of device (electronic nicotine delivery systems)”.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Electronic cigarettes have substantial harms and prolong tobacco and nicotine dependence. Electronic cigarettes should not be recommended by health care providers.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Founding</p><p id="par0050" class="elsevierStylePara elsevierViewall">This work has not received any type of funding.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Dr. Farber served as co-chair for the American Thoracic Society Initiating Pharmacologic Treatment in Tobacco Dependent Adults Guideline Committee. There was no financial support for preparation of this editorial.</p>" "identificador" => "fn1" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initiating pharmacologic treatment in tobacco-dependent adults an Official American Thoracic Society Clinical Practice Guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.T. Leone" 1 => "Y. Zhang" 2 => "S. Evers-Casey" 3 => "A.E. Evins" 4 => "M.N. Eakin" 5 => "J. Fathi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.202005-1982ST" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2020" "volumen" => "202" "numero" => "July" "paginaInicial" => "e5" "paginaFinal" => "e31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32663106" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating tobacco use and dependence: 2008 update. Clinical practice guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Fiore" 1 => "C.R. Jaén" 2 => "T.B. Baker" 3 => "W.C. Bailey" 4 => "N.L. Benowitz" 5 => "S.Z. Curry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "May 2008" "editorial" => "U.S. Department of Health and Human Services, Public Health Service" "editorialLocalizacion" => "Rockville, MD" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guidelines we can trust" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "IOM (Institute of Medicine)" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2011" "editorial" => "The National Academies Press" "editorialLocalizacion" => "Washington, DC" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.ncbi.nlm.nih.gov/books/NBK209539/" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Harms of electronic cigarettes: what the health care provider needs to know" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.J. Farber" 1 => "G.M. Conrado Pacheco" 2 => "P. Galiatsatos" 3 => "P. Folan" 4 => "T. Lamphere" 5 => "S. Pakhale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/AnnalsATS.202009-1113CME" "Revista" => array:6 [ "tituloSerie" => "Ann Am Thorac Soc" "fecha" => "2021" "volumen" => "18" "paginaInicial" => "567" "paginaFinal" => "572" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33284731" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized trial of E-cigarettes versus nicotine-replacement therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Hajek" 1 => "A. Phillips-Waller" 2 => "D. Przulj" 3 => "F. Pesola" 4 => "K. Myers Smith" 5 => "N. Bisal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1808779" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2019" "volumen" => "380" "paginaInicial" => "629" "paginaFinal" => "637" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30699054" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cigarette and e-cigarette dual use and risk of cardiopulmonary symptoms in the Health eHeart Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.B. Wang" 1 => "J.E. Olgin" 2 => "G. Nah" 3 => "E. Vittinghoff" 4 => "J.K. Cataldo" 5 => "M.J. Pletcher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0198681" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2018" "volumen" => "13" "paginaInicial" => "e0198681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30044773" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of stroke with E-cigarette and combustible cigarette use in young adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Parekh" 1 => "S. Pemmasani" 2 => "R. Desai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Prev Med" "fecha" => "2020" "volumen" => "58" "paginaInicial" => "446" "paginaFinal" => "452" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO report on the global tobacco epidemic: offer help to quit tobacco use" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2019" "editorial" => "World Health Organization" "editorialLocalizacion" => "Geneva, Switzerland" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Declaration of the Ibero-Latino-American Respiratory Scientific Societies on Electronic Nicotine Delivery Systems" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "May 2019" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005700000012/v3_202201080532/S1579212921003979/v3_202201080532/en/main.assets" "Apartado" => array:4 [ "identificador" => "45360" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005700000012/v3_202201080532/S1579212921003979/v3_202201080532/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921003979?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 4 | 10 |
| 2024 October | 37 | 18 | 55 |
| 2024 September | 50 | 13 | 63 |
| 2024 August | 47 | 23 | 70 |
| 2024 July | 34 | 14 | 48 |
| 2024 June | 39 | 14 | 53 |
| 2024 May | 48 | 22 | 70 |
| 2024 April | 22 | 31 | 53 |
| 2024 March | 19 | 15 | 34 |
| 2024 February | 32 | 29 | 61 |
| 2024 January | 21 | 19 | 40 |
| 2023 December | 47 | 18 | 65 |
| 2023 November | 33 | 16 | 49 |
| 2023 October | 66 | 33 | 99 |
| 2023 September | 22 | 29 | 51 |
| 2023 August | 22 | 27 | 49 |
| 2023 July | 30 | 22 | 52 |
| 2023 June | 21 | 14 | 35 |
| 2023 May | 33 | 17 | 50 |
| 2023 April | 32 | 21 | 53 |
| 2023 March | 29 | 19 | 48 |
| 2023 February | 24 | 15 | 39 |
| 2023 January | 24 | 20 | 44 |
| 2022 December | 37 | 30 | 67 |
| 2022 November | 31 | 25 | 56 |
| 2022 October | 54 | 35 | 89 |
| 2022 September | 35 | 25 | 60 |
| 2022 August | 26 | 40 | 66 |
| 2022 July | 31 | 47 | 78 |
| 2022 June | 30 | 34 | 64 |
| 2022 May | 26 | 35 | 61 |
| 2022 April | 35 | 36 | 71 |
| 2022 March | 43 | 36 | 79 |
| 2022 February | 11 | 18 | 29 |
| 2021 December | 1 | 0 | 1 |
Show all
