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The addition of counseling to pharmacotherapy increases the likelihood of cessation. In terms of the evidence: Meta-analyses of randomized trials have shown that varenicline, a partial nicotine receptor agonist, more than doubles the likelihood of sustained quitting in the general population of smokers when administered at standard or reduced doses. Systematic reviews of randomized, controlled trials have shown that all forms of nicotine-replacement therapy that deliver nicotine without the products of combustion (i.e., nicotine patches, gums, lozenges, inhalers, and nasal spray) increase the likelihood of sustained quitting by 50 to 60%. Sustained-release bupropion (at a dose of 150 mg administered orally twice daily), through an unproven mechanism of action, increases the likelihood of quitting by 52 to 71% independent of its effect on clinical depression. The paper ends by returning to the case: She should be educated about the risks of continued smoking (e.g., exacerbations and worsening of chronic obstructive pulmonary disease, microvascular and macrovascular complications from diabetes and hypertension, and smoking-related cancers) and the benefits of smoking cessation

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Cornel Radu-Loghin is Secretary General of the European Network for Smoking and Tobacco Prevention (ENSP)

Cigars symbolize celebration and relaxation