Tobacco dependence is a disease has become a consensus. In the recently held Ninth Annual Meeting of the Chinese Medical Association Respiratory Diseases, more than 2,000 participating respiratory doctors in the Chinese Medical Association President Zhong Nanshan and respiratory branch of the chairman of the Council of Liu Yuning, under the leadership of the “promotion of civilization, prevention of disease, take the lead – the Chinese Medical Association Respiratory Diseases Branch of the Tobacco Control Initiative Book” on the solemn signatures. The initiative calls for respiratory physicians to not only take the lead in tobacco control, but also to master professional treatment methods and provide high-quality, professional and individualized guidance and treatment for tobacco-dependent people to quit smoking. China’s first professional tobacco control guidelines were also released at the conference. Tobacco dependence is a chronic, highly recurrent disease. The World Health Organization has included it in the International Classification of Diseases (ICD-10, F17.2), recognizing that tobacco dependence is currently the greatest threat to human health, but a major preventable and treatable cause of death. Typically, smokers with tobacco dependence require repeated interventions and multiple efforts to achieve effective cessation. Medications are effective treatments In May 2008, the U.S. Public Health Service issued a new clinical practice guideline on the treatment of tobacco use and dependence that recommends seven first-line clinical cessation medications that can reliably increase the effectiveness of long-term tobacco cessation based on a summary of more than 8,000 articles in the literature. They are: five nicotine replacement therapy (NRT) cessation medications, i.e., nicotine chewable gum, nicotine inhaler, nicotine oral tablets, nicotine nasal spray, and nicotine patches; and two non-nicotine cessation medications, i.e., bupropion hydrochloride extended-release tablets and varenicline. The guidelines also recommend two second-line smoking cessation medications, colistin and nortriptyline (which are rarely used in clinical practice today). The NRT regimen should last 8 to 12 weeks NRT medications reduce nicotine withdrawal symptoms, such as poor concentration, anxiety, irritability, and depressed mood, by delivering nicotine to the body to replace or partially replace nicotine obtained from tobacco.NRT reduces the discomfort of the withdrawal process, although it does not completely eliminate withdrawal symptoms. Evidence suggests that NRT therapy is effective primarily for people who smoke ≥10 cigarettes per day.NRT is safe and effective for use as an aid to smoking cessation and approximately doubles the likelihood of long-term abstinence. Different NRT products deliver nicotine in different ways, and there is no evidence of differences in efficacy between them, and the choice of medication should be guided by the wishes of the smoker. Smokers often do not achieve optimal treatment outcomes because they do not use sufficient amounts of NRT-based medications, and NRT regimens should last 8 to 12 weeks, with a small percentage of smokers requiring longer regimens (5% may require up to a year of treatment). There are no safety concerns with long-term NRT therapy. Use with caution in patients with recent (within two weeks) post-myocardial infarction, severe arrhythmias, and unstable angina. Pregnant smokers should be encouraged to quit by nonpharmacologic means.5 The ability of five different NRT products to help pregnant tobacco-dependent individuals quit smoking is inconclusive, and their effectiveness in breastfeeding patients has not been evaluated. Non-nicotine cessation medications are promising Bupropion hydrochloride (extended-release) is the first non-nicotine cessation medication that can be effective in helping to quit smoking. Bupropion hydrochloride is taken orally at a dose of 150 mg/tablet, starting at least 1 week before quitting, for a course of 7 to 12 weeks. Side effects include dry mouth, irritability, insomnia, headache and vertigo. It is contraindicated in patients with epilepsy, those with anorexia or abnormal appetite, those currently taking medications containing bupropion as an ingredient, or those who have taken a monoamine oxidase inhibitor within the last 14 days. Varenicline is a new non-nicotine smoking cessation medication, approved by the FDA in 2006 for the treatment of tobacco dependence, with a recommended level of evidence for use of A. Varenicline has a high affinity and selectivity for the neuronal α4β2 nicotinic acetylcholine receptor, is a partial agonist of nicotinic acetylcholine receptors, and at the same time has the dual modulation of agonistic and antagonistic effects. Varenicline binds to the receptor to play the role of agonist, stimulating the release of dopamine from the receptor, which helps to relieve the craving for tobacco and various withdrawal symptoms after the cessation of smoking; at the same time, its antagonistic properties can prevent nicotine from binding to the receptor, reducing the pleasure of smoking and lowering the anticipation of smoking, thus reducing relapse. Varenicline is available in 0.5 mg and 1 mg dosage forms, and treatment is initiated 1 to 2 weeks prior to the quit date for a 12-week course, or for an additional 12 weeks while dose reduction is considered.The FDA-recommended dose of varenicline is 2 mg/d (1 mg twice/d). However, there is evidence that 1mg/d is also effective. In a recent clinical trial involving 15 centers in China, Singapore, and Thailand, varenicline was shown to be efficacious in smoking cessation, with the primary efficacy endpoint of 4-week sustained abstinence rates in the varenicline-treated group (50.3%) significantly higher than those in the placebo group (31.6%), as measured by CO from week 9 to week 12 inclusive. Common adverse reactions to varenicline were gastrointestinal symptoms and neurologic symptoms, most commonly nausea, but most were mild to moderate and diminished over time. Because varenicline is excreted from the body almost in its original form in the urine, it should be used with caution in patients with severe renal insufficiency (creatinine clearance)・. Varenicline is a prescription medication, and because it is partially nicotine antagonistic, it is not recommended for use in combination with NRT medications. Combination therapy improves success rates Combining first-line medications has been shown to be an effective treatment for tobacco dependence and can improve success rates. Effective combination medications include: 1. Long course nicotine patch (>14 weeks) + other NRT medications (e.g., chewable gum and nasal spray). 2, Nicotine patch + nicotine inhaler. 3, Nicotine patch + bupropion hydrochloride (level of evidence A). In conclusion, NRT, bupropion hydrochloride, and varenicline are the medications commonly used during smoking cessation treatment. These medications are effective treatments that can save lives, and in conjunction with behavioral intervention therapies will improve smoking cessation success. Treatment for tobacco use and dependence is more cost-effective and widely available than other commonly used clinical preventive measures, such as mammography, bowel cancer screening, Pap test for early detection of cancer, treatment of mild-to-moderate hypertension, and treatment of hyperlipidemia, and clinicians should encourage every smoker who wishes to quit to receive smoking cessation counseling and medication.