Update on tobaccoism, approach from the community pharmacy and pharmacological treatments of choice

Smoking is a chronic addictive disease with a pandemic character and, therefore, requires the development of prevention and treatment strategies. The relationship of smoking with obesity and genetics has been studied in recent years, as well as its approach in adolescents, the main objective of the tobacco industry. The implications of second-hand smoke (passive smoking), third-hand smoke (toxics in the smoker’s environment) and fourth-hand smoke (environmental pollution from tobacco) are well known, as is the fact that there is no safe level of smoking, as numerous studies show. The community pharmacist, due to his basic training and accessibility, is an ideal health professional to act in the prevention of smoking and its treatment, developing a professional smoking service in his pharmacy, for which specific training and a adequate physical structure of the pharmacy are required. The treatment of tobacco addiction must be, fundamentally, a combination of pharmacological treatment with cognitive-behavioral treatment. The drugs of first choice for its treatment are Nicotine Replacement Therapy (NRT) combined (patches together with oral form) and varenicline. The kinetics of nicotine in NRT and its agonist effect on alpha 4 beta 2 receptors and the agonist-antagonist effect of varenicline on them, explain its mechanism of action and effectiveness. Cytisine, an alkaloid from which varenicline is derived, and with a similar mechanism of action, is a drug recently marketed in Spain, although it has been used in eastern countries for many years. It has demonstrated its effectiveness and safety, and with the experience of its use in our setting, it is expected to be included in the first line of pharmacological treatment of smoking.