New CHEST Guideline Urges Opt-Out Tobacco Treatment for Hospital Patients

The American College of Chest Physicians has issued a clinical practice guideline recommending that hospitals proactively offer tobacco treatment to every patient who smokes, whether or not they say they want to quit. The guideline, published in the journal Chest, draws on more than 9,300 screened abstracts and 142 included studies.

Specific advice includes combining a long-acting nicotine patch with a short-acting form of nicotine replacement, and starting varenicline before discharge, which earned a strong recommendation. Patients should also receive at least 15 minutes of counselling and proactive phone follow-up after they go home, so support does not end at the hospital door.

Commentary from the Medical University of South Carolina's Hollings Cancer Center accompanies the guideline and offers perspective on implementation. The authors acknowledge limits, though: evidence comparing medications and ideal counselling doses is thin, some recommendations rely on panel experience, and the guideline does not specify who should deliver the care inside hospitals.