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Introduction: Tobacco smoking is related with a substantial morbidity and mortality as well as with tremendous socioeconomic burden. Therefore, an early successful smoking cessation bears an enormous medical and socioeconomic importance. The gold standard of smoking cessation, a combination of behavioral und pharmacologic therapy reaches only few smokers every year and so, guideline-based, low-threshold and broadly available digital cessation support could considerably increase the annual cessation rate. With the digital cessation program "Nichtraucherhelden" such a guideline-based program is available in Germany since December 2016., Methods: The program consists of 2 preparation days and 10 program days und contains the major features of common smoking cessation courses. The present study examined the participants from December 2016 to November 2019 (n = 2491) regarding acceptance, adherence and effectivity. 69 % were female and the average age was 46 years., Results: On average cessation was attained after 19 days. One year after the program a cessation rate of 15 % was achieved. Surprisingly, the cessation rate was higher in more addictive compared to less addictive participants., Conclusion: The study shows that a digital guideline-based cessation program is feasible and effectual. For confirmation a control and randomized study is required., Competing Interests: Alena M. Bubeck war während der Auswertung der Daten und der Publikation nebenberuflich für die NichtraucherHelden GmbH tätig.Alexander Rupp, Thomas Hering und Michael Kreuter beraten als wissenschaftlicher Beirat die NichtraucherHelden GmbH., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Tobacco smoking is associated with severe health risks. In 2020, the WHO estimated that 8 million people have died due to smoking. Furthermore, smoking tobacco is a well-known risk factor for various infectious pulmonary diseases. The question raised, whether smoking is facilitating SARS-CoV-2-infections and increases adverse outcomes of COVID-19. To answer these questions a narrative review was conducted, finally including 7 systematic reviews with meta-analyses published in January and February 2021. Tobacco smoking was associated with an increased COVID-19 disease severity (odds ratio range of active vs. never smokers 1.55-2.19 and former vs. never smokers 1.20-2.48) and an increased COVID-19 in-hospital mortality (odds ratio range of active vs. never smokers 1.35-1.51 and former vs. never smokers 1.26-2.58). Beside immediate pulmonary toxic effects through active smoking, the cumulative livelong tobacco exposition and subsequent tobacco-associated diseases seem to predominantly predict adverse outcomes in patients with COVID-19. Data regarding an increased risk of infection among smokers is conflicting. However, a large observational study from England with 2.4 million persons reported an association between tobacco smoking and typical symptoms of COVID-19. For e-cigarettes and vaping less data exist, but experimental and first clinical investigations also suggest an increased risk for adverse outcomes for their use and SARS-CoV-2 infections. Especially during the current SARS-CoV-2 pandemic with limited therapeutic options it is particularly important to advise smokers of their increased risks for unfavourable COVID-19 outcomes. Evidence based support for smoking cessation should be offered. In Germany, the existing and well-established methods to support tobacco cessation need to be reimbursed by statutory health insurances., Competing Interests: R. Bals erhielt Forschungsunterstützung durch das BMBF, Wilhelm Sander Stiftung, Deutsche Krebshilfe, Mukoviszidose e. V., Schwiete Stiftung sowie Zuwendungen für Advisory Boards oder Vorträge von AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, CSL Behring.W. Pankow hatte Einkünfte aus Beratungstätigkeit für Pfizer Deutschland GmbH.C. Rustler: Geschäftsführung im Deutschen Netz Rauchfreier Krankenhäuser & Gesundheitseinrichtungen, Zuwendungen zur Implementierung des „rauchfrei tickets“ zur Vermittlung in die Rauchstoppberatung am Telefon der BZgA, Mitgliedschaft im Wissenschaftlichen Aktionskreis Tabakentwöhnung WAT e. V., Mitautorin der S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“ (2021).Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Based on real-life data for the stage distribution of COPD patients (GOLD) and the actual stage-related treatment costs in a large nationwide cohort study (COSYCONET) 1, the influence of the reduced smoking rate on treatment costs was determined for the scenario of a reduction in the smoking rate of 26 % in this patient group by 10 percentage points to 16 %. The assumption was made that with a reduced smoking rate, lower stages (I/II) will be more strongly represented, while higher and more cost-intensive stages (III/IV) will be proportionally reduced. The intervention to achieve tobacco abstinence was calculated for the rough model calculations with the typical costs of a guideline-compliant treatment by a behavioral therapy group cessation program and the parallel use of medication support 2 3. The result showed a potential reduction of case costs by 10.5 %, not including reduction in costs associated with treatment of comorbidities., Competing Interests: Thomas Hering erhielt in den letzten 3 Jahren Honorare für Beratung und Vorträge von AstraZeneca GmbH, Berlin-Chemie, GSK, Mylan Pharma, Novartis GmbH, Pfizer Pharma GmbH, Sanofi-Aventis, Takeda, bytes4business, Carepath Technologies. Er betreibt die gemeinwohlorientierte Vermittlungsplattform www.rauchfrei-in-berlin.de und ist Autor der Programmes „Mein Nichtraucherprogramm (Entwöhnungsprogramm des Bundesverbandes der Pneumologen – BdP).Anil Batra hat in den letzten 3 Jahren einschlägige Förderungen durch die Bundeszentrale für gesundheitliche Aufklärung (BZgA) e. V., die Deutsche Krebshilfe und das BMBF erhalten. AB betreibt das Tabakentwöhnungsprogramm „Nichtraucher in sechs Schritten“ und führt regelmäßig Fortbildungen zu diesem Thema durch.Stephan Mühlig hatte in den letzten 3 Jahren wirtschaftliche oder persönliche Verbindungen zur AOKPLUS, der Deutschen Krebshilfe, dem Sächsischen Staatsministierium für Soziales und Gesundheit, der BZgA, dem Bundesgesundheitsministerium, den Firmen Pfizer, Johnson & Johnson.Dennis Nowak erhielt Vortragshonorare von Bristol MyersSquibb, Berlin Chemie, Boehringer Ingelheim, GSK, Mundipharma, Novartis, Hexal, Lilly. Er ist im Advisory Board Raucherentwöhnung der Firma Pfizer tätig.Tobias Rüther erhielt in den letzten drei Jahren Beratungs- und Vortragshonorare von Pfizer Pharma GmbH, Johnson & Johnson, Sanofi und Servier und Berlin Chemie.Larissa Schwarzkopf hatte keinerlei finanzielle, persönliche oder sonst wie geartete Konflikte., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Smoking is the biggest cause of premature mortality. Almost half of smokers meet the criteria for addiction. Treatment fails primarily because of the lack of reimbursement. Doctors could treat tobacco addiction and with it the secondary diseases with high efficacy if the conditions with behavioral therapy and medication were made available to them., Competing Interests: Thomas Hering: Honorare für Beratung, Vorträge 2016/2017/2018 von AstraZeneca GmbH, Berlin Chemie, Böhringer, Marpinion, Meda Pharma, Novartis GmbH, Pfizer Pharma GmbH, PulmonX, Roche-Pharma AG, Sanofi-AventisAnil Batra: Wirtschaftliche Verbindungen: Verlage: Thieme. Kohlhammer, Elsevier, Fortbildung: FomF, Ärztekammern, Wissentransfer Tübingen, Forschung: Janssen, Pfizer, ParexelStephan Mühlig: Pfizer: Reisekosten und Vortragshonorare, (© Georg Thieme Verlag KG Stuttgart · New York.)

Smoking cessation as a therapeutic intervention has largely not the significance that it should have according to its potential influence on diseases in the pulmonary practice. Barriers against smoking cessation apart from the addiction character of tobacco dependence are mainly the almost complete absence of reimbursement as well as concerns regarding low achievable long-term abstinence. The presented study shows that despite these barriers smoking cessation in pulmonology practice is successful if carried out by using a 2-step motivation of the participants. The long-term abstinence success of 46 % after 12 months (point prevalence) presented here was achieved with the use of behavioral therapy and medical support. Success factors are doctor's office setting and consequent information and encouragement for medical support (mostly varenicline)., (© Georg Thieme Verlag KG Stuttgart · New York.)

Chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pulmonary tuberculosis are common pulmonary diseases that are caused or worsened by tobacco smoking. Growing observational evidence suggests that symptoms and prognosis of these conditions improve upon smoking cessation. Despite increasing numbers of (small) randomised controlled trials suggesting intensive smoking cessation treatments work in people with pulmonary diseases many patients are not given specific advice on the benefits or referred for intensive cessation treatments and, therefore, continue smoking.This is a qualitative review regarding smoking cessation in patients with COPD and other pulmonary disorders, written by a group of European Respiratory Society experts. We describe the epidemiological links between smoking and pulmonary disorders, the evidence for benefits of stopping smoking, how best to assess tobacco dependence and what interventions currently work best to help pulmonary patients quit. Finally, we describe characteristics and management of any "hardcore" smoker who finds it difficult to quit with standard approaches., (Copyright ©ERS 2015.)

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Cigarette smoking is the main cause of COPD. Quitting smoking is thus the most effective treatment strategy and central in COPD prevention. A number of guidelines on prevention, diagnosis, therapy and rehabilitation of COPD have been published. To help implementing and standardizing smoking cessation in COPD a guideline was published 2008 in Germany focusing on this complex issue. The present guideline is an update of the 2008 guideline and has a high grade of evidence (S3 according to the AWMF; Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften). The guideline gives comprehensive and practical information on how to integrate smoking cessation as an central part of COPD therapy., (© Georg Thieme Verlag KG Stuttgart · New York.)

Continuous cigarette smoking clearly influences the course and prognosis of diseases like COPD/emphysema and asthma bronchiale in an adverse manner. However smoking cessation as a therapy measure is not a common part of general health-care in Germany as reimbursement of the central component of psychosocial support (behavioural therapy - BT) is allowed only to a minor degree and of pharmacotherapy support (nicotine replacement, varenicline, bupropione) is completely excluded by the legislator. This prospective "real-life" study with 198 participants shows, that with the abolition of the reimbursement barrier for cognitive behavioural therapy in the setting of a pneumological practice/clinic a high long-term abstinence of 45.4 % (point prevalence after 12 months) can be achieved. Apart from the reimbursement of BT, predominant success factors were the implementation of the measure in the practice/clinic, where patients are under long-term treatment and the application of a two-stage motivational model for the participation. Reimbursement of smoking cessation pharmacotherapy was not possible in this study. Thus, pharmacotherapy was applied to fewer than necessary patients and was predominantly too short and in a too low dosage., (© Georg Thieme Verlag KG Stuttgart · New York.)

Varenicline is an orally administered small molecule with partial agonist activity at the alpha4beta2 nicotinic acetylcholine receptor. Varenicline was approved by both the US FDA and the European Medicines Agency of the EU in 2006 as an aid to smoking cessation. Subsequently, varenicline has been approved in over 80 other countries. Varenicline is almost entirely absorbed following oral administration, and absorption is unaffected by food, smoking or the time of day. Varenicline undergoes only minimal metabolism and approximately 90% of the drug is excreted in the urine unchanged. Varenicline has a mean elimination half-life after repeated administration of approximately 24 hours in smokers. The area under the plasma concentration-time curve is increased in patients with moderate or severe renal failure. No clinically relevant varenicline-drug interactions have been identified. In two identical, randomized, double-blind, phase III clinical trials in healthy, motivated-to-quit, mainly Caucasian smokers aged 18-75 years in the US, 12 weeks of treatment with varenicline 1 mg twice daily was associated with significantly higher abstinence rates over weeks 9-12 than sustained-release bupropion 150 mg twice daily or placebo. In a separate phase III trial, an additional 12 weeks of treatment in smokers achieving abstinence in the first 12 weeks was associated with greater abstinence through to week 52 than placebo treatment. Varenicline treatment was also associated with significantly higher rates of abstinence than placebo treatment in randomized, double-blind, clinical trials in smokers in China, Japan, Korea, Singapore, Taiwan and Thailand. In a randomized, open-label, multi-national, phase III trial, varenicline treatment was associated with a significantly higher rate of abstinence than transdermal nicotine-replacement therapy. In these trials, varenicline treatment was associated with lower urge to smoke and satisfaction from smoking in relapsers than placebo or active comparators. In the two US phase III trials, 12 weeks of treatment with varenicline 1 mg twice daily had an acceptable safety and tolerability profile. Nausea and abnormal dreams were the most common adverse events that occurred in more varenicline than placebo recipients. The incidence and prevalence of nausea were greatest in weeks 1 and 2 of treatment, and declined thereafter. The prevalence of early adverse effects can be reduced by individual dose titration. Adverse events associated with varenicline therapy have been reported in post-marketing surveillance, including neuropsychiatric events such as depressed mood, agitation, changes in behaviour, suicidal ideation and suicide. Currently, it is unclear whether the association of varenicline therapy with these adverse events is causal, coincidental or related to smoking cessation. Given the greater efficacy of varenicline compared with other pharmacotherapies, and the high risk of morbidity and mortality associated with continued smoking, varenicline is a valuable pharmacological aid to smoking cessation.

Background: As many as 50% of older smokers develop chronic obstructive pulmonary disease (COPD), and more than 80% of COPD-associated morbidity is caused by tobacco smoking. Despite the severe symptoms from which COPD patients suffer, they are often unable to quit smoking on their own., Methods: Experts from 9 medical societies, under the aegis of the German Society of Pulmonology and Respiratory Medicine (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin), have developed an S3 guideline on smoking cessation in COPD. They took previously published guidelines into account, as well as more than 2000 initially surveyed publications, and created the new guideline in two consensus conferences followed by a Delphi process., Results: The following strongly evidence-based statements can be made: A smoking cessation strategy based on a combination of medication and psychosocial support has been found to be effective in COPD patients. Smoking cessation improves pulmonary function, alleviates dyspnea and cough, reduces the frequency of COPD exacerbations, and lowers mortality. Mere smoking reduction does not improve pulmonary function or alleviate symptoms. Smoking cessation is the most effective and least expensive single means of lowering the risk of developing COPD and of arresting its progression. Smoking cessation should therefore be strongly promoted at all levels of health care delivery., Conclusions: There is no question that smoking cessation ranks among the most effective medical interventions, yet the German health care system still does not assign it an adequate priority.

In view of the high morbidity and mortality associated with tobacco, smoking cessation is one of the most urgent medical challenges. It is effective when psychosocial support is combined with accompanying medication. In view of the associated rate of occurrence of cardiovascular diseases, COPD/emphysema as well as lung cancer, it is highly cost-effective. The nicotine replacement substances Bupropion and Varenicline used in smoking cessation therapies demonstrate a well-documented increase in effectiveness. Their use is not complicated. An increase in the overall cessation success rate by a factor of 2-3 is obtained when using an accompanying course of medication.

More than 30 % of the German population are regular smokers, over half of whom will eventually die of smoking-related diseases. Life expectancy is abridged by 10 years in smokers compared to non-smokers. Smoking tobacco is the main risk factor for lung cancer and chronic obstructive pulmonary disease (COPD) and predisposes to a number of other lung diseases. A smoking cessation programme including pharmacological as well as psychosocial support is highly effective in COPD Patients. Smoking cessation improves lung function, symptoms and mortality. In conclusion, smoking cessation services are among the most effective medical interventions. Thus, a sufficient supply of smoking cessation services on a population level must be ensured.

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