New recommendations urge clinicians to deliver dedicated counseling, start pharmacotherapy during hospitalization, and connect patients with postdischarge support.


RT’s Three Key Takeaways:

  1. Inpatient Pharmacotherapy: The American College of Chest Physicians recommends initiating varenicline during hospitalization for adult patients who smoke cigarettes to promote smoking cessation following discharge.
  2. Dedicated Counseling Duration: The panel recommends providing at least 15 minutes of inpatient tobacco treatment counseling rather than brief advice lasting less than 15 minutes.
  3. Postdischarge Continuity: Inpatient counseling should include scheduled follow-ups, direct referrals, or electronic health record referrals to outpatient programs and quitlines to sustain cessation and help reduce hospital readmissions.


The American College of Chest Physicians (CHEST) has released a new clinical practice guideline for tobacco treatment in the inpatient setting.

Published in the journal CHEST, the clinical practice guideline contains six evidence-based recommendations synthesizing available medical literature to guide inpatient tobacco interventions.

According to the CHEST, cigarette smoking remains the leading cause of preventable death in the US, with disproportionately high smoking rates observed among individuals of lower socioeconomic status, and among hospitalized patient populations. Although tobacco treatment interventions rank among the most cost-effective strategies in healthcare, CHEST reported that they remain frequently underutilized in inpatient settings.

“When a patient is hospitalized, there is a real opportunity to initiate tobacco treatment,” said Hasmeena Kathuria, MD, lead author of the guideline, in a news release. “Our hope is that the standardized approach will help more clinicians feel comfortable providing counseling and pharmacotherapy to all hospitalized patients who smoke unless they explicitly decline and support continued treatment after discharge. Implementing these approaches is likely to improve smoking-cessation outcomes and reduce hospital readmissions.”

Core Inpatient Recommendations

According to CHEST, key highlights among the panel’s recommendations include:

  • Initiating Varenicline Inpatient: For hospitalized adults who smoke cigarettes, the guideline recommends initiating varenicline during hospitalization to promote smoking cessation after hospital discharge.
  • Extended Bedside Counseling: For hospitalized adults who currently smoke cigarettes, the panel recommends inpatient tobacco treatment counseling of 15 or more minutes over brief advice lasting less than 15 minutes.
  • Outpatient Referrals and Follow-Up: For hospitalized adults who currently smoke cigarettes, the guideline recommends that inpatient counseling include formal referral to postdischarge tobacco treatment counseling, such as scheduled follow-up contact, direct referral, or electronic health record referral to an outpatient program or quitline.

The full list of recommendations is available on the CHEST journal website under the title, “Tobacco Treatment in the Inpatient Setting: An American College of Chest Physicians Clinical Practice Guideline.”