Treat hospitalized smokers proactively

Hospitals should proactively treat cigarette smoking during admission and continue support after discharge.
*Clinical practice guideline with systematic review; Level 1a (OCEBM).

Citation

Kathuria H, Soghier I, Alexander AC, et al. Tobacco Treatment in the Inpatient Setting: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2026. doi:10.1016/j.chest.2026.08.038

Background

Smoking remains a leading preventable cause of death, and hospitalization is a practical moment to start treatment. This guideline updates inpatient care recommendations using systematic literature review and expert consensus.

Patients

Hospitalized adults on medical or surgical wards who smoked cigarettes within 30 days. Psychiatric units, intensive care units, and non-cigarette nicotine products were excluded.

Intervention

Opt-out treatment, nicotine medicine, varenicline, bupropion, nicotine replacement, inpatient counseling, and post-discharge telephone counseling.

Control

Opt-in care, no medicine, brief advice, inpatient-only counseling, or passive quitline referral.

Outcome

Smoking abstinence, treatment use, quit attempts, patient satisfaction, adverse effects, and costs.

Follow-up Period

Varied by study; commonly 1 to 12 months after discharge.

Results

Intervention Key significant result NNT
Opt-out care Outpatient counseling RR 2.39 (95% CI 2.04 to 2.81); outpatient medicine RR 1.78 (95% CI 1.48 to 2.13) 2; 4
Varenicline started inpatient Biochemically confirmed quitting at 3 months RR 1.54 (95% CI 1.23 to 1.93); sustained quitting at 12 months RR 1.38 (95% CI 1.08 to 1.76) 6; 13
Counseling ≥15 minutes Quitting at longest follow-up RR 1.21 (95% CI 1.11 to 1.32) 24
Post-discharge counseling Quitting at longest follow-up RR 1.23 (95% CI 1.12 to 1.35) 19
Proactive telephone counseling Quitting at 6 months RR 1.22 (95% CI 1.11 to 1.34) 19

OCEBM: Oxford Centre for Evidence-Based Medicine. NNT: number needed to treat.

Limitations

No recommendation had high-certainty inpatient-specific evidence. Studies varied in counseling intensity, medicine use, setting, and follow-up. Findings may not apply to psychiatric, intensive care, or e-cigarette users.

Funding

American College of Chest Physicians; potential society-guideline bias.

Clinical Application

Use opt-out inpatient smoking treatment: start varenicline when appropriate, provide at least 15 minutes of counseling, and arrange proactive post-discharge telephone follow-up.