Table 4.
Evidence ratings assigned to recommendations from included guidelines
| S&D Guidance (Y/N) | Evidence ratinga | Argentina | Australia | Canadab | Canada pregnancy | Chile | Czech Republic | Denmark | France | France pregnancy | France perioperative | Germany | Germany COPD | India | Japan | Jordan | Kyrgyzstan | Malaysia | Netherlands | New Zealand | Norway | Portugal | Scotlandc | South Africa | Sweden | UK | USA | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| General population | ||||||||||||||||||||||||||||
| Identify | N | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
| Brief advice | Y | A | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
| Assess motivation | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||
| Offer assistance | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
| Offer pharmacotherapy | Y | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
| NRT | Y | A | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
| Bupropion | Y | A | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||
| Varenicline | Y | A | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||
| Combination NRT | Y | A | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
| Combined NRT + bupropion | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||||
| Nortriptyline | N | — | ✓e | ✓ | ✓ | ✓e | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||||
| Clonidine | N | — | ✓e | ✓ | ✓e | ✓ | ✓ | |||||||||||||||||||||
| Offer behavioural support | Y | A | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
| Self-help | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||
| Evaluate abstinence | Y | A | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||||||||
| 5A’s framework | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||
| ABC framework | N | — | ✓ | ✓ | ✓ | |||||||||||||||||||||||
| Appropriate training | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||||||
| Subpopulations | ||||||||||||||||||||||||||||
| Pregnancy | Y | B | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
| Offer NRT | Y | C | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||
| BME groups | Y | B | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||||||||
| Children and adolescents | Y | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||
| Offer NRT | N | — | ✓ | ✓ | ✓ | ✓d | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||
| Mental illness/other addiction | Y | B/C | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||
| Bupropion | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||||||||||||
| Nortriptyline | N | — | ✓ | ✓ | ||||||||||||||||||||||||
| Chronic somatic illness | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||
| Offer NRT (CVD) | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||
| Bupropion (CVD) | N | — | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||||||
Note: S&D Service and Delivery Guidance, NRT nicotine replacement therapy, CVD cardiovascular disease, COPD chronic obstructive pulmonary disease, BME black and minority ethnic groups
aEvidence rating based on the SIGN system: A=recommendation is supported by strong evidence, B=recommendation is supported by reasonable evidence, C=recommendation is supported by expert opinion only, I=insufficient evidence to make a recommendation
bThe Canadian guideline did not include a section of recommendations regarding pharmacotherapy. It was noted within these guideline that the development of these recommendations was in progress. At the time of writing this review an update including recommendations for pharmacotherapy had not been released
cThe Scottish guideline did include recommendations for pharmacotherapy, however, these were included within recommendations for Specialist Stop Smoking Services which were not extracted for the purpose of this review. These recommended NRT, combination NRT and bupropion
dThe French guideline for the general population recommends NRT only for adolescent of 15 years and older
eSecond line