Clinical Practice Guidelines DB

Background and objectives

Smoking is one of the major risk factors that threaten the health of the Korean population and has a great impact on the respiratory system. It affects the induction and exacerbation of various types of chronic diseases such as cancer and coronary artery disease, stroke, chronic obstructive pulmonary disease, asthma, and bronchiectasis, resulting in high socioeconomic costs. According to a report by the World Health Organization (WHO), smoking is a major cause of death and is associated with the deaths of one in 10 adults (6 million per year). In developed countries, 28% of all deaths, 35% of all cancer deaths, and 89% of lung cancer deaths are caused by smoking. Without proper smoking cessation support policies, smoking deaths are expected to increase to 8 million annually by 2030.

In Korea, the total number of smokers among adults was estimated to be about 8.9 million in 2017, and 21% of the causes of death have been reported to be related to smoking since 2012. Awareness for smoking cessation is increasing as the perception that abstinence can prevent various diseases and the risk of secondhand smoke is also known. The Ministry of Health and Welfare is also establishing smoking cessation clinics in public healthcare centers and implementing policies to promote smoking cessation treatment, such as the implementation of smoking cessation policies in hospitals. It is needed to establish systematic and high-quality clinical practice guidelines to contribute to improving public health through Korean traditional medical treatment, which has strengths in the prevention and management of diseases as a conservative treatment.

This clinical practice guideline is the first standard clinical practice guideline developed with Korean traditional medicine, and was developed upon comprehensive review of existing guidelines and complying with the development manual. For the development of more objective and utilizable practice guidelines, a systematic literature search strategy was established and The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was applied to the guidance development and recommendation process.

Through this process, this clinical practice guideline was developed to help Korean traditional medical doctors make decisions in the clinical field and to improve patients’ reliability in Korean traditional medicine treatment. Therefore, the clinical basis for smoking cessation was systematically and comprehensively ana- lyzed so that Korean traditional medical doctors could provide standardized treatment. These guidelines will provide practitioners with information on diagnosis and conventional medical treatments needed for smoking cessation treatment, and will allow them to properly select and apply optimal interventions to be used. References in smoking cessation overview, treatment, and management were all presented so that details could be checked through manual retrieval, and appropriate dissemination tools were developed and included in guidelines to increase practitioners’ utilization. This work was intended to improve public health by improving the quality of medical services, and to improve the reliability of Korean traditional medical treatment.

Overview of smoking cessation

Tobacco is made up of more than 4,000 chemicals and contains 60 types of carcinogens. The dangers of tobacco to health have been recognized by the public for over 50 years. Smoking causes pulmonary and respiratory symptoms such as coughing, phlegm, and asthma, and diminishes lung function and adversely affects serum lipid composition. It also increases the risk of various diseases, such as causing arteriosclerosis and chronic obstructive pulmonary disease, lowering the onset age of coronary artery disease, and increasing the risk of tumor. These diseases can lead to death, and smoking also affects the mortality rate of the relevant disease, resulting in high socioeconomic costs.

In 2009, WHO predicted that if the smoking cessation policies are not strengthened, the number of deaths caused by smoking cessation will increase to 8 million annually by 2030. According to ICD-10, smoking itself can be classified as a symptom classified to ‘mental and behavioral disorders caused by the use of psychoactive substances’.

Socially, awareness of the dangers of tobacco is increasing, and awareness of the need for abstinence is also growing, but smoking cessation often fails because it tends to rely only on individual willpower. Smoking is a dependence on nicotine and a kind of addiction symptom, and it is necessary to develop a systematic program to succeed in quitting smoking through professional approach, and then completely quit smoking through steady management.

Patients subject to smoking cessation treatment covered in this clinical practice guideline are not separately classified with diverse dependence on smoking, but are targeted at patients who visited Korean traditional medical institutions for smoking cessation treatment. Treatment methods such as acupuncture, moxibustion, herbal medicine, acupuncture, cupping and meditation can be used for Korean traditional medical treatment of smoking cessation. Each treatment method can be used alone or combined depending on the smoking period, underlying condition, major symptoms, and other treatment status. In addition to the treatment of smoking cessation itself, treatment of complications and abstinence management are pivotal in this area. This comprehensive management could prevent patients from relapse.