Background: Repeated surveys are essential for tracking trends in smoking prevalence among physicians, especially pulmonologists, who play a pivotal role in cessation counseling. Methods: In 2024, we conducted a descriptive cross-sectional surveillance study during the Romanian National Congress of Pneumology. A total of 332 registered pulmonologists were invited, and 226 (68.1%) provided a complete 30-item online questionnaire. The survey assessed smoking behavior and smoking-cessation counseling practices among Romanian pulmonologists for smokers and users of alternative nicotine products. Results: In a 2024 survey, current smoking rates were 4.9% (11/226) for conventional cigarettes, 2.2% (5/226) for heated tobacco products (HTPs), and 0.9% (2/226) for electronic cigarettes (e-cigarettes). Counseling practices were strongest for the initial steps of the 5A model: 93.4% (211/226) consistently asked about smoking status, and 88.1% (199/226) advised cessation. However, fewer assessed readiness to quit (65%, 147/226), monitored long-term abstinence (66.4%, 150/226), or assisted through referral and treatment. Only 36.3% (82/226) referred patients to the national STOP SMOKING program, and just 15.9% (36/226) declared to recommend Quitline programs. Conclusions: Smoking prevalence among Romanian pulmonologists has declined substantially over the past two decades. Despite high adherence to asking and advising patients, significant gaps remain in assistance and follow-up. Strengthened training and system-level support are needed to optimize cessation counseling.
