Objective: Our purpose is to evaluate the present state of tobacco problems, and propose tobacco-control measures in care facilities for the elderly.

Subjects and Methods: We conducted a questionnaire survey on tobacco problems in care facilities for the elderly in Kyoto Prefecture from October to November 2016.

Results: Of the 254 care facilities responded, 86% had adopted certain smoke-free policies for indoor or on their premises for fire prevention and protection of people from second-hand smoke exposure. However, not a few facilities permitted smoking in their premises out of respect for personal lifestyle, individual rights and freedom and stress attenuation.

Discussion: Although the tobacco-control measures have succeeded so far, there remains a deep-rooted perception affirming smoking behavior what is called social nicotine dependence, which is a persisting problem that needs to be resolved.

Conclusion: It is desirable that smoke-free policy is adopted in premises of care facilities for the elderly. We should support tobacco users and smoking employees to quit smoking, and forbid employees smoking while on duty in care facilities. We recommend teaching the facts and harmful effects of tobacco use, and to eventually develop tobacco-free facilities for all concerned.

We described a patient with myasthenia gravis (MG) who quitted smoking with varenicline. During smoking cessation therapy, transient exacerbation of ptosis occurred. We considered it might not be the adverse event by varenicline, but result from the decrease of prednisolone.