Quick tips to help your patient quit smoking


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Key takeaways

  • Smoking is the main causative factor for COPD
  • A range of counselling and pharmacotherapy support is available for you to offer your patient
  • Follow the 5 A’s to effectively plan your patient’s quitting strategy
  • E-cigarettes can support smoking cessation. More evidence is needed on the long-term risks and benefits
  • Occupational and domestic exposures must be assessed in each individual patient


How can guidelines support you?

When diagnosing or managing COPD, NICE recommend that current smokers should be offered advice and support to quit. They suggest offering:

πŸ’Š Behavioural support from trained stop smoking staff
πŸ’Š Bupropion
πŸ’Š Nicotine replacement therapy (NRT)
πŸ’Š Varenicline
πŸ’Š Very brief advice on the consequences of smoking and stopping smoking 2

Consider text messaging as well as behavioral support. Remember to agree quit dates within 2 weeks of starting bupronion and within 1-2 weeks of starting varenicline, reassessing your patient before their prescription ends. Also, ensure those choosing to use NRT have a supply ready before their quit date. You can consider NRT, with the offer of behavioural support, for nicotine dependent smokers > 12 years old. 2

GOLD similarly recommend NRT and the pharmacologic products varenicline and bupropion. 3 Remember:

  • Just 3-minute periods of counseling can improve smoking cessation rates 3
  • Increasing the length and number of counseling sessions can improve treatment success 3
GOLD also suggest using the 5 As strategy when supporting your patient to quit smoking.3

The 5 As

ASK Identify if your patient is a tobacco user
ADVISE Urge your patient to quit using a clear, strong and personalised manner
ASSESS Determine how willing your patient is to attempt quitting and their rationale
ASSIST Provide your patient with a quit strategy based on counselling, support and pharmacotherapy
ARRANGE Book a follow-up with the patient
Adapted from GOLD 2019 3

What data can you discuss with your patient?

Individual counselling can increase chances of quitting by 40-80% compared to minimal support.4

Counselling sessions often comprise:

πŸ“– Reviewing your patient’s smoking history and motivation to quit
πŸ“– Identifying high-risk situations
πŸ“– Generating problem-solving solutions to deal with these situations

When advising your patient to quit, it is important to clearly explain that they can:

  • Reduce the risk of developing lung disease and other smoking related illnesses 1,2
  • Reduce the risk of worsening conditions affected by smoking 2
  • Improve their prognosis if they quit at the early stages of COPD 5
Smokers seem to be more motivated to stop smoking once they realise that their respiratory complaints are caused by smoking and that they are at risk of developing COPD.

While a standard framework can be used for each counselling session, remember that each individual patient will have their own underlying reasons for quitting. This means that any advice must be personalised for that individual. Data can be presented on:

βœ…  Health benefits
βœ…  Financial benefits
βœ…  Benefits to friends and family
βœ…  Benefits to appearance

NHS SmokeFree provides a range of resources with key statistics to motivate your patients.

E-cigarettes and vaping - Good, bad or ugly?

E-cigarettes are increasingly used as a form of nicotine replacement therapy but they remain controversial.3

E-cigarettes can be effective in the short term for smoking cessation, both alone and in combination with pharmacotherapy and counselling.6 However, further studies are needed to understand the longer-term effects of e-cigarettes, both on relapse back to smoking and on the health of the user.

Current evidence indicates that e-cigarettes are associated with much lower risks than smoking:

βœ”  Cancer potencies of e-cigarettes may be only 0.5% of the risk of smoking6
βœ”  To date, no health risks have been identified with passive vaping 6

If your patient is keen to use an e-cigarette to help them quit smoking it is important to continue to provide behavioural support. You can also explain that:

⚠️ While the evidence suggests that e-cigarettes are less harmful to health than smoking, they are not risk free 2
⚠️ Evidence on long term health impact is still developing 2
⚠️ If using your e-cigarette, stop smoking tobacco completely 2

Tobacco isn't the only factor

While smoking is the most important causative factor for COPD, other environmental exposures can contribute to the condition. 3 These include:

Indoor air pollution  -  Occupational exposures  -  Outdoor air pollution

Organic and inorganic dusts, chemical agents and fumes are considered to be under-appreciated risk factors for COPD. 3 The American Thoracic Society have estimated that occupational exposures account for 10-20% of symptoms or functional impairment seen with COPD. 7  

Significant causes of COPD include biomass cooking and heating in poorly ventilated homes. 3 It is therefore key to ascertain whether your patient may be at risk through these exposures.

Ask your patient questions such as:

❓ What appliances do you use for heating or hot water?
❓ What kind of stove do you mostly use for cooking?
❓ Have you ever lived or worked in an area that exposed you to high levels of vapours, gas, dust or fumes?
❓ Have you had to leave any previous jobs because they affected your breathing?


Summary

Smoking is the most important causative factor in COPD with 1 in 2 smokers developing the condition in their lifetime. 5 So, when your patient presents with COPD symptoms it is essential to understand if they smoke, why they smoke and how you can help them to quit.

Assisting your patient to quit smoking is rarely easy but research suggests that up to 1 in 4 smokers may successfully quit long term if you provide them with effective strategies. 


References

  1. https://www.nice.org.uk/guidance/ng115/chapter/Recommendations#diagnosing-copd
  2. NICE smoking. https://www.nice.org.uk/guidance/ng92/chapter/Recommendations. Published 2019.
  3. Gold Initiative For The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (2019 Report).
  4. Lancaster T, Lf S. Individual behavioural counselling for smoking cessation (Review) Summary of findings for the main comparison. Cochrane Database Syst Rev. 2017;(3). 
  5. Laniado-Laborin R. Smoking and chronic obstructive pulmonary disease (COPD). Parallel epidemics of the 21st century. Int J Environ Res Public Health. 2009. 
  6. Public Health England. Evidence review of e-cigarettes and heated tobacco products 2018: executive summary. https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review/evidence-review-of-e-cigarettes-and-heated-tobacco-products-2018-executive-summary#the-effect-of-e-cigarette-use-on-smoking-cessation-and-reduction. Accessed March, 2019.
  7. ATS Board of Directors, American Thoracic Society Statement: Occupational  Contribution to the Burden of Airway Disease. Am J Respir Crit Care Med. 2003;167:787-797.

UK/RESP/0023/19 - March 2019

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March 2019