- 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?
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
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|
What data can you discuss with your patient?
- 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
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:
✅ Benefits to friends and family
E-cigarettes and vaping - Good, bad or ugly?
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.
⚠️ 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
Tobacco isn't the only factor
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?
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.3
- NICE smoking. https://www.nice.org.uk/guidance/ng92/chapter/Recommendations. Published 2019.
- Gold Initiative For The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (2019 Report).
- Lancaster T, Lf S. Individual behavioural counselling for smoking cessation (Review) Summary of findings for the main comparison. Cochrane Database Syst Rev. 2017;(3).
- Laniado-Laborin R. Smoking and chronic obstructive pulmonary disease (COPD). Parallel epidemics of the 21st century. Int J Environ Res Public Health. 2009.
- 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.
- 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.