Smoking cessation advice in COPD

Reduction of risk factors

Smoking cessation is the single most effective way to reduce the risk of developing COPD and stop its progression (1). All people with COPD who still smoke, regardless of age, should be encouraged to stop and offered help to do so at every opportunity (2)

• counselling
  • when compared to self-initiated strategies, counselling delivered through physicians and other healthcare professionals has led to a significant increase in quit rates
    • even a brief (3-minute) counselling session has been shown to improve smoking cessation rates and should be offered to patients at every contact with healthcare professionals
    • there is strong dose-response relation between the intensity of counselling and its effectiveness. Treatment may be intensified by increasing the
      • length of treatment session
      • number of treatment sessions
      • number of weeks over which the treatment is delivered
  • three types of counselling have been shown to be effective:
    • practical counselling
    • social support of family and friends as part of treatment
    • social support arranged outside of treatment
      
      
• pharmacotherapy and nicotine replacement have been shown to increase the long-term smoking abstinence rates
  • nicotine replacement products
    • nicotine gum, inhaler, nasal spray, transdermal patch, sublingual tablet or lozenge
    • recent myocardial infection or stroke is a contraindication to nicotine replacement
      • evidence suggests that treatment could be started 2 weeks after the cardiovascular incident
  • E-cigarettes - efficacy remains controversial
  • pharmacological products
    • varenicline, bupropion, and nortryptyline are helpful but should be used as a component of supportive intervention
• financial incentive programs for smoking cessation may encourage patients to give up smoking

A five-step programme for smoking cessation can be helpful for healthcare workers in providing a strategic framework to help patients stop smoking.

• ask
  • systematically identify all tobacco users at every visit
  • write a patient's smoking status in the medical chart under vital signs
  • implement a system that ensures that, for every patient at every clinic visit, tobacco-use status is queried and documented
  • ask patients about their desire to quit, and reinforce their intentions
• advice
  • strongly urge all tobacco users to quit. In a clear, strong, and personalized manner, urge every tobacco user to quit
  • motivate patients who are reluctant to quit.
• assess
  • most individuals go through several stages (pre-contemplation, contemplation, recycling) before they stop smoking
  • determine willingness to make a quit attempt
  • ask every tobacco user if he or she is willing to make a quit attempt at this time.
• assist
  • aid the patient in quitting. Help the patient with a quit plan; help motivated smokers set a quit date.
  • provide practical counselling; provide, if available, intra-treatment social support; six first-line pharmacotherapies for tobacco dependence - bupropion SR, varenicline, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch -are effective and at least one of these medications should be prescribed in the absence of contraindications
• arrange
  • schedule follow-up contact, either in person or via telephone
  • encourage relapsed smokers to try quitting again
  • tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved (2)

A combination of behavioural support and pharmacotherapy increase smoking cessation rates

In addition, patients should be advised regarding:

• reducing the risk of indoor and outdoor air pollution
  • efficient ventilation, non-polluting cooking stoves and similar interventions should be recommended
• avoiding continued exposure to potential irritants

Reference:

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease
2. Laniado-Laborin R. Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel Epidemics of the 21st Century. International Journal of Environmental Research and Public Health. 2009;6(1):209-224.