Smokers With Lung Disease Need More

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OHSU Smoking Cessation Center scientists outline key steps for developing and implementing clinic-based systems to provide smoking cessation therapy tailored to smokers with respiratory disorders.

Smokers with lung disease require more than brief smoking cessation interventions to successfully quit, scientists in the Oregon Health & Science University Smoking Cessation Center report.

Their recommendations will be published Tuesday, April 1, in the online edition of Pulmonary and Critical Care Update, a publication of the American College of Physicians.

Eventhough effective therapys for smoking cessation exist, and research has shown that patients who receive smoking cessation therapy are twice as likely to quit -- limited insurance coverage, poor adherence to practice guidelines, lack of physician training in smoking cessation, time constraints and inadequate clinic systems to easily identify and treat smokers have limited the availability and quality of smoking cessation therapy.

"Most clinicians who treat their patients for smoking cessation provide only brief interventions, often just three short steps: asking about tobacco at every visit, advising all smokers to quit and referring them to other resources, such as quit lines for assistance and follow-up," said David Gonzales, Ph.D., lead author and co-director of the OHSU Smoking Cessation Center in the OHSU School of Medicine. "When we evaluated the data, we observed that brief intervention is often insufficient for the more dependent, high-risk patients with pulmonary disease".

Patients with respiratory disease have more difficulty quitting, are more nicotine-dependent and need more intensive therapy, Gonzales and his colleagues explained. They may require higher doses of medications, longer periods of therapy and more frequent follow-up than smokers in general. And, eventhough most try to quit on their own without assistance from their health care provider, 95 percent fail, and patients with respiratory disease have even poorer success.

To help clinicians improve tobacco cessation therapy for these patients, the OHSU research team evaluated existing evidence-based therapy guidelines for smoking cessation medicine and behavioral support and OHSU's own programs for treating patients in the hospitals and clinics. They advise that when consistent, evidence-based smoking cessation therapy is tailored to the needs of patients and integrated into ongoing respiratory care, smokers can significantly improve their odds of quitting. And the key to accomplishing this, they advise, is to distribute the responsibility for enhanced therapy among several clinic staff members.

Beginning with new patient intake and continuing with review of vital signs, review of systems, therapy planning and check-out, the scientists recommend nurses, medical assistants, clinicians and clinic support staff all have roles in helping the patient stop smoking. Including tobacco cessation therapy in each part of the clinic visit reduces demands on any one member of the clinic staff, they explained. This approach makes it easier for busy clinics to provide effective therapy.

"Providing patients with pulmonary disease with ongoing smoking cessation therapy as part of their regular respiratory care will greatly improve their odds of quitting," said Gonzales.


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