Smoking cessation: You’re more influential than you think
With the vast majority of COPD cases attributable to
Tobacco smoking is the main cause of COPD.
smoking, strategies to support smoking cessation
Smoking cessation has been shown to be beneficial
are critical to slowing disease progression and reducing
at all stages of severity (see Figure 1).
However, smoking cessation at an early stage of the
Primary health care nurses can play a critical role
disease has been shown to slow the decline in forced
in providing the motivation to quit and the support to
expiratory volume in one second (FEV ) to that observed
prevent a relapse in their patients with COPD.
Providing the motivation to quit, particularly at an early
COPD and smoking in Australia stage, along with the strategies to prevent a relapse, is a In Australia, COPD is a leading cause of death and
critical part of the management of patients with COPD.
disease burden after heart disease, stroke and cancer. COPD has also been identified as the second leading
Smoking cessation –
cause of preventable hospital admissions. the barriers
One in seven people aged over 40 in Australia will have
Evidence shows that smokers are more likely to quit with
some form of COPD, from mild – where symptoms may
the help of a health professional, including a general
not yet be evident – to more severe – where simple daily
practitioner or practice nurse. Some health professionals,
tasks such as tying shoelaces or showering can become
however, continue to be reluctant to raise the subject
The burden on the hospital system is significant.
Nearly all smokers are interested in quitting and expect
However, the burden on the individual is perhaps more
their primary care practitioners to raise the subject.
marked. Symptoms such as breathlessness, cough and
A summary of some of the important myths and evidence
sputum production progress with time and can affect a
about provision of smoking cessation advice is provided
patient’s ability to function independently as the disease
Figure 1: Adapted from BMJ, 1977, Fletcher C and Peto R, The natural history of chronic airflow obstruction, 1:1645-8.
20 | Primary Times | Volume 12 Issue 4 Smoking cessation: You’re more influential than you think What works
If airway obstruction is shown to be present, 16.3 per cent were smoke free at 12 months. Even where no
Evidence shows that all health professionals can be
airway obstruction is demonstrated, a 12 per cent
effective in providing smoking cessation advice. While
spending more time (longer than ten minutes) advising
The Australian Lung Foundation has developed
smokers to quit yields higher abstinence rates than
an open access online tool, the Lung Age Estimator.
minimal advice, offering even brief three minute advice
Together with spirometric testing, the Lung Age Estimator
has been shown to have clear benefits.
offers health professionals a way to motivate their
A review of smoking cessation interventions by
patients to quit smoking by providing a graphic il ustration
Tønnesen 2009, considered the success of a range
of the physiological effects of their smoking and of
of interventions after one year and showed that the
quitting, along with their estimated lung age.
most effective strategy combines intensive counsel ing/support and pharmacotherapy (see Figure 3). The Lung Age Estimator Providing motivation to quit
Simply enter the smoking patient’s age, height and spirometry results online. The Lung Age Estimator
Knowing what works is critical, but one of the challenges
provides a personalised graph showing the rate of lung
facing primary care practitioners is to move their patients
function decline for that particular patient and what that
along the continuum of readiness to quit. How can the
would look like if the patient continues to smoke (red
practice nurse motivate his or her patients to start
line) compared to decline in lung function of a normal
non-smoker (green line). The tool also provides a revised
Other useful links
Studies have shown that demonstrating the
rate of decline in lung function if the patient quits (orange
• RACGP smoking cessation guidelines www.racgp.org.au
physiological effects of smoking can increase the
line). An estimated lung age is also provided.
Insert image: Primary Care Respiratory Toolkit
• Lung Foundation patient education material www.
Gary Parkes, a general practitioner in the UK, showed
The Lung Age Estimator is part of The Australian Lung
that giving smokers an estimate of their ‘lung age’
Foundation’s Primary Care Respiratory Toolkit, an online
(through spirometric testing) doubles the quit rate
decision support tool that summarises the COPD-X
at 12 months. Lung age is the age of the average healthy
Guidelines for the Management of Chronic Obstructive
person who would perform similarly on spirometry to the
Pulmonary Disease (www.copdx.org.au).
The Lung Age Estimator can be found by visiting
For a full list of references please email
Other studies have shown that, even without providing
a lung age, patients are more likely to quit after learning
results of their lung function after performing spirometry fol owed by short smoking cessation behavioural support.
Evidence Smoking Cessation Interventions Quit rate
Assistance with smoking cessation is Most patients think smoking cessation assistance is part of your clinical role
Nearly all smokers are interested in quitting although some are temporarily
put off by past failures – more than 40% of smokers make quit attempts
Clinicians can achieve quit rates over 6-12 months of 12-25%
Visit satisfaction is higher when smoking is addressed appropriately
Effective counselling can take as little as one minute
Figure 3: Tønnesen P. Smoking cessation: how compelling is the Figure 2: Adapted from Supporting smoking cessation: a guide for health professionals, RACGP, 2011.evidence? A Review. Health Policy 2009;91 Suppl 1:515-25.
Volume 12 Issue 4 | Primary Times | 21
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