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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 lungfoundation.com.au/lung-information/patient- 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 www.lungfoundation.com.au/professional-resources/ a lung age, patients are more likely to quit after learning general-practice/primary-care-respiratory-toolkit.
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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