We found high-quality evidence in a meta-analysis including four (1,540 participants) of the 16 included studies that a combination of behavioural treatment and pharmacotherapy is effective in helping smokers with COPD to quit smoking. Furthermore, we conclude that there is no convincing evidence for preferring any particular form of behavioural or pharmacological treatment.
Smoking cessation is the only effective intervention to slow down the accelerated decline in lung function in smokers with chronic obstructive pulmonary disease. Nevertheless, physicians often do not routinely provide evidence-based smoking cessation treatment to their patients. To understand underlying reasons, we explored how physicians engage in smoking cessation treatment in their chronic obstructive pulmonary disease patients. In total, 21 focus group discussions were held with general practitioners and pulmonologists in seven different countries in Europe and Asia. We generated three themes, whereby some of the issues concerned smokers in general: first, ‘physicians’ frustration with chronic obstructive pulmonary disease patients who smoke’. These frustrations interfered with the provision of evidence-based treatment and could result in this group of patients being treated unequally. Second: ‘physicians’ limited knowledge of, and negative beliefs about, smoking cessation treatment’. This hindered treating smokers effectively. Third: ‘healthcare organisational factors that influence the use of smoking cessation treatments’. Money and time issues, as well as the failure to regard smoking as a disease, influenced how physicians engaged in smoking cessation treatment. Our results indicate that there is a number of barriers to the provision of effective smoking cessation treatment in patients with chronic obstructive pulmonary disease and smokers in general. Introducing an informative smoking cessation programme, including communication skills and ethical issues, in the vocational and postgraduate medical training may help to address these barriers. This is important in order to increase engagement with smoking cessation treatment and to improve quality of chronic obstructive pulmonary disease care.
ever used pharmacological, behavioural and alternative smoking cessation treatments. Furthermore, smokers with COPD more often received triggers to quit from their environment and from their general practitioner, and they were more concerned about, and aware of, the health risks of smoking. Importantly, smokers with COPD reported higher levels of depression and cigarette dependence and a lower self-efficacy to refrain from smoking than smokers without COPD. Conclusion: Smokers with COPD differ from smokers without COPD on several factors which are associated with tobacco smoking and quitting. Taking into account these differences may help to increase the effectiveness of smoking cessation treatments for the specific group of smokers with COPD.
BackgroundSmokers with chronic obstructive pulmonary disease (COPD) seem to be a special subgroup of smokers that have a more urgent need to quit smoking but might find it more difficult to do so. This study aimed to explore which justifications for tobacco smoking and experiences of quitting were commonly shared in smokers with and without COPD, and which, if any, were specific to smokers with COPD.MethodsIn ten primary healthcare centres in the Netherlands, we conducted semi-structured, in-depth interviews in 10 smokers with and 10 smokers without COPD.ResultsThree themes were generated: ‘balancing the impact on health of smoking’, ‘challenging of autonomy by social interference’, ‘prerequisites for quitting’. All participants trivialized health consequences of smoking; those with COPD seemed to be less knowledgeable about smoking and health. Both groups of smokers found autonomy very important. Smokers with COPD were indignant about a perceived lack of empathy in their communication with doctors. Furthermore, smokers with COPD in particular had little faith in the efficacy of smoking cessation aids. Lastly, motivation for quitting was dominated by fluctuation and smokers with COPD specifically maintained that their vision of life was linked with quitting.ConclusionsThe participants showed many similarities in their reasoning about smoking and quitting. The corresponding themes argue for a less paternalistic regime in the communication with smokers with attention required for the motivational stage and room made for smokers’ own views, and with clear information and education. Furthermore, addressing social interactions, health perceptions and moral agendas in the communication with smokers with COPD may help to make smoking cessation interventions more suitable for them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0382-y) contains supplementary material, which is available to authorized users.
In Western countries, cigarette smoking is the most important risk factor for the development of chronic obstructive pulmonary disease (COPD) [1]. Besides, patients with COPD who continue to smoke have a higher prevalence of respiratory symptoms, more accelerated decline in lung function and higher mortality rate than nonsmokers [1]. Therefore, smoking cessation is the single most effective way to prevent COPD and reduce its progression [1]. The Cochrane Review on smoking cessation interventions for people with COPD shows that evidence-based smoking cessation interventions exist, but the chances of successful quitting are still relatively low in this group of smokers [2]. The effectiveness of such interventions can depend on the characteristics of the patient [3]. Knowing which patient characteristics are associated with successful quitting might facilitate the design of more effective smoking cessation interventions for patients with COPD. We used data from a randomised controlled smoking cessation trial to identify patient-specific predictors for long-term abstinence. This trial was originally designed to assess the efficacy of confronting smokers with newly found airflow limitation to facilitate smoking cessation (ISRCTN 64481813) [4]. A total of 296 smokers with mild-to-moderate COPD were randomly allocated to confrontational counselling with a nurse and administered nortriptyline for smoking cessation (experimental group), regular counselling with a nurse and nortriptyline (control group 1), or "care as usual" for smoking cessation by their general practitioner (control group 2) [4, 5]. Inclusion criteria were as follows: a smoking history of ⩾10 pack-years; competency in reading and speaking Dutch; reporting of at least one respiratory symptom (cough, sputum production, or shortness of breath); and a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <70% in combination with post-bronchodilator FEV1 >50% predicted [1, 6]. Exclusion criteria were as follows: having contraindications for the use of nortriptyline; prior respiratory diagnosis; and having undergone spirometry during the preceding 12 months [4, 5].
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