Treating tobacco dependence

What can we do as healthcare practitioners in our clinics and hospitals to help individual smokers quit? Before we try and answer this question it may be useful to think about tobacco use at population and individual levels.

Worldwide tobacco use is increasing, it remains one of the biggest single causes of preventable morbidity and mortality and it disproportionately affects the poorest members of societies. The tobacco problem has never gone away and has become normalized in many countries. ¹

Countries can drive down the prevalence of smoking by reducing the uptake of smoking in children and increasing the quit rates among adults. To increase quit rates among adults, the biggest gains have come from legislation and public policy including the banning of tobacco use in public places, increased taxation on tobacco products, media campaigns, prohibiting tobacco advertising and more recently the introduction of plain packaging in Australia. Helping individuals to quit smoking through tailored smoking cessation programmes compliments public policy in many countries. ¹

When we think about individual smokers that we see in our clinics and hospitals, there are some other useful pieces of information to think about. We know that smoking is an addiction to nicotine and like all addictions, it is difficult to overcome and that most smokers want to quit but need several attempts. Research has shown that the most successful way of quitting is by using the combination of behavioural support and pharmacotherapy. One of the biggest barriers to helping smokers quit is that most healthcare practitioners do not know how to help. ^2,3

The outpatient clinic provides a unique opportunity to help smokers quit and in this month’s journal, the study from Bahadir and colleagues investigated factors that may contribute to smokers dropping out from a smoking cessation clinic. They looked at 1324 patients attending a specialist smoking cessation. They found that 40% of patients dropped out of the clinic after the first visit and compared to people who continued the smoking cessation clinic, those who dropped out were younger, less addicted to tobacco and more likely to be treated with only behavioural therapy or nicotine replacement therapy.

So how can this study help us with the patients that you and I have in our clinics around the world? Firstly, it confirms that the majority of smokers (60%) will pursue treatment for tobacco addiction, that is, they are motivated and want to stop smoking. Secondly, the full menu of behavioural therapy together and pharmacotherapy are required to help the maximum number of smokers to quit their addiction. Thirdly, younger, less addicted patients may require a different approach as this group seems to have a higher dropout rate.

To conclude, knowing how to treat tobacco dependence effectively is fundamental to the practice of respiratory medicine and this study adds to our pool of knowledge.