Characteristics and predictors of readiness to quit among emergency medical patients presenting with respiratory symptoms

Do we need tailored smoking cessation interventions for smokers with COPD? A comparative study of smokers with and without COPD regarding factors associated with tobacco smoking

BACKGROUND

The prevalence of tobacco smoking in patients with chronic obstructive pulmonary disease (COPD) is high. It is assumed that this group of smokers has more difficulties quitting than smokers without COPD. In order to increase the effectiveness of smoking cessation treatments in smokers with COPD it is important to identify any smoking-related factors which are specific to this group of smokers.

OBJECTIVE

To compare smokers with COPD with smokers without COPD regarding factors associated with tobacco smoking and quitting.

METHODS

We conducted a questionnaire survey in all smoking patients with a recorded diagnosis of COPD from a large Dutch primary health care network. We compared this group with twice as many age-, sex- and health care centre-matched smokers without COPD.

RESULTS

Respondents were 107 smokers with COPD and 86 smokers without COPD. The number of attempts to quit was similar in both groups but more smokers with COPD had 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.

Cigarette smoking and emergency care utilization among asthmatic adults in the 2011 Asthma Call-back Survey

OBJECTIVE

Estimate the association between smoking and emergency care in the past 12 months among asthmatic adults in a nationally representative sample.

METHODS

Using the 2011 Asthma Call-Back Survey, the association between smoking status and emergency department (ED) and urgent visits among asthmatic adults (n = 12 339) was assessed through multivariable logistic regression by a cross-sectional study design. Analyses used survey weights for US population-based estimates. Attributable and population attributable risk were calculated to describe the potential benefits of smoking cessation.

RESULTS

Adjusting for potential confounders, during the past 12 months former smokers had 1.30 (95% CI: 0.97, 1.74) times the odds and current smokers had 1.46 (95% CI: 1.05, 2.03) times the odds of visiting the ED compared to never smokers. Former smokers had 1.28 (95% CI: 0.99, 1.65) times the odds and current smokers had 1.29 (95% CI: 0.96, 1.73) times the odds of urgent visits compared to never smokers. Among adult asthmatics, an estimated 9% of ED visits and 6% of urgent visits can be attributed to current smoking while 7% of ED visits and 7% of urgent visits can be attributed to former smoking.

CONCLUSIONS

Current and former smokers are more likely to need emergency care than never smokers. About 10% of emergency care visits among asthmatics can be attributed to smoking assuming smoking is causally related to emergency care. Long-term effective management of asthma, particularly the prevention and cessation of smoking, could reduce emergency care use and health care costs.

Asthma and smoking--healthcare needs and preferences of adults with asthma who smoke

OBJECTIVE

People with asthma smoke at least as much as, if not more than, people without asthma. The aim of this study was to explore the unique healthcare needs and preferences of smokers with asthma, in terms of smoking topography and initiation, perceived interplay between asthma and smoking, motivation and readiness to quit, and proposed smoking cessation techniques.

METHODS

Qualitative, semi-structured, in-depth telephone interviews with adult smokers who have concurrent asthma were conducted. Participants were recruited through flyers displayed at community pharmacies, general practice surgeries, university campuses, and respiratory clinics of tertiary hospitals and through an advertisement on the "Asthma Foundation" website. Recorded interviews were transcribed verbatim and analysed using NVivo 10 software (QSR International, Melbourne, Victoria, Australia). Obtained data were content-analysed for emergent themes using the 'framework approach'.

RESULTS

Twenty-four semi-structured interviews were conducted. Most participants believed that smoking often worsens their asthma and increases the frequency and severity of their symptoms. Fear of asthma-related exacerbations and poor self-control appeared to be the major triggers for quitting smoking. Most patients reported being motivated to quit smoking; however, in many cases, determination and strong will power need to be coupled with public, social, professional, and therapeutic support to achieve and maintain success.

CONCLUSIONS

Given the unique needs of people with asthma who smoke, it is imperative that evidence-based smoking cessation programs be designed and tailored to assist them in effectively quitting smoking.