Psychological Approaches to Increase Tobacco Abstinence in Patients with Chronic Obstructive Pulmonary Disease: A Review
BACKGROUND Smoking cessation is the primary disease modifying intervention for chronic obstructive pulmonary disease (COPD). SETTING A Regional Respiratory Centre (RRC) out-patient department in Northern Ireland. METHODS A randomised controlled trial (RCT) evaluated the effectiveness of brief advice alone or accompanied by individual nurse support or group support facilitated by nurses. Smoking status was biochemically validated and stage of change, nicotine addiction and dyspnoea were recorded at 2, 3, 6, 9 and 12 months. PARTICIPANTS Ninety-one cigarette smokers with COPD were enrolled in the study (mean age 61 years, 47 female). RESULTS After 12 months cessation rates were not significantly different between groups (p=0.7), but all groups had a significant reduction in their nicotine addiction (p=0.03-0.006). No changes in subjects' motivation or dyspnoea were detected over the 12 months. CONCLUSION Patients with COPD were unable to stop smoking regardless of the type of support they received. Harm reduction may be a more appropriate goal than complete cessation for intractable smokers and nurses must evaluate their role in this arena.