2006 OPEN FORUM Abstracts
TOBACCO DEPENDENCE AND TREATMENT: AN EVALUATION AND REVIEW OF MOST RECENT STUDIES
Thomas John, Ph.D., RRT,
Tennessee State University, Nashville, Tennessee
Background: The effects of smoking result in
approximately 440, 000 deaths annually, with a cost of over $100 billion. Cigarette smoking continues as a cause for
serious health consequences and early death in Americans. As tobacco dependency is growing, smokers
need a multifactorial treatment program to help stop smoking.
Methods: Several recent articles related to tobacco
dependence and treatments were identified using Medline and pubMed
databases. Findings of the studies are
summarized.
Results: Bars et al (2006)
tested the hypothesis that the number of cigarettes smoked per day determines the
severity of tobacco dependence and consequently provides a way to give more
effective, individualized pharmacotherapy, i.e., individualizing treatment
based on disease severity. Their study
concluded that increasing combinations of medications according to personal
history (i.e., the number of cigarettes smoked daily) would improve abstinence
rates. Every enrollee in the study
received the same ongoing evaluation, education, advice and support. This tobacco dependency treatment program was
effective, safe with continuous abstinence rates exceeding most other published
studies. Fabio et al reported (2006)
that treatment with cognitive behavior therapy (CBT) + bupropion resulted in a
better 6 month rate of smoking cessation compared to CBT + nortriptyline or CBT
+ placebo. Abdullah et al reviewed
(2006) other effective smoking cessation intervention studies. All the reported studies demonstrate the
effectiveness of various smoking cessation interventions. A statistically significant percentage of
subjects quit smoking by behavioral therapy (advice, counseling). Older smokers (age ≥ 40) reported a
higher quit rate (25%) compared with younger smokers (age < 40; 17%) when
they used transdermal nicotine. Nicotine
replacement therapy (NRT) is most widely used to aid smoking cessation. NRT is available as patch and gum systems;
prescriptions are required for inhaler, nasal spray and lozenges. Sustained release bupropion is a second
controller medication. Individualizing
and tailoring medication combinations and doses improve tobacco dependence
treatment effectiveness. Other options include
the 5 A's approach (Ask, Advise, Assess, Assist and Arrange). Many people find it difficult to quit
smoking. Approximately 70% of smokers
having made at least one unsuccessful attempt to quit smoking. Even though such initial failures are disappointing,
the individuals concerned could succeed later with the help of proper
counseling and treatment modalities.
Conclusion: Quit smoking and abstinence rates can be
improved by appropriate interventions.
Respiratory Therapists and other health care professionals should
prepare themselves to provide smoking cessation service to each smoker they
encounter.