The Science Journal of the American Association for Respiratory Care

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.

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