Smoking Cessation in Clinical Practice: Experience of a Multidisciplinary Team in Smokers with Multiple Chronic Conditions

Objectives: To inform the profile of smokers with multiple chronic conditions (MCC) inserted in a unit aimed at smoking cessation, as well as the routine of a team of health professionals in assisting this population. Methods: Monocentric cohort study, retrospective longitudinal evaluation data from users of a therapeutic group for smoke cessation, with 51 consecutive groups of smokers with MCC assisted by a multidisciplinary team in Juiz de Fora, Brazil. Treatment consisted of pharmacotherapy and cognitive behavioural sessions followed by periodic evaluations up to 6 months. Results: Of the 348 smokers, 61.8% were female the average age was 56.2±9.1 years-old and 75.4% had low education. Physical inactivity 61.7%; alcohol abuse 18.6%; obesity 40.5%; hypertension, 89%; diabetes mellitus type 2, 47.5%; depression 49.7% and cognitive decline of 85.8%, among other diseases. Comparing who remained abstinent for 24 weeks or more with those who could not stop smoking, the abstainers had cessation rates of 18.7%. Brief cessation represented 57.7% and late cessation 58.3%. Those who stopped at the 4th and 12th week of follow-up were those who maintained abstinence (p<0.001). Conclusion: There was a considerable smoking rate, even among a population with multimorbidities and high cardiovascular risk. Strengthening, broadening and spreading tobacco control efforts is critical. Thus, health professionals must be motivated and able to conduct smoking cessation interventions.

Electronic cigarette

Despite significant efforts during the last decades, cigarette smoking still remains prevalent. Discouraging the use of all tobacco products, it is certainly the most effective mean to enhance public health, but complete prohibition is unlikely to succeed. The greatest challenge is the approach to chronic smokers, particularly those affected with cardiovascular conditions. To better support these patients during the difficult process leading to complete smoke cessation, it is important to characterize each patient from a clinical and psychological perspective, introducing the most reliable approaches to incentivize and support abstinence, such as varenicline and nicotine replacement therapy, thus providing a personalized recommendation. The recent introduction of electronic systems for nicotine release or tobacco heating (electronic cigarettes), offers an important challenge. These devices are reasonably considered as lower risk tools, thus providing a useful alternative which unable the patient a smoother transition toward smoking cessation, also presenting an array of choices among which a personalized selection could be made. This technology, though, should not be overemphasized, considering also its potential harmful effects, and certainly its use should be strongly discouraged in non-smokers, particularly at young age. This approach, cautious and pragmatic, aside from demonization or over-enthusiastic appraisal, could provide favourable results in the constant struggle against cigarette smoking.

Smoke cessation in cardiovascular pathology from the perspective of evidence-based medicine

The effectiveness of smoking cessation methods has been studied in various studies. However, little is known about the peculiarities of treatment of nicotine dependence in patients with cardiovascular diseases. In the presented review, according to the literature, the prevalence and characteristics of smoking, the duration of abstinence from smoking in patients with cardiovascular diseases with different methods of quitting tobacco use are described.It is shown that smoking cessation not only shows long-term positive effects, but almost immediately the supply of cells with oxygen increases, platelet aggregation, fibrinogen synthesis decreases. Carrying out treatment for nicotine addiction, especially when combined with behavioral support, significantly increases the effectiveness of quitting smoking. With the cardiovascular pathology, the efficacy and safety of varenicline has been proven.

Exploring Efficacy of a Serious Game (TOBBSTOP) for Smoking Cessation in Pregnant Women: Pilot Case-Control Study (Preprint)

BACKGROUND Tobacco use entails, during pregnancy, a serious risk to the mother and harmful effects on the development of the child. Europa has the highest tobacco smoking prevalence (19.3%) as compared to a worldwide mean of 6.8%. Twenty to thirty percent of pregnant women used tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on risks associated to tobacco use during pregnancy. OBJECTIVE This study aims to investigate the possibility to address this problem through a serious game (TOBBSTOP), something that has proven efficient as a tool for learning in many situations. By using a game for smoke cessation during pregnancy, we aim to maintain cessation and interest pregnant smokers in learning about health care and effects of tobacco by playing a game that helps them to achieve their challenge. METHODS A pilot case-control study enrolls 44 women who were visited in two primary care centers in Spain between March 2015 and November 2016. All participants were pregnant smokers over the age of 17 years attending consultation to a midwife during the first trimester of pregnancy who expressed their desire to stop smoking. We recruited the intervention group (n=22) among the attended on the centers and instructed them to install the game on their smartphone or tablet and use it for 3 months. Until the delivery, all participants had to respond to a questionnaire, assessing their stage on smoke cessation during their follow-up midwife consultations. The selected control group participants (n=22), matched for age, level of tobacco-dependence and number of smoking attempts. We tested the amount of CO at each visit with a carboxymeter during the entire intervention period to assess the abstinence. RESULTS Pregnant women from the intervention group, with 80.0% (12/15), had significant higher rates of cessation until delivery than control group (χ2=8.4; P=.004). Logistic regression analyses revealed that game’s use was associated with an increased likelihood to maintain smoking cessation during the intervention period compared with those not using the game (odds ratio 4.0; 95% CI 1.3-12.2). Additionally, a Mantel-Cox means’ analysis revealed that the use of the game was associated with an increased number of days without smoking, with an average of 139.7 days (95% CI 97.1-182.4) in the intervention group (χ2=13.912; P<.001). CONCLUSIONS Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games is an emerging technology, growing in importance, which is shown as a good tool to assist in maintaining women without smoking and help behavior change during pregnancy. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study.