Introduction. Smoking is a leading cause of morbidity and mortality globally and it is a significant modifiable risk factor for cardiovascular disease (CVD) and other chronic diseases. Efforts to encourage and support smokers to quit are critical to prevent premature smoking-associated morbidity and mortality. Hospital settings are seldom equipped to help patients to quit smoking thus missing out a valuable opportunity to support patients at risk of smoking complications. We report the impact of a smoking cessation clinic we have established in a tertiary care hospital setting to serve patients with CVD. Methods. Patients received behavioural and pharmacological treatments and were followed up for a minimum of 6 months (mean 541 days, SD 197 days). The main study outcome is ≥50% reduction in number of cigarettes smoked at followup. Results. One hundred and eighty-six patients completed ≥6 months followup. More than half of the patients (52.7%) achieved ≥50% smoking reduction at follow up. Establishment of a plan to quit smoking and use of nicotine replacement therapy (NRT) were significantly associated with smoking reduction at followup. Conclusions. A hospital-based smoking cessation clinic is a beneficial intervention to bring about smoking reduction in approximately half of the patients. 1. Introduction Smoking is a leading cause of premature and preventable death worldwide claiming the lives of over 5 million people each year [1]. Twenty percent of Canadians over the age of 15 years continue to smoke [2]. Lifelong smokers die 10 years earlier than nonsmokers [3]. However, these lost life years can be regained if smoking cessation occurs early [3, 4]. Smoking therefore represents one of the most important modifiable risk factors which when changed can prevent significant mortality and morbidity. Nicotine (a component of cigarettes) is an addictive substance [5] similar in its addictive properties to other addictive substances including opioids and alcohol where nicotine-dependence is manifested by physical withdrawal symptoms and the continued use of smoking to relieve such symptoms [6]. Therefore, attempts to quit smoking can be challenging needing specialized treatments and interventions. Both population and individual tobacco prevention and treatment strategies are required to minimize tobacco use and to reduce the exposure of nonsmokers to secondhand smoke. Effective strategies include increased taxation on tobacco products [7] and banning smoking in public places. In hospital settings, smokers commonly present with life-threatening conditions
References
[1]
WHO, “WHO report on the global tobacco epidemic, 2009: implementing smoke-free environments,” Tech. Rep., WHO, Geneva, Switzerland, 2009.
[2]
Canadian Tobacco Use Monitoring Survey (CTUMS).
[3]
R. Doll, R. Peto, J. Boreham, and I. Sutherland, “Mortality in relation to smoking: 50 Years' observations on male British doctors,” British Medical Journal, vol. 328, no. 7455, pp. 1519–1528, 2004.
[4]
Z. A. K. Frosch, L. C. Dierker, J. S. Rose, and R. J. Waldinger, “Smoking trajectories, health, and mortality across the adult lifespan,” Addictive Behaviors, vol. 34, no. 8, pp. 701–704, 2009.
[5]
N. L. Benowitz, “Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics,” Annual Review of Pharmacology and Toxicology, vol. 49, pp. 57–71, 2009.
[6]
N. L. Benowitz, “Clinical pharmacology of nicotine: implications for understanding, preventing, and treating tobacco addiction,” Clinical Pharmacology and Therapeutics, vol. 83, no. 4, pp. 531–541, 2008.
[7]
Monitoring the Ontario Tobacco Strategy. Smoking Cessation in Ontario 1998/99-Current Trends, Interventions and Initiatives, 2000, http://www.otru.org/special_reports.html.
[8]
P. S. Yusuf, S. Hawken, S. ？unpuu et al., “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study,” The Lancet, vol. 364, no. 9438, pp. 937–952, 2004.
[9]
R. West and J. Stapleton, “Clinical and public health significance of treatments to aid smoking cessation,” European Respiratory Review, vol. 17, no. 110, pp. 199–204, 2008.
[10]
N. A. Rigotti, M. R. Munafo, and L. F. Stead, “Smoking cessation interventions for hospitalized smokers: a systematic review,” Archives of Internal Medicine, vol. 168, no. 18, pp. 1950–1960, 2008.
[11]
E. J. Mills, P. Wu, D. Spurden, J. O. Ebbert, and K. Wilson, “Efficacy of pharmacotherapies for short-term smoking abstinance: a systematic review and meta-analysis,” Harm Reduction Journal, vol. 6, no. 1, p. 25, 2009.
[12]
M. J. Eisenberg, K. B. Filion, D. Yavin et al., “Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials,” Canadian Medical Association Journal, vol. 179, no. 2, pp. 135–144, 2008.
[13]
L. F. Stead, R. Perera, C. Bullen, D. Mant, and T. Lancaster, “Nicotine replacement therapy for smoking cessation.,” Cochrane Database of Systematic Reviews, no. 1, p. CD000146, 2008.
[14]
D. E. Jorenby, S. J. Leischow, M. A. Nides et al., “A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation,” New England Journal of Medicine, vol. 340, no. 9, pp. 685–691, 1999.
[15]
N. Rovina, I. Nikoloutsou, G. Katsani et al., “Effectiveness of pharmacotherapy and behavioral interventions for smoking cessation in actual clinical practice.,” Therapeutic advances in respiratory disease, vol. 3, no. 6, pp. 279–287, 2009.
[16]
C. T. Bolliger, J. P. Zellweger, T. Danielsson et al., “Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety,” British Medical Journal, vol. 321, no. 7257, pp. 329–333, 2000.
[17]
E. Beard, A. Mcneill, P. Aveyard, J. Fidler, S. Michie, and R. West, “Use of nicotine replacement therapy for smoking reduction and during enforced temporary abstinence: a national survey of English smokers,” Addiction, vol. 106, no. 1, pp. 197–204, 2011.
[18]
K. Kroenke, R. L. Spitzer, and J. B. W. Williams, “The patient health questionnaire-2: validity of a two-item depression screener,” Medical Care, vol. 41, no. 11, pp. 1284–1292, 2003.
[19]
K. O. Fagerstrom and N. G. Schneider, “Measuring nicotine dependence: a review of the fagerstrom tolerance questionnaire,” Journal of Behavioral Medicine, vol. 12, no. 2, pp. 159–182, 1989.
[20]
S. S. Anand, F. Razak, A. D. Davis et al., “Social disadvantage and cardiovascular disease: development of an index and analysis of age, sex, and ethnicity effects,” International Journal of Epidemiology, vol. 35, no. 5, pp. 1239–1245, 2006.
[21]
J. Treasure, “Motivational interviewing,” Advances in Psychiatric Treatment, vol. 10, no. 5, pp. 331–337, 2004.
[22]
W. R. Miller and S. Rollnick, Motivational Interviewing: Preparing People for Change, 2002.
[23]
V. Lemmens, A. Oenema, I. K. Knut, and J. Brug, “Effectiveness of smoking cessation interventions among adults: a systematic review of reviews,” European Journal of Cancer Prevention, vol. 17, no. 6, pp. 535–544, 2008.
[24]
N. Dawood, V. Vaccarino, K. J. Reid, J. A. Spertus, N. Hamid, and S. Parashar, “Predictors of smoking cessation after a myocardial infarction: Te role of institutional smoking cessation programs in improving success,” Archives of Internal Medicine, vol. 168, no. 18, pp. 1961–1967, 2008.
[25]
FDA drug safety communication: Chantix (varenicline) may increase the risk of certain cardiovascular adverse events in patients with cardiovascular disease, 2011, http://www.fda.gov/Drugs/DrugSafety/ucm259161.htm.
