Dr. Perk Joep
This session on strategies for smoking cessation commenced with a presentation from Sidney Smith (US) who asked whether patients will survive government policy and tobacco industry efforts. It is estimated that 15.000 persons die every day due to active smoking and another 1000 persons die due to second hand smoke. Dr Smith stated that the WHO Framework Convention on Tobacco Control (FCTC) is the most important initiative in tobacco control worldwide, reaching out to 87% of the global population. In Europe, the United Kingdom (UK) provides the most successful services for smoking cessation through the National Health Service. However, in general, Europe appears to be lagging behind in legislation on smoke-free environments, on cigarette packaging and on picture pack warnings: ample room for improvement in government policies.
From the UK Kornelia Kotseva and David Wood both presented the smoking data from the EUROASPIRE III database and from the EUROACTION demonstration project. It was shown that 17% still smoked one year after a coronary event but the picture was more gloomy among the younger age groups: below 50 years of age the prevalence of smoking was 27.8% and a surprisingly large majority of those who smoked before the coronary event still smoked one year later: 88.6%!
In the EUROACTION project, no significant beneficial effect of the program on smoking cessation could be shown, neither among CVD patients nor among those at high risk for CVD. Therefore they designed the EUROACTION PLUS trial, a trial in general practice of a nurse-led prevention program among patients at high CVD risk and their partners, where the optional use of the drug varenicline was added to the protocol. This resulted in a positive outcome regarding smoking cessation: 51.2% had stopped smoking as compared to 18.8% in the control group. Even the partners showed higher rates of smoking cessation: 73.1 vs 36.7%. When asked if the result was due to the nurse or the drug, Kotseva and Wood replied it was the combined effect of the program. When interpreting the positive outcome, it should be noted that patients were only included if they had agreed upon stopping smoking before entering the program, which resulted in 20% inclusion of the entire eligible population.
Eva Froelicher (US) demonstrated the excellent guidance for smoking cessation programs (US surgeon general) that nowadays can be found on the Internet, clear step by step models for use in clinical practice. Intensive programs should consist of 4-7 sessions of 20-30 minutes lasting at least two weeks. She concluded by stating that healthcare systems should be modified to routinely identify and intervene in cases if current smoking and that patients should be provided with personalized quit plans.
Strategies for smoking cessation: policy and practice
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