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Tobacco Cessation and Prevention |

Ethics and Smoking Cessation: Should the Medical Treatment Be a "Freewill" Choice or a Mandatory Issue for Hospitalized COPD Patients?

Lavinia Tilea, MD; Paraschiva Postolache, MD PhD FCCP; Florentina Lica, LPC; Magdalena Ciobanu*, MD
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National Institute of Pneumology "Marius Nasta", Bucharest, Romania


Chest. 2012;142(4_MeetingAbstracts):1089A. doi:10.1378/chest.1390670
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Abstract

SESSION TYPE: Tobacco Cessation and Prevention Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To identify the results of respecting the free-choice of COPD-related hospitalized patients regarding the method for smoking cessation

METHODS: All smokers hospitalized for COPD exacerbation in a Pneumology hospital received the same intensive counseling, consisting in motivational and behavioral counseling, specific education regarding smoking-related influences on COPD, the role of medication for cessation. It was emphasized the opportunity to start medication during hospitalization and to continue after discharge, free-of-charge. After one day, the patients were asked if they wish to follow the medical treatment for smoking cessation with varenicline or if they want to quit “cold turkey”. The treatment was initiated after all the possible drug interactions were evaluated. The smoker status was determined by CO measurement. A final evaluation was made at discharge. Evaluations at 3, 6 and 12 months will follow.

RESULTS: In the first 2 months of our study, 56 smokers with COPD-related exacerbations were admitted. 35 out of 56 patients (62,5%) considered sufficient the specific counseling for smoking cessation, while 21 patients (37,5%) expressed their wish to start medical treatment. From the 21 patients receiving medication, only one discontinued medication due to complications of COPD, meaning that 95.2% were non-smokers at discharge. From the 35 patients receiving only specific counseling, 19 (representing 54.3%) were non-smokers at discharge. This means that almost a third (30.3%) of all COPD patients were still smokers at discharge.

CONCLUSIONS: Despite their precarious physical and psychological status, intensive psychological counseling and free-of-charge, efficient treatment, almost one third of patients hospitalized for COPD exacerbation are reluctant to choose the evidence-based recommendation for quitting smoking and continue to smoke.

CLINICAL IMPLICATIONS: Taking into account the evidences about the effects of smoking on the evolution and prognosis of COPD, the efficacy of the medication for smoking cessation, these preliminary results could contribute to give an answer to the ethical issue: should we or should we not introduce the treatment for tobacco addiction in the regular treatment of COPD exacerbation, regardless the opinion of the patient.

DISCLOSURE: The following authors have nothing to disclose: Lavinia Tilea, Florentina Lica, Magdalena Ciobanu

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National Institute of Pneumology "Marius Nasta", Bucharest, Romania

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