Most of the disorders that respiratory therapists treat are caused by or exacerbated by smoking. Therefore, respiratory therapists are in a special position to promote the health of their clients through encouraging smoking cessation.
Smoking-related respiratory disorders
Approximately 16 million + Americans are living with chronic obstructive pulmonary disease (COPD) or other respiratory disorders (which include emphysema and chronic bronchitis).13
There are four types of respiratory disorders10:
- Obstructive - emphysema, bronchitis, asthma attacks, etc.10
- Restrictive - fibrosis, sarcoidosis, alveolar damage, pleural effusion, etc. 10
- Vascular - pulmonary edema, pulmonary embolism, pulmonary hypertension10
- Infectious - pneumonia, tuberculosis, asbestosis, etc.10
Chronic Obstructive Pulmonary Disease (COPD), Bronchitis, Emphysema, Asthma, and Pneumonia are the most common respiratory disorders.10 Smoking magnifies the effects of these respiratory illnesses.11 Tobacco smoking adversely affects the control of asthma2 and it also negatively affects diseases such as pneumonia and tuberculosis.2 A recent meta-analysis has shown an association between tobacco smoking and the onset of tuberculosis, such that the relative risk for contracting tuberculosis is higher in individuals who are active smokers (although the mechanism for the higher rates of contraction is still under investigation).5
Tobacco smoking significantly contributes to respiratory disorders. It is a major factor in the development of COPD and lung cancer.3 Several epidemiological studies have shown that cigarette smoking is the primary factor in causing lung cancer and death from lung cancer.4 Research has also shown that cigarette smoking is the most impactful risk factor for COPD.3
Smoking cessation should be an integral component of treatment for COPD and other respiratory disorders.2
Quitting smoking after diagnosis
Even after being diagnosed with a respiratory illness, it's not too late to quit smoking. Smoking exposes DNA to harmful chemicals which physically alter its helical structure, causing damage and introducing mutations which oftentimes lead to cancer. Quitting smoking can slow the impact of these negative consequences and recovery is possible.
Data also reveals that while quitting is beneficial at any age, quitting while young is the best. The surgeon general reports that "Approximately one in six young adult smokers who do not quit until 40 years of age still may die prematurely from a smoking-related disease, but the excess risk more than doubles among former smokers who do not quit before 55 years of age”11. Quitting earlier leads to a faster recovery rate. Continuing to smoke after diagnosis worsens the problem. DNA continues to get damaged and health risks continue to increase, which worsens the respiratory illness and minimizes the chance of recovery.
Characteristics of respiratory patients who smoke
Respiratory patients are a difficult target. At some stage in a patient’s development of respiratory symptoms, advice from a general practitioner is likely to have been given, perhaps multiple times. During this process, it is possible the patient will become “tolerant” to the practitioner’s advice and recommendations may have less and less of an effect on the patient. The more severe the lung disease, the more difficult it is for a patient to give up smoking. In the advanced stages of COPD, quality of life may be low and the smoking patient might consider smoking one of the few things that improve ones life.2
Research has shown that anxiety level, which is associated with depression, is higher among COPD smokers. In this situation, smoking may help COPD smokers control anxiety and emotions and serve as a form of self-medication for patients.2
Smokers who have respiratory problems, especially COPD, exhibit higher dependence on tobacco.6 Smokers with COPD also tend to inhale more deeply and rapidly than other smokers.6
Respiratory therapists should possess the following tobacco treatment competencies:
- Tobacco dependence knowledge and education
Respiratory therapists should be able to provide patients with clear and accurate information about tobacco use, strategies for quitting, and the causes and consequences of tobacco use.7
- Counseling skills
Respiratory therapists should be able to demonstrate effective application of counseling theories and establish a collaborative relationship with patients.7
Motivational enhancement strategies help tobacco users feel supported and understood, not judged, and can be especially effective for engaging the process of change to help patients with respiratory disorders move toward quitting.8
Respiratory therapists should express genuine empathy, avoid arguments and confrontations, support confidence for the patient to change, and encourage the patient to make an informed, autonomous decision to change.8
- Assessment interview
Respiratory therapists should be able to conduct an assessment interview to obtain comprehensive and accurate data for treatment planning.7
Respiratory therapists can use various brief interventions to help patients with tobacco cessation.8
Ask: It is crucial to ask patients about tobacco use every time. Respiratory therapists should ask patients about their current and past smoking patterns.8
Advise: Respiratory therapists should advise patients to quit in a clear, strong, and personalized manner.8
Assess: It is important to assess how ready the patient is to quit tobacco use. Readiness Rulers and Stages of Change assessments help to address how ready a patient is to change.9
Note: If you become Fax to Assist certified through our website, you can download a copy of a Readiness Ruler to use in your practice!
Assist: Respiratory therapists can provide help for individuals ready to quit through helping patients develop a personalized quit plan.8
Arrange: Follow-up contact is important in helping patients remain quit.8
- Treatment planning
Respiratory therapists should be able to demonstrate the ability to develop an individualized treatment plan using evidence-based treatment strategies.8
Options for patients include medications and Nicotine Replacement Therapy (NRT). Patients can also access the Maryland Quit Line or therapists can help refer them to the Quitline via the Fax to Assist program.8
Some forms of NRT are offered for FREE via the Maryland Quit Line!
- Relapse prevention
Respiratory therapists should offer methods to reduce relapse and provide ongoing support to patients.7 Follow-up contact in-person or via telephone is helpful for patients. Patients should be encouraged to remain quit and congratulated for their successes.8 For patients who have quit tobacco, respiratory therapists can affirm their successes and discuss any challenges they may face in maintaining tobacco cessation8.
- Diversity and specific health issues
Respiratory therapists should demonstrate competence in working with diverse population subgroups.7
- Documentation and evaluation
Respiratory therapists should describe and use methods for tracking individual progress, record keeping, and outcome measurement.7
- Professional resources
Respiratory therapists should utilize resources available for client support and for professional education in patients.7
Recommendations for respiratory therapists
Patients with respiratory problems have a greater and more urgent need to quit smoking. Therefore, respiratory therapists should prioritize smoking cessation in their patients.2
Respiratory therapists must take a proactive and continuing role with smokers in motivating them to quit.2
In treating smoking patients, respiratory therapists should:
- Regularly assess the smoking status of their patients. This assessment should include examining CO in exhaled air and checking the patient’s breath or fingernails. This assessment should also include determining the patient’s motivation for giving up smoking. Respiratory therapists should assess the patient’s dependence through biochemical measures or a questionnaire. The patient’s smoking status should be clearly documented in his or her record.2
- Complete a brief intervention to effectively address tobacco use with the patient.2
- Provide the patient with information on pharmacological treatments for smoking cessation.2
- Provide the patient with information on behavioral support, such as psychosocial interventions and quit lines.2
- Advise patients not interested in quitting that he or she will return to the question later.2
Respiratory Disorders and COVID-19
Individuals with respiratory disorders such as chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), asthma, idiopathic pulmonary fibrosis and cystic fibrosis, are at a higher risk for severe illness from COVID-19.13 For more information on COVID-19 and its impact on individuals who use tobacco, please click here.
American Association for Respiratory Care (AARC) Tobacco Resources
American Association for Respiratory Care (AARC) The Role of Respiratory Therapists in Tobacco Cessation
Did you know that the Medicaid population is significantly more likely to use tobacco than the general population? Do you want to enhance your skills at reaching and intervening with Medicaid patients who use tobacco? MDQuit has an online training to teach you the strategies that can be utilized with all patients—regardless of their health insurance status. You can sign-up for this FREE self-paced online training by going to https://HABITSLabTraining.litmos.com/self-signup/ and entering the training code, "medicaid".
American Association for Respiratory Care. (2019). Tobacco resources. Retrieved June 11, 2020 from https://www.aarc.org/resources/clinical-resources/tobacco-resources/
Tonnesen, P., Carrozzi, L., Fagerstrom, K.O., Gratziou, C., Jimenez-Ruiz, C., & Nardini, S. (2007). Smoking cessation in patients with respiratory diseases: A high priority, integral component of therapy. European Respiratory Journal, 29: 390–417. doi: 10.1183/09031936.00060806
Bollmeier, S. G., Hartmann, A. P. (2020). Management of chronic obstructive pulmonary disease: A review focusing on exacerbations. American Journal of Health-System Pharmacy, 77(4), 259–26.
Di Cicco, M. E., Ragazzo, V., Jacinto, T. (2016). Mortality in relation to smoking: the British Doctors Study. Breathe,12, 275-276. doi: 10.1183/20734735.013416
Patra, J., Bhatia, M., Suraweera, W., Morris, S. K., Patra, C., Gupta, P. C., & Jha, P. (2015). Exposure to Second-Hand Smoke and the Risk of Tuberculosis in Children and Adults: A Systematic Review and Meta-Analysis of 18 Observational Studies. PLosMED, 12(6), doi:10.1371/journal.pmed.1001835.
Jiménez-Ruiz, C.A., et al. (2015). Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. European Respiratory Journal, 46, 61-79. doi: 10.1183/09031936.00092614
- Association for the Treatment of Tobacco Use and Dependence. (2011). Integrated Tobacco Treatment with Behavioral Health. Retrieved June 16, 2020 from https://www.attud.org/pdf/ATTUD-position%2Btalkingpoints.pdf
- MD Quit. (2012). Brief interventions & 5 A’s. Retrieved September 4, 2012 from http://mdquit.org/cessation-programs/brief-interventions-5
- MD Quit. (2012). Transtheoretical Model. Retrieved September 4, 2012 from http://mdquit.org/health-behavior-models/transtheoretical-model-ttm
- Disabled World. (2015-04-09). Retrieved 2017-03-31, from https://www.disabled-world.com/health/respiratory/
US Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 17.
Centers for Disease Control and Prevention (2019). COPD: Symptoms, Diagnosis, and Treatment. Retrieved on June 16, 2020 from https://www.cdc.gov/features/copd-awareness-month/index.html
Centers for Disease Control and Prevention (2020). Groups At Higher Risk for Severe Illness. Retrieved on June 17, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html