Four years’ follow up at a smoking cessation clinic

• Published in: Revista portuguesa de pneumologia (English ed.) Vol. 15; no. 2; pp. 179 - 197
• Main Authors: Aguiar, M, Todo-Bom, F, Felizardo, M, Macedo, R, Caeiro, F, Sotto-Mayor, R, Bugalho de Almeida, A
• Format: Journal Article
• Language: English
• Published: Elsevier España 01.03.2009
• Subjects: consulta; Desabituação tabágica; fumador; Internal Medicine; outpatient smokers; Pulmonary/Respiratory; Smoking cessation; Smoking cessation; fumador; outpatient smokers; consulta; Desabituação tabágica
• ISSN: 2173-5115; 2173-5115
• DOI: 10.1016/S2173-5115(09)70104-6

AbstractSmoking is an important cause of pulmonary pathology and this addiction can be regarded as a chronic, recurrent disease. The benefits of smoking cessation are unquestionable and all physicians should become more active and assertive in recommending it.AimTo characterise the population seeking medical support for smoking cessation and understand why some successfully stop smoking and others do not.Material and methodsRetrospective analysis of medical records of outpatients in follow-up between January 2003 and June 2006. Age, gender, age at smokinginitiation, smoking burden (number of pack–years), associated diseases, degree of dependence (Fagerström test for nicotine addiction), prior attempts at and motivation for smoking cessation, need for cognitive/behavioural support and success and abandonment rates were evaluated.ResultsFive hundred and twenty six patients were studied, 50% male with an average age of 45.5 ± 11.4 years. Almost half (43.1%; n = 227) of the patients started smoking before the age of 15. Average smoking burden was 35.8 ± 20 pack-years although 21.4% (n = 113) smoked more than 50 pack-years. Respiratory disease was present in 52.1% (COPD, 39.9% and others, 12.2%) and cardiovascular disease in 14.6% of the patients. In 46% of patients (n = 242) a relevant psychiatric disorder was identified; depression (21.4%), anxiety disorder (19.4%), other dependencies (2.1%) bipolar disorder (1.5%) and schizophrenia (0.6%). The evaluation of degree of addiction revealed maximum level in 69.7% of the patients (n = 380). Many patients (72.2%; n = 380) reported prior attempts to quit smoking. The strongest reasons for giving up smoking were concern over health (83.5%), financial issues (8.2%) and search for better quality of life (5.7%). Most patients (81.7%; n = 430) had undergone nicotine replacement therapy; skin patches (53.3%), chewing gum (1.1%) or both (45.6%). Psychopharmacological treatment included administration of sedative-hypnotics (86.5%), bupropion hydrochloride (2.3%) and antidepressants (0.6%). Seventy six patients (14%) benefited from cognitive/ behavioural support. Two hundred and twenty three patients (42.4%) were successful in giving up smoking while 219 (41.6%) abandoned follow up, the majority after the first appointment. Most patients that abandoned follow up reported lack of motivation and the price of therapy. ConclusionsThe population under study had a high rate of psychiatric disorders and a high level of dependence and lack of motivation that might justify the drop-out rate. Successful treatment was associated with close follow up, behavioural support and pharmacological therapy.