Smoking Cessation and the Outcomes Strategy for COPD and Asthma

1. Smoking Cessation and the Outcomes Strategy for COPD and Asthma Anne Moger Nurse Advisor Department of Health Respiratory Programme

2. Where are we now? • Consultation on a Strategy for Services for people with COPD in England - NHS Operating Framework – 24 recommendations • BTS Stop Smoking Champions

3. ‘A burning platform’ for Stop Smoking interventions for people with COPD, asthma & mental health conditions Dr Louise Restrick and Dr Noel Baxter NHS London Respiratory Team Leads

4. What did we say in the consultation? • Recommendations • Actions

5. Recommendations: The consequences of exposure to the main risk factors of COPD should be understood and people with early symptoms of lung disease need to be able to recognise their symptoms and seek further investigations • interventions should seek to establish a connection between inhalational exposure and poor lung health. • the greatest risk to lung health is posed by smoking. Other factors include workplace exposure and general environmental pollution. • the two ways in which air pollutants can cause ill health or death are: day-to-day variations in exposure causing day-to-day increases in mortality; and long-term exposures causing disease in previously disease-free individuals.

6. Recommendations: Further evaluation work should be undertaken on the impact of the use of lung age tests on individual’s motivation for smoking cessation and testing for lung disease as a case finding approach • A new focus in prevention is the shift from viewing smoking as a lifestyle issue to viewing it as a preventable cause of premature death and disease for which there are psychosocial and pharmacotherapy treatment options. • Stop smoking services offer potential case-finding opportunities and we will be exploring the relative benefits, practicality and efficacy of case-finding methods to maximise this potential. We will also be exploring the opportunity to use lung age test to help increase individuals motivation to smoking cessation. • We estimate that over a ten-year period an additional 10,000 smokers who are diagnosed with COPD could potentially quit smoking long-term, thus helping to meet our aspiration to reduce adult smoking rates.

7. Recommendations: All people with COPD should receive evidence based treatment using a structured medicines management approach. A step up approach to smoking cessation intervention as part of preventative management strategies should be taken • Stop smoking services need to offer a long-term programme that is flexible enough to deal with an individual’s needs. • It is important that there is access to behavioural support and recommended stop smoking pharmacotherapies (e.g. nicotine replacement therapy including combination therapy, varenicline and bupropion) that greatly increase the chances of stopping smoking. • Evidence-based stop smoking interventions, which combine behavioural support and pharmacotherapy, offer the best chance of stopping smoking, and therefore avoid or significantly reduce the impact of lung disease.

8. Does smoking matter in eg London? Londoners dying from smoking ‘1 in 5 deaths due to smoking’

9. What does smoking cost? 'Smoking is the single biggest preventable cause of early death and illness. Smoking is estimated to cost the NHS £2.7 billion a year in England.' The NHS needs to address the gap between the £2.7 billion a year spent on treating smoking related illness and the less than £150 million spent on smoking cessation ….. 5% of the NHS 'smoking' budget is currently spent on quit smoking support …

10. High Quality care and support- COPD in hospital • Information about stop smoking interventions where appropriate

11. Actions: • Support pilot programmes to investigate the costs and benefits of simple testing for impaired lung function and lung age measurement in order to support the motivation to stop smoking.

12. Interventions: Extensive literature on stopping smoking demonstrates that success rates increase with the intensity of the intervention provided, ranging from 2% for brief opportunistic advice from a GP to 13–19% for intensive behavioural support plus pharmacotherapy. The advent of varenicline as a stop smoking treatment approved by NICE may further enhance quit rates within certain groups.

13. So what can you do? – the evidence • Access to an efficient Stop Smoking Service in every hospital would make a significant contribution to improving quit-smoking rates, and to decreasing hospital resource utilisation for example, in reducing post- operative complications in smokers .  (7. Ann M Møller et al. 2002. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 359:114-117).

14. The evidence (cont’d) There is evidence that a hospital stay can trigger smoking cessation in the absence of intervention (particularly for cardiac and respiratory patients)  and this effect can be enhanced with smoking intervention that begins in hospital and continues after discharge  Further, hospitalised smokers have to abstain from smoking while in hospital and are accessible to multiple healthcare workers who could provide brief smoking cessation advice and referral.

15. So… • You are part of the solution • Keep on keeping on • Thank you for listening! Anne.moger@pcc.nhs.uk