Smoking Cessation/Vaccinations

Key points

Smoking cessation in chronic obstructive pulmonary disease

Cigarette smoking is the leading risk factor for chronic obstructive pulmonary disease (COPD) in developed countries and an important contributor to the burden in most societies around the world. Patients with COPD who continue to smoke have a higher prevalence of symptoms persistence, an accelerated decline in lung function, increased exacerbations, and higher mortality rate than nonsmokers.1, 2, 3, 4, 5, 6 Therefore, smoking cessation has been identified as the single most cost-effective and

Smoking prevalence in chronic obstructive pulmonary disease

A significant proportion of patients with COPD continue to smoke despite knowing they have the disease, and as a consequence this behavior has a negative impact on the prognosis and progression of the disease.⁷

Several cross-sectional worldwide population-based studies have assessed the smoking status (never, former, and current smokers) in different COPD population. The IBERPOC study in Spain reported a prevalence of 15% and 12.8% for patients with COPD who are current and ex-smokers ,

Characteristics of smokers with chronic obstructive pulmonary disease

There are differences in clinical characteristics between smoking patients with and without COPD. Smokers with COPD exhibit higher levels of nicotine dependence, smoke more cigarettes a day, have higher cotinine concentrations, and have less self-efficacy and self-esteem than those without the disease, all of which affect their ability to quit smoking.^13,23,24 This does not seem to be due to lack of motivation to quit, which was not different between smokers with and without COPD.²⁴ On the

Smoking diagnosis in chronic obstructive pulmonary disease

The approach to the smoking patient in general should consider the mental situation in which the subject is at the time of consultation, paying attention to 2 aspects intimately linked with tobacco use: motivation and dependence.

Smoking cessation treatments

Several studies have shown that a combination of counseling plus pharmacotherapy is the most effective cessation intervention for smokers with COPD.34, 35, 36, 37

Smoking reduction

Approved smoking cessation medications (NRT, bupropion, and varenicline) in combination with SCC have shown to double or triple quit rates under stringent settings of clinical trials. Nonetheless, relapse is common in the course of a smoking cessation; therefore, harm reduction has been considered as an alternative approach for resistant smokers with COPD or for those who are not ready to quit. This represents a dilemma for many pulmonary physicians and the results of the smoking reduction

E-cigarettes

Recently the use of novel tobacco products, particularly the electronic cigarette (EC) has increased probably due to the presumption that this is associated with less damage, as well as reducing the symptoms of anxiety and withdrawal from tobacco by sharing the same visual and sensory characteristics. Although the potential harm reduction due to switching from conventional cigarettes to EC in patients with COPD has not been studied, the perception exists that they are safer or are an effective

Vaccination in patients with chronic obstructive pulmonary disease

Acute exacerbations are an important cause of morbidity and mortality in patients with COPD. Although COPD exacerbations can be precipitated by factors, including environmental pollution, the most common causes seem to be respiratory tract infections by virus and bacteria (50%–70% of cases). Therefore, preventing exacerbations in patients with COPD is a major objective, and vaccination is accepted as an effective and simple preventive strategy to achieve this goal.⁶⁴ The most common vaccines

Vaccination rates

Although immunization against influenza is recommended for all patients with COPD by several international health authorities and guidelines, the coverage rates of influenza vaccination for high-risk patients including those with chronic respiratory diseases, remain less than target levels in many countries.65, 66, 67, 68, 69, 70 In the United States coverage of high-risk adults was less than the target of 70% (47.6% for those between 18 and 64 years and 66.7% in adults ≥65 years) in 2014 to

Influenza disease

Influenza are RNA viruses of the family orthomyxoviridae. Influenza A, B, and C are able to infect humans, with influenza A and B being the most common circulating types. Influenza A virus has been divided into subgroups based on the 2 core proteins hemagglutinin (H) and neuraminidase (N). There are at least 18 and 11 subtypes of hemagglutinin and neuraminidase, respectively; however only 3 H proteins (H1, H2, and H3) and 2 N proteins (N1 and N2) have been detected in human.

Influenza is an

Pneumococcal diseases in patients with chronic obstructive pulmonary disease

Streptococcus pneumoniae is an encapsulated gram-positive coccus and a major cause of community-acquired pneumonia (CAP) in adults worldwide, associated with considerable morbidity and mortality.89, 90, 91, 92

Lower respiratory tract infections and COPD are the fourth and the third leading causes of death worldwide in 2016, respectively, and about half of all deaths from lower respiratory infections are attributable to pneumococcal pneumonia.⁹³

A systematic review and meta-analysis reported an

Summary

More than one-third of patients with COPD continue smoking despite knowing that they have the disease and that this behavior has a negative impact on the disease prognosis and progression. Smokers with COPD exhibit higher levels of nicotine dependence and lower self-efficacy and self-esteem, which affects their ability to quit smoking. A combination of counseling plus pharmacotherapy is the most effective cessation treatment of smokers with COPD. Varenicline seems to be the most effective

Disclosure

M. Montes de Oca has stated that she has nothing to disclose.