A recent study in the Journal of Clinical Nursing (Wilson, et al) looked at the experience of tobacco/cigarette smokers who had been diagnosed with chronic obstructive pulmonary disease, better known as COPD. The lion-share of those with this diagnosis are people who suffer from emphysema. Perhaps many COPD diagnosed individuals think it is too late for them to quit smoking. Perhaps, they just don't care. It has been my experience that people with COPD fall into three categories: 1) they feel it's too late for them; 2) they already stopped smoking, but still suffer the consequences of COPD; or 3) they want to quit, but they're not yet convinced that they're really bad off yet.
In fact, previous studies show that people who have COPD are less likely to quit smoking, as their smoking cessation rates are fairly low compared to the remaining population at large. Interestingly, the number one treatment outlined in the GOLD guidelines is to remove the cause of the disease, or in other words, quit smoking. COPD is the single most preventable disease. Simply quit smoking and sit back and watch the disease rates melt to insignificance.
In the past, nobody really knew why their smoking cessation rates were so low. This study was a randomized controlled trial and evaluated the national smoking cessation guidelines and conducted interviews to distinguish why COPD patients were unsuccessful at quitting smoking. They questioned the participants and identified 6 themes listed as follows:
1 - Too late to stop now2 - Finding motivation
3 - Guilt about continued smoking
4 - Bargaining/contemplation
5 - Need to stop
6 - Reduced quality of life
What they found in this population is that a complex pattern of thought and behavior is at work, in spite of the rather obvious connection between cigarette smoking and poor or declining health. For many with COPD, cigarettes are regarded as "friends". It clearly helps us understand the old expression that says, "with friends like these, who needs enemies". Additionally, these people also avoid healthcare opportunities which contributes to their continuing disability.
So as we first said in the beginning, many with COPD associate smoking cessation with ambivalence. Sadly, this is all too prevalent a problem in many who smoke, regardless of their disease state(s). They either misunderstand the hazardous health affects of smoking or don't feel it will happen to them. As was demonstrated in this particular study, they may also feel it's simply too late for them. But the catch is, it isn't too late for many with COPD. Remember, COPD is a progressive disease that can be slowed through avoidance. The continuation of the disease will lessen once smoking cessation occurs.
We as healthcare workers need to get this message out to those with COPD. We need to let them know that they too can reap many benefits when they stop smoking - and the earlier the better.
