The article, titled “Neglecting the neglected: Tobacco cessation support is essential for the management of asthma and COPD” by Karadoğan et al., published in Tob. Induc. Dis. in 2024, presents a critical examination of asthma and Chronic Obstructive Pulmonary Disease (COPD) management in Türkiye. The study highlights a significant gap in care: despite the essential role of smoking cessation in the comprehensive management of these chronic airway diseases, support for quitting tobacco appears to be largely neglected. Instead, the focus for both pulmonologists and patients often remains predominantly on pharmaceutical treatments, such as inhaler therapies.
The study aimed to investigate the real-world characteristics, smoking habits, and treatment strategies of individuals with chronic airway diseases, and to explore the feasibility and limitations of routinely implementing smoking cessation support. It was a multicenter, descriptive, and questionnaire-based follow-up study conducted between May and September 2022, gathering data from pulmonology departments of three government hospitals in Türkiye. The researchers analyzed data from 145 patients with asthma and 148 patients with COPD, all aged 18 years or older and diagnosed with their respective conditions for at least a year.
Key Findings on Smoking Prevalence and Associated Factors:
- The study revealed that 18.8% of asthma patients and 34.5% of COPD patients were current smokers. This is significant, especially for COPD, where other studies have shown rates around 50%.
- Current smoking was negatively associated with older age (≥65 years) and longer disease duration for both asthma and COPD patients. This suggests that younger patients (<65 years) were more likely to be current smokers, and patients might continue smoking in the early phases of their disease when clinical manifestations are still moderate, potentially due to a poor perception of their illness.
- For asthmatics, the presence of pulmonary disease in the family was negatively associated with current smoking.
- For COPD patients, at least one hospitalization in the last year was negatively associated with current smoking.
Outcomes of Smoking Cessation Interventions: The study involved implementing routine cessation interventions, including counseling based on the “5As” (Ask, Advise, Assess, Assist, Arrange follow-up), and directing all current smokers to smoking cessation clinics that offer counseling and free cessation medications. However, the follow-up after one month revealed extremely low engagement with cessation support:
- Among current asthmatic smokers, 85.1% did not attempt to call any quitline, while only 14.8% tried to contact one.
- Among current smoker COPD patients, 60.7% did not attempt to call quitlines, and despite 37.2% attempting contact, only 1.9% (just one patient) actually visited a smoking cessation clinic.
Why Quitting is Crucial and the Unmet Need: The article strongly emphasizes that avoidance of tobacco smoke exposure is an unquestionable factor in extending survival for patients with mild and moderate COPD. Moreover, continuing to smoke diminishes the efficacy of inhaler therapy, and even with advanced triple inhaler combinations, continued smokers showed no improvement in symptoms or functional status. Current smokers were also found to be more symptomatic and more likely to overuse inhaler treatments. Even a history of former smoking in asthmatics is associated with airway eosinophilic inflammation and lower response rates to systemic corticosteroids.
The low uptake of cessation services highlights an unmet need for accessible and effective smoking cessation support. Barriers to quitting identified include a lack of awareness about cessation clinics (21% of smokers unaware) and access issues such as distance and transportation costs.
Conclusions and Call to Action: The study concludes that tobacco cessation support is indeed neglected in the real-world care of asthma and COPD patients. It recommends that smoking cessation should be considered a first step for current smoker asthma and COPD patients, and healthcare providers must thoroughly explain that therapy will not be effective unless patients quit smoking, reiterating this at every “teachable moment”. The findings suggest a need for novel tobacco cessation recommendations to provide more effective support, potentially including immediate cessation support regardless of a patient’s preparedness to quit. Further research is warranted to improve the availability of and access to smoking cessation clinics.
The study’s strengths include its assessment of real-life situations and the detailed data collected by pulmonologists, providing informative insights into two common chronic airway diseases. However, its cross-sectional design limits causal inferences, and site-specific data may limit generalizability to other countries.
Reference: Karadoğan, D., Kaya, İ., Şenel, M. Y., Konyalıhatipoğlu, E. B., Telatar, T. G., & Akgün, M. (2024). Neglecting the neglected: Tobacco cessation support is essential for the management of asthma and COPD. Tob. Induc. Dis., 22, 22. https://doi.org/10.18332/tid/176228
