Importance of Smoking Cessation among Patients with Chronic Obstructive Pulmonary Disease - Essay Example

Importance of Smoking Cessation among Patients with COPD Introduction Patients with Chronic Obstructive Pulmonary Disease (COPD) require various interventions which are meant to increase their breathing and pulmonary functions. Clearing lung congestion is an important aspect of patient management and this process can be secured medically, surgically, psychologically, and physically. One of the most important interventions among COPD patients is smoking cessation. Smoking cessation helps clear lung congestion and prevents the further accumulation of tar and cigarette components in the lungs. Evidence is however needed in order to support the importance of advocating and implementing smoking cessation among COPD patients. This paper will now critically evaluate evidence-based practice on the impact and the importance of smoking cessation among COPD patients. This topic is of importance because smoking is a major issue among COPD patients and the importance of smoking cessation has to be supported with evidence in order to provide practitioners as well as patients with logical foundations for their actions or inactions. Evidence-based practice Evidence-based practice has been considered one of the most crucial improvements in the health practice (Hjorland, 2011). Its application has assisted health professionals in the assessment of the most current evidence in the administration of patient care. The significance and multidisciplinary application of evidence-based practice is based on ideology and method (Hjorland, 2011). The ideology is based on ethical principles of clients deserving to be given the most effective of interventions. The method is the means by which individuals go about discovering and then later implementing the interventions (Duffy, Fisher, and Munroe, 2008). Under these conditions, evidence based practice indicates the commitment of the practitioner to use all the different means by which the strong evidence for any given situation can be applied (Duffy, et.al., 2008). Establishing best knowledge would require computer searches; moreover, it is a major challenge among practitioners since the techniques of finding effective interventions often require rigorous processes (Raines, 2008). Where practitioners applying empirically-based practice would make do with the use of two or three studies as evidence of effectiveness, evidence-based practice often involves the long and protracted search for numerous evidence to support efficacy (Raines, 2008). Evidence-based practice also involves the critical appraisal of evidence, mostly in terms of validity and utility within practice. The focus of evidence-based practice is on achieving a comprehensive search and a critical assessment of the results, in collaboration with clients with appropriate considerations on patient preference, as well as socially and culturally relevant approaches (Houser and Oman, 2010). While evidence-based practice has its benefits, issues in its application have been forwarded by different practitioners. For one, evidence-based practice often requires the application and use of randomized controlled trials (RCTs) which may not always be relevant in actual treatment scenarios (Houser and Oman, 2010). These RCTs can also be very expensive. Moreover, the studies published do not necessarily represent all the studies which have been carried out on the subject matter; in some cases, they may even be unreliable considering the varying conditions and variables which are present for each study (Freshwater and Rolfe, 2012). Locating and Appraising Evidence This study specifically searched for information related to smoking cessation and COPD. Specifically, this study needed information on the relevance, importance, impact, effect, or significance of smoking cessation on COPD patients. This research also covered relevant UK-based literature. Relevant studies used included randomized controlled trials, systematic reviews, cohort studies, and other relevant journals. Background information on COPD and smoking also considered statistical information. The period covered was the last 5 years. Search terms for this study primarily included: smoking cessation + COPD; impact smoking cessation COPD; importance smoking cessation COPD; quitting smoking COPD; smoking cessation chronic obstructive pulmonary disease. The following databases were searched: MEDLINE, Embase, Cochrane Collaboration, CINAHL, and PubMed. Google Scholar was also used to generate possible results from relevant databases. These databases are the most credible databases where peer-reviewed journals are usually published and posted (Courtney and McCutcheon, 2009). Peer-reviewed journals are journals which have been evaluated by peers and other practitioners and researchers in the same field; in some cases, the review is carried out by accredited health organizations practicing in the specific fields of practice (Courtney and McCutcheon, 2009). Other reviews are usually carried out by research units of accredited universities or research-based hospitals. Peer-review allows for the application of critical analysis on the validity and reliability of the study (Mateo and Kirchhoff, 2009). These databases are the most reliable databases on the medical and health practice. Studies selected included the following: randomized controlled studies and cohort studies in English, human subjects with both limited and unlimited population, as well as review articles from January 2008 and December 2012. Studies which sought to review smoking cessation as well as other variables and their impact on COPD were excluded from this study. Non-English published literature was also not included in this review. The initial search was carried out in December 2012 and additional articles were added to consider any recent relevant studies. The search yielded about 3940 relevant articles with a total of 80 meeting the predefined inclusion/exclusion criteria. Further review of the relevant articles helped narrow down the specific studies to be included. Selected elements from the article were secured into a standard data extraction form and each article was assessed in terms of data presented – whether the data refer to standards, impact, or importance to COPD patients. From the extracted articles, evidence was developed in relation to the search question. The specific data was indicated based on author, year, study population, purpose, relevance to COPD, and outcome measures. The critiquing tool used for this study was the tool suggested by Coughlan, Cronin and Ryan (2009) because it provided a comprehensive assessment of the related studies, measuring validity and reliability of the methods as well as the substance of the journal articles and evidence base. This was chosen as opposed to any other because no other tool was as comprehensive and as relevant in its application for this evidence-based study. Findings – general overview Initially, about 80 studies were assessed for full analysis and text assessment. Most (about 70%) of the studies were excluded because these were not randomised and 16 more were eliminated because they did not specifically refer to COPD patients. Finally, eight trials were included, totalling 16,808 COPD patients. Three of the trials had patients with airflow difficulties ranging from mild to moderate (Etter, 2010; Kotz, et.al., 2009; Sundblad, et.al., 2008), and there were two studies which had patients with severe and moderate airflow difficulties (Shaker, et.al., 2011; Roos-Engstrand, et.al., 2009). The other studies did not specify data on airflow difficulties. There were two studies with treatment groups securing different comparisons between the usual care and hospitalization as well as nursing support to ensure smoking cessation (Sundblad, et.al., 2008; Wilson, et.al., 2008). No other additional interventions to secure smoking cessation were seen in the other studies. In five of the trials, prolonged abstinence, proved to be effective means of ensuring more sustained smoking habits for smoker COPD patients (Etter, 2010; Sundblad, et.al., 2008; Shaker, et.al., 2011; Roos-Engstrand, et.al., 2009; Browne, et.al., 2011). In terms of the quality of the trials, majority of the studies applied blinding. Six of the trials also proved to be of good quality (Sundblad, et.al., 2008; Etter, 2010; Roos-Engstrand, Shaker, et.al., 2011; Wilson, et.al., 2008; Kotz, et.al., 2009), the rest of moderate quality (Browne, et.al., 2011; Tonnesen, 2013). Smoking cessation when combined with therapy (nursing support) experienced a reduction in their nicotine addiction; results which indicate long-term improvements in smoking cessation (Wilson, et.al., 2008). With the application of increased intensity smoking cessation practices, improved and prolonged abstinence was also seen (Browne, et.al., 2011). The search provided both research and non-research papers, and majority of the research papers found were quantitative studies. Questions being asked involved the impact of smoking cessation on the COPD patients (Tonnesen, 2013), impact of smoking cessation on airflow obstruction (Roos-Engstrand, et.al., 2009), and the relationship between smoking cessation and the morbidity and mortality of the patients (Etter, 2009). Answers provided in relation to my topic choice mostly indicate that smoking cessation can help reduce the morbidity of the patient and lengthen their life as well (Etter, 2009; Roos-Engstrand, et.al., 2009). Smoking cessation can also reduce airflow obstruction among COPD patients (Roos-Engstrand, et.al., 2009). The search was mainly on UK with some European sources also considered. The answers to these questions indicate that smoking cessation is a generally beneficial option for COPD patients and therefore this must be one of the primary interventions which should be planned with the patient in order to improve his outcomes. The most important sources found were from the European Respiratory Journal as they provided peer review materials relevant to the current subject matter. Findings – review of a single research report Based on the critiquing tool by Coughlan, Cronin, and Ryan (2009), this study will now evaluate the research by Etter (2010) which discussed the short-term change in self-reported COPD symptoms after smoking cessation. This study is a quantitative study covering internet samples. It was able to highlight the fact that in general, respiratory symptoms improved soon after smoking cessation. Their data collection procedure was based on the self-selection process of website visitors to a smoking cessation website as well as a Google link. This procedure was able to estimate and select individuals concerned about COPD. Moreover, the selection process was also able to establish a sample population with a high prevalence for smoking and related respiratory symptoms and difficulties. The incidence of coughing and of expectoration is deemed higher in the sample as compared to the larger population of smokers. In addition, the study was also able to determine the higher incidence of asthma in the sample population as compared to the general population. Respondents also represented a younger population, with an average age of 35 years. The results cannot therefore be generalized to a larger population. In effect, this study cannot be considered and evaluated as a prevalence study. Nevertheless, the authors were able to fulfil their goals in assessing the validity of COPD screening and in assessing the relationship between smoking and respiratory symptoms within the short term period after smoking cessation. There is a need to carry out studies covering representative respondent samples due to the rarity of data on short-term longitudinal studies covering the current subject matter and due to the limited size of other studies covering this same topic. Even as the study eventually yielded a selected sample, the data collection process proved effective and cost effective in covering a large sample with smoking and respiratory symptoms relating to COPD. The response rate during the follow-up was low, however, it was a rate which is similar to response rates in other internet surveys (Cook, et.al., 2000). Respondents during the follow-up were different from nonparticipants and this also limited the generalisability of the evaluation. However, this did not impact on the validity of the analysis. Gathering data after the 30 day follow-up period guaranteed that the authors were able to summarize the short-term impact of smoking cessation. All the benefits however of smoking cessation on respiratory conditions do not manifest after the short period of observation, and the effects could only be founded on long-term information (Etter, 2010). During follow-up, the general period of abstinence among the new quitters ran up to 31 days. This represents too long a time to allow for an accurate detection of short-term effects. Outcome measures including coughing cessation and improved breathing days after smoking cessation could not be accurately measured after the 31 day period of the follow-up study (Etter, 2010). In effect, there is a need to consider studies with shorter periods of follow-ups in order to accurately detect the respiratory effects of smoking cessation. Yet another limitation of this study relates to the fact that the authors conducted a limited set of validity tests. More tests on construct validity would help provide greater reliability for future studies. Issues of sensitivity and specificity on clinical diagnosis of COPD were also not carried out. Results were also not compared with the general attributes of other COPD questionnaires. Despite these issues, the study was able to establish useful trends which can be used in future studies in the assessment of smoking cessation and its impact on COPD outcomes. Can this evidence inform practice? This evidence presented above can inform practice most especially in terms of the benefits of smoking cessation on the management and reduction of respiratory symptoms among COPD patients. The results of the study can be used to support interventions which seek to manage COPD using the short-term effects of smoking cessation and its impact on respiratory symptoms (Kotz, et.al., 2009). The results can inform practice with strong associations made between the duration of abstinence and the manifestation of respiratory symptoms. In effect, it is best to encourage smokers to quit smoking and to strengthen their commitment to such lifestyle change because the longer they stay smoke-free, the more they can experience substantial improvements in their coughing, expectoration, breathing, and wheezing (Wilson, et.al., 2008). The results of this study also support previous short-term studies which indicated improvements in coughing and related respiratory symptoms for the first days of weeks following smoking cessation (Fassberg, et.al., 2009). Barriers to evidence use would relate to difficulties for the smoker in quitting smoking (Joshi, et.al., 2010). Most patients who have COPD have been smoking for years and their smoking is a major contributory factor to their COPD. As they continue to smoke, their COPD would also continue to worsen and present with complications (Joshi, et.al., 2010). Within the practice, the contribution of nurses in patient support for quitting smoking and drinking habits is very much a significant factor (Zwar, et.al., 2010). However, not all nurses are properly informed and educated about the means and measures they can undertake in order to provide a support system to the COPD clients who need to quit smoking (Coronini-Cronberg, et.al., 2011). There is a need therefore for nurses to be informed about the appropriate and effective ways by which they can motivate their patients to quit smoking. Within the health practice, smoking cessation would be a difficult process to undertake, especially as it is a very addictive habit and most patients with COPD have been smoking for years. Nevertheless, concerns about health can be used by the health practitioners in order to get the patients to cease their habit (Zwar, et.al., 2010). Health concerns are one of the major motivators for smoking cessation and in understanding these health concerns, the health practitioners can eventually achieve improved health outcomes for the patient (Zwar, et.al., 2010). The fact that smoking cessation can manifest immediate improvements in the breathing and the respiratory symptoms of COPD patients can be used in order to motivate the patients to quit. Smoking cessation among COPD patients would be a huge undertaking for the patient and a major challenge for health professionals as well. However, with the training and routine appraisal of skills, health professionals would be able to secure desired results (Etter, 2010). There is however a significant amount of burden on health professionals to understand information about smoking cessation and about COPD. The use of motivational dialogue was highlighted in the study by Coronini-Cronberg, et.al., (2011) with such dialogue being used to evaluate and support the patient’s ability to manage his own situation and change his habits. The challenge of implementing smoking cessation is especially apparent for recent and or struggling quitters who may not be able to avoid smoking for a prolonged period of time (Coronini-Cronberg, et.al., 2011). However, support from the staff can come in the form of regular checks at different points in time – three months, six months, and 12 months after their scheduled dates of quitting. Moreover, the evidence above also sets to inform practice about the importance of focusing on means by which self-efficacy and self-management among COPD patients can be utilised in relation to smoking cessation (Coronini-Cronberg, et.al., 2011). Implications for practice I have learned that evidence-based practice is a difficult and comprehensive process to be involved in. It requires a commitment into research which would call for a logical discernment of research materials and related critical appraisal tools. Searching for applicable literature can, by itself, require a rigorous and protracted process which can sometimes overwhelm one’s resources and mental ability. Nevertheless, the rigorous processes involved in this exercise provided strong evidence which helped support my current knowledge about the practice, mostly on smoking cessation and COPD. Based on the literature and results of the studies, the importance of engaging health practitioners in motivating processes for smoking cessation among has emerged. All health practitioners involved in the COPD patient’s care must also appreciate the importance of coordinating with each other and with the patient in order to deliver effective and adequate health services. This exercise also highlighted for me the importance of evidence-based practice. I was also able to appreciate more the importance of having logical and research evidence to support nursing interventions. I also understood that there are changes and developments in the nursing and health practice which are constantly being introduced in the practice. I therefore need to be updated about these changes and the evidence available to support their ability to secure improved patient outcomes. References Browne, J., Aslam, N., Jones, E., Flint, B., et.al., 2011. Stop smoking as treatment for COPD: quit-interventions of higher intensity and duration are required. Thorax, 66, A117-A118 Cook, C., Heath, F., Thompson, R., 2000. A meta-analysis of response rates in web- or internet-based surveys. Educ Psychol Meas, 60, pp. 821–836. Coronini-Cronberg, S., Heffernan, C., and Robinson, M., 2011. Effective smoking cessation interventions for COPD patients: a review of the evidence. JRSM Short Rep., 2(10), p. 78. Coughlan, M., Cronin, P., and Ryan, F., 2009. 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