The COPD Patient in the Emergency Department: Education for Smoking Cessation

Krysta Thompson Chamberlain College of Nursing NR505: Advanced Research Methods: Evidence-Based Practice July 2017

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Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a significant health concern worldwide, with smoking being the leading risk factor for its development and progression. COPD is a chronic condition characterized by persistent respiratory symptoms and airflow limitation, which are typically caused by significant exposure to noxious particles or gases, with tobacco smoking being the most common cause. Patients with COPD frequently visit Emergency Departments (EDs) due to exacerbations of their symptoms, which often result from continued smoking. Despite the well-documented risks, many COPD patients continue to smoke, thereby exacerbating their condition and increasing the frequency of their hospital visits. This paper aims to explore the effectiveness of smoking cessation education provided to COPD patients during their visits to the ED and how this intervention can potentially reduce smoking rates and improve patient outcomes. Furthermore, the discussion will consider the implications of this issue for the Family Nurse Practitioner (FNP) specialty track, the critical role of evidence-based practice, and the need for comprehensive educational strategies in the ED.

The Role of Smoking in COPD Development and Progression

Smoking is the single most significant risk factor for developing COPD, with research indicating that approximately 85-90% of COPD cases are attributable to tobacco use (Lo Tam Loi et al., 2013). Smoking causes chronic inflammation in the airways and lungs, leading to irreversible damage and reduced lung function. Even after a COPD diagnosis, many patients continue to smoke, which accelerates the disease’s progression and increases the likelihood of exacerbations requiring emergency care. The persistent habit of smoking among COPD patients presents a significant challenge for healthcare providers, particularly in acute care settings such as the ED, where the focus is often on immediate symptom management rather than long-term behavior change.

The Need for Smoking Cessation Education in the ED

Given the high prevalence of smoking among COPD patients, integrating smoking cessation education into ED care is essential. Studies have shown that smoking cessation is the most effective intervention to slow the progression of COPD and improve patient outcomes (Gratziou et al., 2014). However, achieving smoking cessation is challenging, particularly in an acute care environment where patients may not be receptive to educational interventions due to the stress and discomfort associated with their visit.

One study found that patients who received intensive smoking cessation counseling in the hospital setting had significantly higher long-term quit rates compared to those who received standard care (Gratziou et al., 2014). This suggests that the ED, despite its focus on acute care, can be a critical point of intervention for smoking cessation. By leveraging the “teachable moment” when patients are acutely aware of the consequences of their smoking, healthcare providers can deliver impactful education that may encourage patients to quit smoking.

Impact on the Family Nurse Practitioner (FNP) Specialty Track

For FNPs, the role of providing smoking cessation education to COPD patients is multifaceted and extends beyond the immediate care provided in the ED. As FNPs often manage the ongoing care of COPD patients, they are in a unique position to reinforce the importance of smoking cessation during follow-up visits and chronic disease management. The integration of smoking cessation strategies into the FNP’s practice is crucial for reducing COPD-related morbidity and mortality.

In the ED setting, where the FNP may also work, the challenge lies in balancing the immediate needs of the patient with the opportunity to provide preventive care education. The FNP must be adept at identifying patients who are ready to quit smoking and providing them with the necessary resources and support, including referrals to smoking cessation programs and follow-up appointments to monitor progress.

Research and Literature Review

Research on the effectiveness of smoking cessation interventions in the ED highlights the potential benefits of such programs but also underscores the challenges. For instance, a systematic review by Stead et al. (2017) found that brief interventions delivered in hospital settings, including the ED, can be effective in promoting smoking cessation. However, the success of these interventions often depends on several factors, including the intensity of the intervention, the timing, and the patient’s readiness to quit.

The literature also points to the importance of using evidence-based strategies when designing smoking cessation programs. The U.S. Public Health Service’s Clinical Practice Guideline for Treating Tobacco Use and Dependence recommends a combination of behavioral counseling and pharmacotherapy as the most effective approach to smoking cessation (Fiore et al., 2008). These guidelines suggest that even brief interventions can be effective if they are based on established principles of behavior change and supported by appropriate follow-up care.

Implementation of Smoking Cessation Education in the ED

To effectively implement smoking cessation education in the ED, a structured approach is necessary. This involves training ED staff, including FNPs, on the delivery of brief interventions and ensuring that all patients who smoke are identified and offered support. The 5 A’s model (Ask, Advise, Assess, Assist, Arrange) provides a useful framework for delivering smoking cessation interventions in a busy ED environment (Fiore et al., 2008).

Additionally, the use of technology, such as electronic health records (EHRs), can facilitate the integration of smoking cessation education into routine ED care. EHRs can prompt providers to assess smoking status and offer cessation resources, track patients' progress over time, and ensure continuity of care by flagging smoking status for follow-up visits.

Conclusion

Smoking cessation is a critical component of COPD management, and the ED provides a unique opportunity to deliver effective education to patients at a time when they may be most receptive. For FNPs, integrating smoking cessation strategies into both acute and primary care settings is essential for improving patient outcomes and reducing the burden of COPD. By leveraging evidence-based practices and implementing structured interventions in the ED, healthcare providers can make a significant impact on the health of COPD patients who smoke. Continued research and refinement of these strategies are necessary to ensure that all COPD patients receive the support they need to quit smoking and improve their quality of life.

References

• Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J., … & Wewers, M. E. (2008). Treating tobacco use and dependence: 2008 update: Clinical practice guideline. U.S. Department of Health and Human Services. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK63952/
• Gratziou, C., Florou, A., Ischaki, E., Eleftheriou, K., Sachlas, A., Bersimis, F., & Zakynthinos, S. (2014). Smoking cessation effectiveness in smokers with COPD: The impact of intensive behavioral support. Respiratory Medicine, 108(8), 1070-1076. doi:10.1016/j.rmed.2014.05.003
• Lo Tam Loi, A. T., Hoonhorst, S. J. M., Franciosi, L. G., Bischoff, E. W. M., Hoffman, R. F., Heijink, I. H., van Oosterhout, A. J. M., Boezen, H. M., Timens, W., Postma, D. S., Lammers, J. W. J., Koenderman, L., & ten Hacken, N. H. T. (2013). Smoking cessation and lung function in relation to the presence of bronchial hyperresponsiveness: A real life study. Respiratory Research, 14(1), 107. doi:10.1186/1465-9921-14-107
• Stead, L. F., Koilpillai, P., & Lancaster, T. (2017). Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews, 2017(2). doi:10.1002/14651858.CD001837.pub3