In this article, we’re going to review what is the Respiratory Therapist’s role in smoking cessation.

As a Respiratory Therapist, you are going to deal with smokers on a daily basis. That is why it’s so important to have an understanding of all the causes and side effects of smoking, as well as how to properly instruct the patient (and their family) on how to quit.

You’re going to need to be able to interview the patient to get a full assessment of their smoking history and make every effort to help the patient to quit.

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Below, I’ve written out some of the most important information that you’ll need to know for when you starting practicing as a Respiratory Therapist, and it’s also important to learn this information now because you may see some of it again on the TMC Exam as well. So let’s dive in!

COPD is caused by smoking tobacco and asthma can be irritated by tobacco smoke (as well as other pollutants, of course). So when you interview the patient, you must get a good understanding of the smoke exposure and home environment in order to educate them on the matter.

Here are some common questions to ask:

  • Do you smoke?
  • Have you ever smoked?
  • If yes, how long have you smoked?
  • How many packs of cigarettes a day do you smoke?
  • Does your spouse smoke, or are you frequently around someone who smokes?
Even if the patient is not a smoker, second-hand smoke can be just as bad, which can affect their spouse or children. So in some cases, you need to suggest that their family members quit smoking as well because it harms the patient.

What is smoking cessation?

It is simply the process of stopping or discontinuing the act of smoking tobacco.

To help the patient stop smoking, as we already noted, it’s important to assess their pulmonary health. A good way to achieve this is by calculating their pack-years.

How to calculate pack-years for a smoker?

You do this by multiplying the number of packs smoked per day by the number of years that they smoked.

For example, if the patient has smoked 2 packs per day for 15 years, they would have a 30 pack-year smoking history.

2 packs per day X 15 years = 30 pack-year smoking history

Many patients will be unable to stop smoking because of withdrawal symptoms. In this case, it is likely that they have a nicotine addiction. So for these patients, you can treat them with nicotine replacement therapy.

What is nicotine replacement therapy?

It is a method to cease a nicotine addiction by using a means other than tobacco and has been shown to increase the chance of quitting smoking by 50 – 70%.

Although it doesn’t work 100% of the time, in most cases, nicotine replacement therapy combined with psychological support will help the patient quit smoking.

What are the types of nicotine replacement therapy?

  • Nicorette gum
  • Nicotrol inhaler
  • Nicotine transdermal patches
  • Nicotine nasal spray

By using these types of therapy, the patient, over time, the patient will be able to wean themselves away from craving nicotine and stop smoking.

Another alternative is to use prescription medications that will alter the brain’s chemistry so that it no longer craves nicotine. These include:

  • Zyban
  • Chantix

Smoking Cessation Practice Questions:

Here are a few more practice questions about smoking cessation and nicotine replacement therapy, just so that you can get some more practice in and really learn this information. 🙂

1. In a smoking cessation program, what are the two types of support that can be given by the Respiratory Therapist?
(1) Physical and (2) emotional support.

2. In a smoking cessation program, how can the Respiratory Therapist physically assist?
Ask the patient about their smoking history. Advise the patient about the benefits of quitting smoking. Assess their willingness to attempt to quit. Assist the patient by discussing helpful medications and counseling. Arrange a follow-up meeting to begin the quitting process.

3. What are the four treatment types in smoking cessation?
(1) Nicotine Inhaler, (2) Nicotine gum, (3) Nicotine Patch (Transdermal), and (4) Nicotine nasal spray.

4. What does the nicotine MDI (inhaler) do?
It works just like a regular MDI. It is very portable and has titratable doing.

5. How does oral nicotine gum work?
It’s basically like chewing gum on a schedule and supplements the patient’s nicotine intake so they do not need to obtain it by smoking tobacco. The major brand is Nicorette. It may not be appropriate for patients with jaw pain or those who are unable to chew properly. Also, it has a very fast delivery.

6. How does the nicotine transdermal patch work?
It’s applied directly to the skin and delivers a steady dose of nicotine over a 24-hour period. Over time, the dose is gradually reduced until the patient no longer has nicotine craving. Then they can stop using the medication. The patch requires a once-a-day placement.

It has slow delivery and must maintain a certain blood level in order to be effective. You can titrate the doses with different strengths for each patch.

7. How does the nicotine nasal spray work?
It’s a medicine that helps to reduce nicotine craving when a measured dose of nicotine solution is sprayed into the nose through the mucous membrane and is absorbed into the bloodstream. It has a very fast deliver and is portable to use on the go. Also, the patient should be careful when administering the spray because it can irritate the nose and eyes. The patient will need a prescription in order to obtain nicotine nasal spray.

8. After a person quits smoking, shortness of breath gets better and coughing decreases in this time frame?
Usually within 1 to 9 months

9. After a person quits smoking, heart attack risk begins to drop, lung function begins to improve, and ciliary begins to work within this time period?
Usually within 2 weeks to 3 months

10. How long does it take for carbon monoxide levels to return to normal after a person quits smoking?
Usually within 12 hours

11. One of the most immediate benefits of smoking cessation is that the heart rate drops in approximately how many minutes?
20 minutes

12. What are two helpful things to know about cigarette smoke?
(1) It has over 1000 agents that damage tissue and (2) It causes short and long-term health problems.

13. The 1964 Surgeon General’s Report of the advisory committee of smoking and health concluded that smoking can cause these four illnesses:
(1) Lung cancer, (2) Laryngeal cancer, (3) Emphysema, and (4) Cardiovascular disease

14. What did Mark Twain say that can be applied to smoking?
“Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.”

15. What are eight benefits of smoking cessation:
(1) Food tastes better, (2) Improved smell (of clothing, body odor, etc.), (3) You save money by not buying cigarettes, (4) You feel better about yourself, (5) Your personal items will smell better, (6) It sets a good example and decreases the odds that your children will smoke, (7) You will perform better physically, (8) Improved appearance, i.e. wrinkles, etc.

16. What percentage of adults smoke in the united states?
According to the CDC, 17.8% of adults smoke in the United States.

17. What percentage of smokers have called a quitline in an attempt to quit?

18. What percentage of all cancer deaths are attributable to smoking?
28.7% (in 2010)

19. What are the five A’s of Smoking Intervention?
(1) Ask if the patient smokes, (2) Advise them to quit smoking, (3)Assess their willingness to quit at this time. (4) Assist the patient by discussing helpful medications and possibly counseling, and (5) Arrange a follow-up meeting.

20. What are the 5 R’s to help patients quit smoking?
(1) Relevance, (2) Risks, (3) Rewards, (4) Roadblocks, and (5) Repeat.

21. What medications are used to help patients stop smoking?
Prescriptions medications used include (1) Chantix and (2) Zyban.

22. What are the side effects of Chantix?
Nausea is the most common side effect and may persist for several months. Other side effects include: stomach pain, indigestion, constipation, gas, weakness, tired feeling; dry mouth, unpleasant taste in your mouth; headache; insomnia and/or unusual dreams.

23. What are the smoking risks for pregnant women?
Smoking during pregnancy can cause a baby to be born premature and/or to have low birth weight. This increases the odds that the baby will be sick and have to stay in the hospital for a longer period after birth. It can even cause death, as smoking during and after pregnancy is a major risk factor of Sudden Infant Death Syndrome.

Final Thoughts

So there you have it! That wraps up this article about Smoking Cessation and I hope it was able to teach you a thing or two so when the time comes for you to help your patient, you’ll be more than ready to go.

Having a good knowledge and understanding of smoking and all the harmful side effects is very important for Respiratory Therapists because we deal with these patients on a daily basis. And what a better time to learn and understand it than now?

Find care. Take care. And I’ll see you in the next article. Breathe easy, my friend!

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