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KEYWORDS:
he growth of an ageing
population in the UK means
that patients with chronic and
multiple disease are more common
(Department of Health [DH], 2013).
One of the most important challenges
for the future of health care is how
to improve quality of life for people
living at home with long-term
disease for ever-longer periods of
time. Community nurses working
to avoid hospital admission for their
patients will be only too aware of the
cycle of chronic disease management,
exacerbation, hospital admission,
discharge and yet further exacerbation.
It is by interrupting this cycle that
community nurses can make the
most valuable contribution to people
who smoke namely, to enable
them to improve their quality of life
and avoid admission by stopping
smoking. After all, if nurses are not
letting patients know what they
can do to help themselves make a
difference, they are missing out an
essential element of primary care.
Camilla Peterken, smoking cessation
specialist,service development, training and change
management specialist, the Nyvej Partnership
72
EFFECTS OF SMOKING
Nicotine itself is not the primary cause
of harm from smoking, but it is a
known stimulant and highly addictive.
The main reason that people continue
to smoke is that they are addicted
to nicotine and the unpleasant
withdrawal symptoms prevent them
from sustaining cessation.
Tobacco smoke contains more
than 4,000 chemicals, many of which
are known irritants (Richter et al,
2008). Nicotine is addictive and
keeps people smoking, but it is the
combination of tars, carcinogens,
metals and free radicals that are toxic
and cause greatest harm.
Smoking also causes
carbon monoxide to attach
itself to haemoglobin to form
carboxyhaemagloblin, which reduces
the oxygen-carrying capacity of the
blood and its subsequent supply
to the tissues (Morgado et al,
1994). This affects both cardiac and
respiratory function the heart
has to work harder to pump less
oxygenated blood through arteries
RESPIRATORY CARE
ASTHMA
For every 1% increase in smoking
prevalence in the asthma population,
there is a 1% increase in asthmarelated admissions to hospital
(Purdy et al, 2011). Active smokers
will experience more severe asthma
74 JCN 2014, Vol 28, No 4
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)
COPD is the collective name for a
range of lung conditions including
emphysema, chronic bronchitis, and
chronic obstructive airways disease.
COPD causes a narrowing of the
airways and subsequent difficulties
in breathing this is called airflow
obstruction. Symptoms include
breathlessness, persistent coughing,
increased phlegm production and
chest infections.
Smoking cessation is the most
effective method of slowing the poor
respiratory function associated with
COPD (Global Initiative for Chronic
Obstructive Lung Disease [GOLD],
2014). Stopping smoking should be
a core tenet of the treatment plan
for any patient with COPD, not least
because cessation is associated with a
43% decreased risk of hospitalisation
(Godtfredsen et al, 2002). It is
important that patients realise that
abstaining from smoking significantly
reduces the risk of exacerbating their
COPD symptoms.
Red Flag
Persistent cough
Useful interventions
RESPIRATORY CARE
Patient: I know its no good for me, the doctor keeps bringing it up...
Patient: But whats the point? We cant turn the clock back can we?
Nurse: You dont feel its worth it? reflecting meaning
Patient: Not really.
Nurse: I can understand that, and we cant reverse the damage, but giving
up smoking could make a real difference to the amount of oxygen you receive
on a daily basis and that can happen quite quickly. You could also find you
dont need to get admitted to hospital quite so often?' providing relevant
information in the here and now
Patient: Well, that would be good. I seem to go back to hospital every few
months and each time it's worse.
Nurse: So would that be a reason to have a go at quitting? Would you like
me to refer you to the local stop smoking service? They can offer you free
support over the phone if you dont feel up to going to see them and they can
provide medication such as nicotine patches?
In this conversation the patient is enabled to consider the control they
might have and to express both their concerns and their reasons for
quitting. Finally, the community nurse is able to make sure the patient
knows that effective free services do exist.
76 JCN 2014, Vol 28, No 4
RESPIRATORY CARE
CONCLUSION
Smoking has long been linked with
respiratory disease and is a recognised
risk factor for COPD, asthma, lung
cancer and interstitial lung disease.
Community nurses are tasked with
improving the quality of life for
people living at home with long-term
conditions and, for many, smoking
is a large part of this, affecting the
healing and maintenance of many
respiratory conditions.
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