Introduction Smokers with COPD are highly nicotine addicted and often have additional complex needs. Quit rates are poor and there is little evidence-based guidance on specific cessation interventions for these patients. This pilot study aimed to identify barriers to smoking cessation for this patient group.
Method Smokers with COPD were offered up to 12 individual sessions with a clinical psychologist in addition to standard smoking cessation counselling and pharmacotherapy. The psychological intervention included an initial assessment and formulation on factors maintaining smoking which informed an individualised psychology intervention targeting barriers to smoking cessation.
Results 57 patients (moderate COPD, high prevalence of complex physical andpsychological comorbidities) were included in the study (Table 1). 20/57 (35%) patients attended >2 sessions (mean=5, range 2–12). 7/20 had already quit (relapse prevention referrals), 13 were smokers. 22/57 (39%) patients never engaged, 15/57 (26%) were lost to follow-up. 6/7 (86%) of the relapse prevention group maintained their quit. 2/13 (15%) of the current smoker group maintained a 28 day quit and 4/13 (31%) reduced tobacco intake. Psychological barriers to quitting were identified including smoking as a means of emotion regulation.
Conclusions For COPD smokers with a heavy smoking history and multiple quit attempts, and complex needs, additional psychological intervention alongside traditional quit smoking support may aid in preventing relapse, although further research is needed. For current smokers, the hypothesis was not supported, although the study did illuminate common themes regarding obstacles to quitting for this complex group who present a challenge to traditional quit smoking services.
It is clear that the current ‘one size fits all’ approach to smoking cessation does not meet the needs of these smokers who require more focused specific interventions to support smoking cessation including:
‘Cut down to quit’ approach
Long-term, intensive follow up
The above recommendations may provide a starting point for future service design.