Introduction and objectives Evidence-based tobacco dependence (TD) treatment is recommended for all smokers admitted to hospital. TD remains a significant driver of respiratory admissions in national audits contributing to 37% COPD admissions and 27% asthma admissions.^{1 2} The aim of this study was to define the burden of TD on a respiratory ward and identify what resources are needed to treat this long-term condition (LTC) more effectively.

Methods Electronic records of all patients identified as ‘smokers’ on discharge from a respiratory ward were reviewed for demographics, admission diagnosis, spirometry, smoking history, co-morbidities, medications, cessation support and TD medication (TDM; nicotine replacement therapy (NRT) and/or varenicline) from 1/8/17 to 31/1/18.

Results 78 (47 M; 31 F) patients, mean age 54 (range 19–82) years with TD were discharged over 184 days from a 21–23 bed respiratory ward. 21/78 (27%) were admitted with asthma, 16 (20%) COPD, 11 (14%) pneumonia, 6 (8%) lung cancer and 4 (5%) pneumothorax. Mean (SD) FEV1 was 1.52 (0.85)L and FVC 2.45 (0.99)L; n=53. Mean (range) number of co-morbidities was 4.5 (1–12) and mean (range) number of medications was 7.7 (0–20). 26/78 (33%) had serious mental illness, including alcohol dependence.

62/78 (79%) received very brief advice (VBA), 61/78 (78%) saw a smoking cessation specialist (SCS) on the ward and/or had SCS outpatient follow-up arranged. 63/78 (81%) were prescribed one or more TDM (figure 1).

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Abstract S50 Figure 1

Tobacco dependence interventions for inpatients discharged over a 6 months period from an inner city respiratory ward (n=78)

Conclusions TD is a common LTC on an inner city respiratory ward; one patient with TD was discharged almost every other day and of note asthma was the commonest respiratory diagnosis. Delivering TD treatment in hospital is challenging; one in 5 did not receive documented VBA and 1 in 5 were not prescribed any NRT, even though we have established treatment pathways. This patient group has high prevalence of multi-morbidities and poly-pharmacy and one third had serious mental illness. Effective TD treatment is therefore likely to require access to highly skilled smoking cessation specialists as well as clinical teams who have been trained in smoking cessation, want to treat tobacco dependence, and are confident to prescribe TDM.

References

1. www.rcplondon.ac.uk/projects/outputs/copd-who-cares-matters-clinical-audit-2014

2. www.brit-thoracic.org.uk/document-library/audit-and-quality-improvement/audit-reports/bts-adult-asthma-report-2016/