Three-Pronged Approach Helps Smokers
Quit for Good
Ileen Gilbert, MDMedical College of Wisconsin Pulmonologist and Critical Care Physician
The Smoking Cessation Program at Froedtert & Medical College of Wisconsin gives smokers access to medical support and more. Ileen Gilbert, MD, explains this successful approach to breaking free from tobacco.
Q. What can a person expect from the Smoking Cessation Program?Our program approaches smoking cessation from three perspectives — education, counseling and medical management. When patients come to us, we first give them a good idea of what smoking may or may not have done to their lung function. Patients don't really understand that you can actually lose about half of your lung function and be entirely asymptomatic. So we identify patients who, while they might feel fine, have lost lung function. We can use this as an incentive, one of many, to help them to stop smoking.
Q. How can you measure lung function?The National Institutes of Health recommends using a technique called spirometry. It is a way to measure lung function and it lets people know if they have any damage from their cigarette smoking. Again, by the time they would feel symptomatic, they might well have lost half their lung function because of Chronic Obstructive Lung Disease.
Q. What is Chronic ObstructiveLung Disease?
There are two main forms of Chronic Obstructive Lung Disease (also known as Chronic Obstructive Pulmonary Disease) that are directly related to smoking cigarettes. One is emphysema and the other is chronic bronchitis. With emphysema, the patient loses the supporting structure of their airway. You might see holes on their chest X-rays — there is actual loss of lung tissue. These patients lose gas-exchanging units. Not only do they lose their air sacs, their airways become more floppy. And when their airways become more floppy, they tend to collapse and that also leads to respiratory impairment.
Chronic bronchitis is sputum production and cough three months of the year for two years in a row. That's how you make that diagnosis. For the patient, chronic bronchitisis "I wake up every morning and I cough, I bring up sputum and I get a lot of respiratory infections." You don't necessarily lose lung tissue, but it sets up a chronic inflammatory state. You can lose lung function from that and it can be very life-impairing.
Q. What else do you teach patients?
We educate patients about other conditions that are worsened by the use of cigarette smoking — conditions like hypertension, peripheral vascular disease, cardiovascular disease and cerebral vascular disease and cancers. We give them a lot of facts.
We also teach people about the addiction of cigarette smoking. We help patients identify the best techniques for dealing with their particular form of addiction. Some people are chemically addicted and they have true physical withdrawal symptoms. Other people are much more emotionally addicted. We try to help those patients with some of the behavioral aspects of smoking cessation.
There is a lot of one-on-one counseling. We give patients tips about changing their lives. We give them a quit plan. We also get them hooked up to the Wisconsin Quit Line. In addition, we provide very practical information on what may or may not work from a pharmacotherapeutic standpoint. Most people who are addicted to cigarettes do need medication in addition to counseling and education in order to stop.
Q. What kinds of medications are available to help people quit?
There are many, many products on the market. One type is nicotine replacement therapy — the gum, the patches, the lozenges. There are also nicotine inhalers and nicotine nasal sprays, which are by prescription only. In addition, there is a prescription medicine that has been extremely successful for patients who want to quit smoking because it interrupts the dopaminergic pathways in the brain that cause some of this addiction.
What we do is look at a particular patient and, along with the patient, decide what would be most appropriate — whether a pill that interrupts the biochemical basis for smoking addiction or nicotine replacement alone or the combination of the two. We help people understand how to properly use these products — often times people will buy things over the counter, and, while they will read the instructions, they do not use them effectively.
One reason why I think we have a somewhat higher success rate is that we are able to provide patients with some of these pharmacologic agents at the time they are with us. We can provide patches, gum and lozenges to patients who are uninsured or whose insurance does not cover them. Just starting people with the medications as they are walking out of the clinic gives them a little bit of a head start.
Q. How else can you approach smoking cessation medically?
We also help patients optimize their respiratory status. We have had a great deal of success in helping people live a better life through better lung function. There are medications now that have been found to help people with Chronic Obstructive Lung Disease. Froedtert & Medical College of Wisconsin also has a pulmonary rehabilitation program that we can refer patients to.
You cannot rebuild the lungs. What you can do through rehabilitation exercise is help people strengthen their muscles and learn how to do their activities of daily living in a more efficient manner. When you do this, the cost of these activities on their lungs is less and the patient is able to do more.
In addition, if you are able to help people medically with some of their respiratory symptoms, it gives them a pretty good impetus to stop smoking because they can see some short-term success.
Q. Is it possible to reverse loss of lung function?All people lose a little bit of lung function every year as adults. Once you stop smoking, you will start to lose lung function at the same rate as a non-smoker. But what studies have shown is that for patients who have lost lung function from cigarette smoking, if you stop smoking you will have some recovery of your lung function for about a three- to five-year period.
What we’re hoping is that if we catch people before they have had that critical loss of lung function and we optimize their lung function, it won’t get to the point where their activities of daily living are impaired, where they are in need of chronic oxygen therapy.
Q. How long do patients stay in your program?We see patients on a monthly or an every-six-week basis until we believe we have helped them to the point where they have been successful quitters. Then we’ll spread it out to every three months or every six months. With respect to the medical implications, if it is found that the patient does have Chronic Obstructive Lung Disease that needs to be treated, we will see them in a continuity clinic fashion to make sure their disease is optimized.
Q. What are some of the myths about smoking cessation?One myth is that if you try once to quit and are unsuccessful, you will never be able to stop smoking. Actually, most people who are successful quitters have needed two or three attempts. So you should never be discouraged if you tried in the past and were unable to quit.
Q. Do you gain weight when you quit smoking?Actually, that’s another myth — that you are going to gain weight by stopping smoking. People do tend to gain small amounts of weight, but it tends to be less than five pounds.
We give people some behavioral modification tips to help with the weight gain. We deal with this issue up front, looking at what people can do to curb their eating, refrain from cravings and choose healthy foods. One issue is that people need to find different things to do with their hands besides smoking. The pharmacotherapeutic agents to help with stopping smoking actually will help with the weight gain as well.
Q. How can someone get started with the Smoking Cessation Program?Just call scheduling at Froedtert & Medical College of Wisconsin. You do not need a referral unless your insurance plan mandates a primary care doctor referral.
If you would like to stop smoking but you also have asthma or Chronic Obstructive Lung Disease, you could also ask to be scheduled into our asthma and Chronic Obstructive Lung Disease clinics.