NUR432 Clinical Research Online Tutoring

Clinical Research

The latest approximate of the worldwide dominance of chronic obstructive pulmonary disease (COPD) is sixty-four million, with three million deaths in 2015 alone (WHO, 2017).  COPD is going to be the leading cause of death worldwide by 2030 and that 90% of its victims live in low and middle-income countries.  It is mainly caused by cigarette smoke, primary or secondary, and exacerbated by long-term asthma (WHO, 2017).

COPD refers to progressive multisystemic inflammatory diseases that lead to a limitation of airflow (Jimenez-Ruiz et al., 2015; Yang IA et al., 2017).  COPD patients in developed countries are smokers or have smoked. Smoking cessation in COPD patients has the potential to assist patients to control the disease and predict exacerbations. Treatment to prevent smoking should include pharmacological and behavioral treatments for best results (Jimenez-Ruiz & Fagerstrom, 2015).  The objective of the review is to assess the accuracy of COPD diagnoses in primary care in Australia and to describe the experiences and preferences of smokers to quit smoking. This analysis looks at the impact of a doctor’s lack of involvement and its impact on smoking cessation treatment outcomes among COPD patients who smoke.

Clinical research questions (Qualitative):

(P) Patient problem: COPD from smoking

(I) Intervention: Stop smoking by doctors.

(C) Comparison: A smoking cessation information program for health professionals during medical training to extend their commitment to smoking cessation treatment.

(O) Outcome: Effective commitment of professionals and patients to reduce COPD symptoms caused by smoking.

How do physicians have interaction to assess the effectiveness of smoking cessation for the treatment of COPD and the prognosis of exacerbations?

Van Eerd et al. (2017) reviewed the key factors that influence smoking cessation treatment among COPD patients due to smoking.  Physicians highlight the organizational factors of patients and physicians that impede regular evidence-based smoking cessation treatment (Van Eerd et al., 2017).  The study found that doctors experienced increased dissatisfaction with COPD smokers, as they were not responsible for their treatment, they were not honest about their smoking habits, they avoided health visits, and they did not pay much attention to the effects of tobacco.  This led doctors to develop negative feelings about such patients and, as a result, they were not treated effectively (Van Eerd et al., 2017).  Furthermore, problems with money and time have led to the failure of programs that consider smoking to be a disease. Doctors and patients made little effort to take immediate preventive measures against smoking habits.

Liang et al. (2018) focused on patients who have been at least forty years old and have visited GPs at least twice in the past twelve months, report that they are current or former smokers with a history of smoking of at least ten packs or have been treated for COPD.  Spirometry test, FEV1/FEV6 is taken into account besides an assessment of the quality of life, dyspnea, and health-related symptoms. Studies show that the effective use of a spirometry test can improve diagnosis. Side effects and difficulties in quitting smoking during attempts to quit smoking are common (Liang et al., (2018). Therefore, health professionals ought to emphasize evidence-based treatment and closely monitor the cessation of the difficulties, and the side effects of termination aids.

The variation between the articles and the way they provide smoking cessation services produces conflicting results from the literature review. Future research should emphasize the standardization of smoking cessation and the predictability of exacerbations.

References

Jimenez-Ruiz, C. A., & Fagerstrom, K.O. (2015). Smoking cessation treatment for COPD smokers: the role of pharmacological interventions. Monaldi Archives Chest Disease, 79(1), 27-32. DOI: 10.4081/monaldi.2013.106

Jiménez-Ruiz, C. A., Andreas, S., Lewis, K. E., Tonnesen, P., Van Schayck, C., Hajek, P., … Gratziou, C. (2015). Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. European Respiratory Journal, 46(1), 61-79. doi:10.1183/09031936.00092614

Liang, J., Abramson, M. J., Zwar, N. A., Russell, G. M., Holland, A. E., Bonevski, B., … George, J. (2018). Diagnosing COPD and supporting smoking cessation in general practice: evidence-practice gaps. Medical Journal of Australia, 208(1), 29-34. doi:10.5694/mja17.00664

Van Eerd, E., Risor, M., Spigt, M., Godycki-Cwirko, M., Andreeva, E., Francis, N., …Kotz, D. (2017). Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study. npj Primary Care Respiratory Medicine, 27(41), 1-6.doi: 10.1038/s41533-017-0038-6

WHO. (2017). Chronic obstructive pulmonary disease (COPD). WHO | World Health Organization.https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

Yang IA, et al., (2017). COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29129177