DDN_April_2024 DDN April 2024 | Page 22

TOBACCO HARM REDUCTION

THE ENEMY WITHIN

We must step up our efforts to tackle smoking-related lung disease , heard the RCGP & AP conference . DDN reports

‘

When

I was working in the NHS I saw so many people with lung
conditions and COPD ,’ said Dr Sharon Cox , who is now a principal research fellow at the UCL Tobacco and Alcohol Research Group . ‘ Smoking remains the single largest cause of preventable cancers , respiratory and cardiac disease and premature death .’ When e-cigarettes came along she felt they might represent ‘ the methadone of the smoking world ’. The main advantage was that there was no combustion , so you could get the nicotine hit without smoking . No combustion also meant slower nicotine delivery – she compared a cigarette to a meal , and a vape to a graze .
With a fast-evolving market , ‘ it felt like we had a handle on e-cigarettes – until disposables came out ,’ she said . ‘ They were cheap – and an entry point for young people .’ The
market became confused – and further confused by the flood of unregulated vapes with a cocktail of toxic ingredients . Just as the UK government was announcing a ‘ Swap to Stop ’ scheme to cut smoking rates through offering fully regulated vape starter kits and behavioural support , e-cigs were being blanket banned in some countries . As stories emerged of more and more young people vaping , some of whom had never smoked , public panic set in and the evidence became a secondary conversation . The headline was that the use of e-cigs by young people had increased , driven by the market for single use and disposables – and that they weren ’ t concerned if there were risks .
At UCL , Cox ’ s workplace , they had been collecting data on nicotine and tobacco use since 2007 . ‘ Most smokers wish they hadn ’ t started , so raising the age
of sale is the best measure ,’ she said . ‘ It ’ s a really hard habit to break , really difficult to quit . And if you have parents who smoke , you ’ re twice as likely to smoke .’ Smoking prevalence was coming down and most people who were using e-cigs were long-term ex-smokers . ‘ A small amount use when they ’ ve never smoked – but it ’ s ridiculous to say they should ’ ve smoked before they can use them .’ Interestingly , ‘ there ’ s no benefit to dual using ,’ she said . ‘ The only benefit is a complete switch .’
So what do we do about the current situation , where the public health campaign that was serving so many ex-smokers well is in danger of being derailed ? Cox feels that plain packaging could have been a practical first move before banning disposable vapes – a ban that will be difficult to police . ‘ A mass media campaign is a good way to correct misconceptions ,’ she said .
‘ It felt like we had a handle on e-cigarettes – until disposables came out . They were cheap – and an entry point for young people .’
DR SHARON COX
‘ The evidence is being trumped by anecdotes .’ As part of this , the likely success rates when using properly regulated e-cigs could help to motivate smokers who are confused by the mixed messages . ‘ The certainty of quitting smoking with e-cigs is high ,’ she said . ‘ And if you can get to 12 months with an e-cig , the chances of relapse are quite low .’ DDN
SPIROMETRY IN LIVERPOOL
COPD IS THE THIRD HIGHEST CAUSE OF DEATH IN LIVERPOOL after overdose and hepatitis C , among patients who use illicit drugs , said Paul Tinnion , clinical team leader at Liverpool ’ s Acute Respiratory Virtual Ward and Community Respiratory Team . At Brooke Place drug dependency unit he worked with a caseload made up of a ‘ historically difficult to engage group ’, but those that did engage were referred to spirometry – a simple lung function test that measures how much air someone can exhale in a single breath .
‘ This [ remote referral ] didn ’ t really work , so we installed it in the clinic , where 64 patients were diagnosed .’ Their conditions were ( variously ) asthma , fibrosis , pre-COPD , and a risk of COPD in the future . ‘ So we put in interventions ’ – smoking cessation , pulmonary rehabilitation , as well as other support services such as mental health , social prescribing and financial advice .
‘ Patient feedback was predominantly positive ,’ he said . ‘ They found the service helpful and friendly – and they keep dropping back in . Some sort of relationship was built up and we found bringing things closer to the patient very effective . We can put in things with lifealtering consequences .’
SEFTON ’ S CLINICAL PATHWAY
SEFTON ’ S RESPIRATORY DISEASE CLINICAL PATHWAY had been a collaborative project , said Sally Morrison-Griffiths , clinical lead at the drug and alcohol treatment service in Merseyside . Clinicians and managers had looked at co-morbidities and drug-related deaths data and found that respiratory disease – primarily COPD , emphysema and respiratory failure – were among the highest causes of death .
Stigma experienced by people with drug and alcohol problems made it likely that they would avoid interacting with traditional treatment services . So by using the clinical pathway , drug and alcohol services had a ‘ golden opportunity ’ to offer primary and secondary prevention of respiratory disease , diagnosis and treatment , she said . Clinical evidence and guidelines had been incorporated into the pathway as well as tests and brief interventions , and she was hopeful that spirometry would soon also be included in the clinic .
The pathway had been designed as a guide and not ‘ you must do this ’, she explained , but she hoped it would help the generation , now around 60 years old , who were dying of COPD .
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