R.Ph. uses spirometer to wean patients off tobacco

April 3, 2006

Picture this. A respiratory therapist uses a spirometer to determine a patient's lung age. Then a pharmacist provides information about the different types of smoking cessation products and how to use them. The patient also receives free nicotine replacement patches.

Robert Gold, R.Ph., a hospital pharmacist in Evansville, Ind., turned this scenario into reality when he put into practice this model which he developed. The model incorporates nicotine replacement therapy with a pharmacist's counseling and a respiratory therapist's use of a spirometer.

A spirometer is a device that measures airflow exhaled from fully inflated lungs. Data obtained from the spirometer are useful in determining lung function and the presence of any signs of restrictive or obstructive lung disease as well as a person's lung age. "If you are having trouble with your lung age at an early age, you are at increased risk for developing lung cancer in the future. There are studies showing that early spirometry problems are a precursor to cancers," said Gold.

Gold has conducted two studies to test his model. In Gold's preliminary study in 2004, 450 subjects were given a one-week supply of nicotine patches. In the second study, conducted July 2004 through July 2005, 363 subjects were given a two-week supply of patches. Six months after the intervention, 268 of the 450 subjects from the preliminary study were reached by telephone. Fifty-five percent were still smoking, 23% had cut back, and 22% had refrained entirely.

Of the 363 subjects in the second study, 215 subjects were eligible to be contacted. Results showed that 45% of the subjects were still smoking, 11.3% had cut back, and 43.2% had refrained from smoking.

In the first study, the average lung age of patients was more than 20 years older than their chronological age; in the second study, the average lung age was 20 years older.

Gold said that in addition to learning how their lungs were tolerating smoke, patients were informed about the dangers of secondhand smoke. The results of the lung tests were discussed in relation to the patient's health profile. Gold reviewed what smoking cessation products patients had previously tried and informed them about the various products currently available. Finally, he dispensed free patches and explained how to use the patches, counseling them as to the potential risks of using the product.

"People liked the one-time intervention and being able to talk to professionals. Patients were given tools for the future so that if they fail, they can say, 'I've bombed, but I'm going to try again,' " he said.

In a separate development, the Delaware Pharmacists Society recently released results of a smoking cessation study that utilized pharmacists and pharmacy student interns. The project identified 28 women, interested in quitting smoking, who were pregnant, who recently had given birth, or who were thinking about becoming pregnant in the next three months. The project referred 76% of the women interested in quitting smoking to the Delaware Quit Line and the Delaware Pharmacists Society Network of Pharmacist Smoking Cessation counselors.

Although recent statistics from the Centers for Disease Control & Prevention indicate that the smoking rate among U.S. adults declined in 2004 to 20.9% from 21.6% in 2003 and 22.5% in 2002, officials are still concerned that the nation is unlikely to reach the public health goal of reducing the smoking rate to 12% by 2010.

Pfizer's investigational smoking cessation drug varenicline tartrate, which is under priority review by the Food & Drug Administration, could help Americans in their battle to kick the habit. If approved, varenicline tartrate will be the first of a new class of drugs specifically designed to work at the same receptor site as nicotine to relieve craving and withdrawal symptoms while blocking the reinforcing effects of nicotine.

Meanwhile, an FDA committee recently voted against recommending Sanofi-Aventis' Acomplia (rimonabant) for smoking cessation.