- Too late to stop now – health already compromised, can’t change it, why stop now
- Finding motivation – can’t muster the willpower to try again
- Guilt about continued smoking – led to depression which led to lack of desire to change
- Bargaining/contemplation – need to deal w/another life issue before quitting
- Need to stop – past failure at attempts to quit led to giving up trying again
- Reduced quality of life – smoking provided structure/social outlet – don’t want to lose
In all of these responses (and the candid snippets of comments from study participants included in the study), there is strong sense of loss of hope. There is also a strong current of a belief that no action a smoking COPD patient can take will help them feel better. (Wilson JS, et al. ‘It’s not worth stopping now’: why do smokers with chronic obstructive pulmonary disease continue to smoke? A qualitative study. J Clin Nurs. 2010 Aug 24. [Epub ahead of print])
“The way I have suffered with my chest for the last two years, I say to myself is it worth it stopping now? It’s the only enjoyment I’ve got.”
“I cough and cough and I know rightly if I wasn’t smoking I would be able come up the stairs a bit better and feel a bit better. I know that for a fact like.”
“Emptiness in the house, nobody cares about me (pause) I don’t see anybody hardly… (I’m) just lonely.”
I don’t think smokers (COPD patients included) should believe there is no hope of feeling better – whether they quit now or later. Yes, smoking cessation is difficult decision to make and a harder decision to see through. The physical habit of smoking and the addiction to nicotine are very powerful inhibitors. But there are steps you can take to feel better - even if you continue to smoke.
To be clear, I am not advocating the concept that one should continue to smoke. Quite the opposite – quitting smoking is so powerfully beneficial to your health (at any stage of lung disease) that it is always the best first option you can consider.
However, I am increasingly concerned that medical professionals are so focused on smoking cessation that they do not discuss with patients other steps a cigarette smoker can take in conjunction with smoking cessation or in lieu of smoking cessation (in the event one is not ready to quit but is ready to take steps to improve their health).
It is remarkable when I read in studies and articles (and hear at conferences and symposiums) physicians make comments along the lines of, “I am reluctant to share this information with patients who smoke because they will interpret my sharing this information as me granting permission for them to continue smoking.”
While I can understand the basic sentiment behind the comment, I think it is misguided. Knowing that smoking cessation success rates are very low in general, knowing that these rates are even lower for COPD patients, knowing that in the U.S. alone there are over 40 million currently smoking adults, doesn’t it make sense to provide smokers every available option to help improve their health – whether it involves smoking cessation or not?
Imagine if doctors said to obese patients - I want you to lose weight and so I want you to change your diet. But, I’m not going to tell you to exercise until you’ve lost the weight because I don’t want you to think you don’t need to change your diet. Weight loss programs are all about combining dietary changes with exercise to improve metabolism, burn calories and increase overall physical activity. Why not the same kind of approach for smokers?
From a societal standpoint, the main goal of medical professionals and public policy makers is to lower the societal burden of smoking (meaning reduce the health care costs associated with smoking). So shouldn’t we as a society provide smokers with every option available to improve their health (including smoking cessation) in pursuit of this goal?
Statistics from bodies like the American Lung Association and U.S. Surgeon General’s office tell us that approximately 70% of current smoking adults express a desire to quit each year. Of this 70%, only 40% actually try, and of this amount only about 15% are successful in quitting for 12 months or more if you take the most aggressive/optimistic range of success rates. That means that out of approximately 43 million current smoking adults, only about 2 million adults successfully quit for 12 months or more each year.
So what does society/medicine do for the 41 million people who can’t or won’t stop smoking in a given year? Other than barrage them with new laws that restrict smoking in public, passive smoking cessation discussions in doctor’s offices, and public service announcements that also push the smoking cessation message, the honest answer is…nearly nothing outside of prescribing rescue inhalers for shortness of breath (that is until lung disease is so advanced that more intensive medical intervention is required).
But did you know, for example, there have been a number of studies conducted that demonstrate health benefits for smokers from exercise and improving nutrition/dietary intake? We’ve written articles in the past that shed more light on recent studies in these areas (links to a sampling of these articles provided below):
Exercise articles:
http://breathebetterblog.blogspot.com/2009/11/pulmonary-rehabilitation-as-precursor.html
http://breathebetterblog.blogspot.com/2010/04/new-study-demonstrates-pulmonary-rehab.html
Nutrition articles:
http://breathebetterblog.blogspot.com/2010/08/black-currant-shown-to-reduce-airway.html
http://breathebetterblog.blogspot.com/2010/07/n-acetyl-cysteine-reduces-airway.html
http://breathebetterblog.blogspot.com/2010/06/chinese-herb-dramatically-reduces.html
http://breathebetterblog.blogspot.com/2010/05/vitamin-c-supplementation-possible.html
Now I recognize that many smokers (especially COPD patients who smoke) find it hard to do any form of physical activity because they become breathless quickly. But guess what? Lack of physical activity actually makes breathlessness worse…greater physical activity reduces breathlessness! Exercise also lowers lung cancer risk (even if you continue to smoke) and has been shown in recent studies to improve success rates for smoking cessation.
No one expects a person who suffers from chronic breathlessness to leap up and run a marathon. One has to start slow, build a base level of conditioning, and slowly over time increase the intensity and duration of exercise. That is the core belief set behind the treatment option pulmonary rehabilitation and our Breathe Better for Life guide/CD, www.breathebetterforlife.com.
On the nutrition side, smoking seriously depletes protective nutrients in the body known as antioxidants. So much so, in my humble opinion, it is impossible for a pack-a-day-or-more smoker to consume enough antioxidant rich food to offset the effects of smoking. But, improving dietary intake and supplementing with vitamins and other dietary supplements that have good antioxidant content have been shown to reduce lung inflammation – the core cause of breathlessness in COPD patients according to the vast majority of practitioners and researchers.
Imagine then if you, as a current smoker who has not been successful in quitting, decided to start a modest exercise program and add antioxidant rich foods and/or dietary supplements to your daily routine (in consultation with your physician). Imagine then that the proactive acts each day of trying to do something healthy (while continuing to smoke) helped you feel better physically, helped you gain confidence in your ability to improve your quality of life, helped you get out and meet new people, and helped you accomplish more basic activities of normal every-day life like shopping, walking up stairs and preparing meals without pronounced breathlessness.
If you were able to do that for 8-12 weeks, wouldn’t you think that because of all of these positive changes you would be in a better frame of mind and better physical condition to attempt smoking cessation, therefore increasingly the likelihood of your success?
I think so, and from a COPD patient perspective I think it is a helluva lot better option than believing that nothing will help you feel better. From a physician standpoint, I think it’s a helluva lot better option than simply writing a prescription for a bronchodilator, providing a brochure about smoking cessation, and then waiting for the inevitable hospital admission call to come.
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