When smokers say, “I can’t quit” or “I don’t want to quit,” what should the doctor tell them?
This is one of the difficult questions that more than 50 doctors and scientists from 26 countries were looking for at the medical-scientific conference “Tobacco Harm Reduction: Novel products, Research and Policy” in Greece.
Doctors and scientists discussed the validity of implementing harm reduction programs as a tool of global public health policy. They also wondered whether such an approach should be used in the case of smoking patients who are unable to break the habit with the available methods.
Professor Andrzej Fal – allergist and specialist in the field of public health – who represented Poland at the conference drew attention to the fact that today smoking is more and more often mentioned as a new risk factor for public health. Cigarette smoke kills not only the smokers themselves, but also exposes outsiders to passive inhalation.
Moreover, it also influences the development of pulmonary diseases and coronary artery disease, which, in the opinion of the Polish allergist and specialist in internal medicine and public health, makes it a special risk factor that must be taken into account.
– In pneumology offices about 30 percent. patients today are refusing to undertake any form of therapy to quit smoking. In such situations, we can offer them today less harmful products that can meet their needs or habits. We also have an obligation to provide them with such an opportunity – emphasized prof. Andrzej Fal.
He also added that e-cigarette liquids are among the most dangerous products today. They are mixtures of various substances that are often not intended for inhalation. Users of e-cigarettes compose such liquids themselves, pouring them into the device’s reservoir, and then injecting them into the lungs in the form of steam.
The expert noted that the composition of these liquids in electronic cigarettes remains a mystery to the doctor and can have disastrous health consequences for the person who inhales them. On the other hand, as an example of products for smokers with a higher safety profile, prof. Andrzej Fal replaced the tobacco heating systems.
As he emphasized, thanks to heating, and not burning, tobacco, these systems have an average of 85 percent. less mutagenic than cigarettes. In the opinion of the Polish scientist, they also pose a lower risk to the health of smokers than the continued smoking of cigarettes. The Polish expert noted that less harmful products should be introduced in public health regulations, and the regulations themselves must be based on scientific and medical documentation relating to such products.
As a positive model in the area of regulation, the Polish allergist mentioned the recent decision of the US Food and Drug Administration (FDA), which, after 4 years of scientific documentation analysis, authorized the IQOS tobacco heating system as a product “appropriate for the promotion of public health”. The FDA’s decision paved the way in the United States to propose this device to smokers as a harm reduction tool to reduce the exposure of both smokers and bystanders to the harmful substances in cigarette smoke.
The Polish expert stated that any product reducing the harmfulness of cigarettes should have open access to the market, but strongly opposed the further introduction of further products presenting similar harmfulness to cigarettes. He also noted that harm reduction is a tool of tertiary prevention in health policy.
In turn, prof. Piotr Kuna took part in a panel about the difficult decisions that doctors face today when faced with an ethical choice: should I inform smoking patients who do not want to quit or do not respond to pharmacotherapy that they can switch to less harmful alternatives? Is it not allowed or proper for a doctor to give such controversial recommendations to patients?
The Polish pulmonologist talked about respiratory diseases caused by smoking, which lead to the deterioration of lung function. This is the first and fastest-growing sign of the early stage of COPD development in cigarette smokers.
The data he cited on cigarette smoking and mortality due to an exacerbated course of COPD indicate that only 22 percent. patients in the last 14 years have decided to quit this addiction. He noted that even temporary abstinence from cigarettes improves lung function.
Prof. Kuna also admitted that, as a doctor, he follows a specific protocol for treating patients who smoke cigarettes. First of all, he offers them medical advice, carefully informing them about the harmful effects of smoking and the health risks associated with the development of cigarette diseases.
If this advice is unsuccessful, Prof. Kuna recommends that patients be treated with cytisine, a plant-derived ingredient that chemically resembles nicotine and is intended to satisfy the narcotic aspect of addiction in a smoker. If the patient still smokes, the next, third step is nicotine replacement preparations (NRTs). If NRT also fails, and the smoker is still addicted, the fourth step is pharmacological treatment with preparations with buproprion, varenicline and cytisine. However, this is the last systemic option of treating patients with nicotine addiction in Poland.
If the patients continue to smoke despite these attempts, only then prof. Kuna talks about the use of harm reduction, i.e. recommending to such smokers certified heating systems for tobacco or standardized e-cigarettes, which – although still harmful and risky to health – may, in the opinion of prof. Piotr Kuna, reduce the potential health effects of continuing to smoke cigarettes.