Acute Respiratory Disease as a Fulcrum Point to Quit Smoking: Evaluation of an ED-based Intervention

Emergency departments (EDs) are among the most critical referral centers for individuals with health problems resulting from the direct and indirect effects of smoking. Individuals may be more motivated to change their smoking habits, especially during acute attacks of respiratory diseases. The American College of Emergency Physicians (ACEP) and some organizations recommend that interventions for smoking cessation should be implemented by physicians and nurses in the form of counseling for patients with active smoking who receive treatment for acute respiratory infections (ARI) in EDs. However, interventions for smoking cessation are frequently performed in primary health care institutions and according to studies, a high majority of emergency physicians think that EDs are not the appropriate place for this intervention and are not included in their professional responsibilities.

The effect of nicotine dependence (ND) severity on smoking cessation has been shown in studies. Fagerström Test of Nicotine Dependence (FTND) developed by Fagerström et al. is a widely used tool to measure the ND level of individuals. The Turkish validity and reliability study of the test was conducted by Uysal et al. In the approach to smoking cessation, ND level comes to the forefront in determining personalized intervention strategies. At high levels of addiction, nicotine replacement therapy or pharmacologic support is recommended because the physical and psychological dependence of individuals is more intense. In these cases, motivational counseling and regular follow-up are necessary during the cessation process. At moderate levels of addiction, nicotine replacement products or behavioral therapies are usually recommended, while less pharmacological intervention may be required. At low levels of addiction, behavioral support and counseling may be sufficient for smoking cessation. Pharmacologic treatment is usually not needed in these individuals, but education and awareness-raising methods that support smoking cessation can be used. Intervention with strategies appropriate to the level of ND is a crucial factor in increasing the success of smoking cessation.

When determining the assistance method in individuals who want to quit smoking; WHO recommends five major steps (5A) in smoking cessation treatment. In practice, the "Ask, Advise, Assess, Assist, Arrange" approach is an evidence-based smoking cessation model that has been developed to provide effective interventions in a short time, especially in busy working environments.

This study aimed to examine the effects of short structured interviews with patients who presented to the ED due to ARI on smoking cessation behavior and to follow up for one month. It is aimed to evaluate the applicability of smoking cessation interventions on those with ARI in EDs.

Inclusion criteria

• Patients who were active smokers and admitted to the emergency department with acute respiratory system complaints.

Exclusion criteria

• Exclusion criteria included individuals under 18 years of age, ASA class III-IV, pregnancy or breastfeeding, communication difficulties such as language barrier or cognitive impairment, psychotic behaviors or history of psychiatric treatment, and initiation of smoking cessation treatment.