Respiratory health, tobacco control and smoking cessation

Continuing our celebration of 50 years of respiratory therapy, the current issue of the Canadian Journal of Respiratory Therapy highlights contemporary respiratory health issues confronting our patients and our profession.

Dr Jason Nickerson

Kathleen Spurr et al (1) (pages 45–49) present the results of a study aimed at assessing and improving patients’ understanding of the air quality health index in Nova Scotia, highlighting the particular role of air quality as an important determinant of respiratory health. The results of this study demonstrate that while much attention has been devoted to many aspects of chronic respiratory disease diagnosis and management, there are still significant areas for greater understanding and research to ensure a comprehensive approach that addresses not only the medical, but also the social determinants of our patients’ health, including the use of available information such as the air quality health index.

Taking this point further, David Sweanor (2) (pages 41–42) argues in a commentary solicited by the Journal that electronic cigarettes offer yet another opportunity for assisting in smoking cessation and tobacco control that should be welcomed by the public health community. This argument is predicated on the notion that although smokers face an addiction to nicotine, it is the delivery system (the combustion of tobacco cigarettes) – rather than the drug (nicotine) – that leads to the vast majority of morbidity and mortality attributed to smoking. It stands, then, that by eliminating the offending device, harms should be reduced.

The particular role of these devices in practice and among public health and respiratory practitioners has been controversial, as Professor Sweanor alludes to. Few randomized controlled trials have been conducted, although the evidence from those that have been completed appears to be promising (3,4). Several authors have, however, highlighted potential and theoretical risks of electronic cigarettes, leading to uncertainty in the minds of many clinicians who work with smokers (5,6).

Pragmatically, electronic cigarettes are likely being used by patients under our care and are almost certainly here to stay. As a profession concerned with the respiratory health of Canadians and people around the world, this is a technology that ought to be at the forefront of discussions within our profession, and is a subject requiring more data and evidence concerning the efficacy of electronic cigarettes in smoking cessation and harm reduction, their long-term safety and their impact on the sale of tobacco cigarettes (7). Despite all of the options available, smoking-related morbidity and mortality continues to be stubbornly high in Canada, which should prompt us to consider not only the best mechanisms for encouraging smoking cessation, but also models of care for addressing the pathologies associated with tobacco use.

For these reasons and more, the Canadian Journal of Respiratory Therapy will publish a special issue focused on tobacco use and smoking cessation in fall 2015.

The intention of this issue is to examine current evidence and trends related to tobacco use and smoking cessation initiatives. This could include observational studies and descriptive epidemiology of the prevalence of smoking or tobacco-related harms in certain patient populations, evaluations of new drugs, devices and therapies, and models of care for implementing smoking cessation programs across the continuum of care. We are particularly interested in respiratory therapist-led research and initiatives such as the implementation of hospital-based smoking cessation interventions. However, we also welcome submissions from a broad range of health care providers, researchers, social scientists and policy makers who can provide new insights into the dynamics of tobacco use and addiction.

For inclusion in this issue, manuscripts should be submitted no later than May 1, 2015. Hospitals, clinicians and researchers with a potential idea for an article to be included are welcome to contact the editorial office to discuss their proposed article further.

As we begin to close our 50th anniversary of the profession, we look forward to the opportunity to revisit an old problem in a new light. By focusing on tobacco use, we continue to advance the science of respiratory therapy while advocating for a broad focus on the medical and social determinants of respiratory health. Adopting a focus on not only clinical interventions, but also on public and population health, is an area of much-needed growth for the profession of respiratory therapy (8). We look forward to the new evidence and insights generated by this issue and the discussions that ensue.