Leo is a 58-year-old single white male who works as a grocery store manager. He has...

Leo is a 58-year-old single white male who works as a grocery store manager. He has been admitted for COPD exacerbation for the second time in 7 months. He was in the intermediate intensive care unit for 5 days and is now on the general floor. Leo's COPD has been classified as group C. He has been on a home oxygen regimen of 3 L for 2 years and is presently receiving oxygen therapy via nasal cannula a 4 L. He has a 60-pack-year history and unfortunately continues to smoke. However, this exacerbation has frightened him, and he has expressed a willingness to quit. AS a CTC (Case Transition Coordinator) same as a Case Manager, you have been consulted to see Leo to provide tobacco cessation counseling as well as follow up with him after discharge.

What considerations/guidelines should you follow to optimize smoking cessation counseling?

What measures might enhance this patients transition of care?

Expert Solution

Interventions For Smoking Cessation

Brief advice and encouragement during hospitalization and each time of visit
The smoking cessation program should be personalized according to the use of Mr.Leo's pattern of tobacco use and his general health condition
The 5A's model' for treating tobacco use and dependence guidelines can be followed here

Ask about smoking.
Advise smokers to stop.
Assess the smoker's willingness to stop.
Assist those smokers willing to stop.
Arrange follow-up.

Systematically identify all tobacco users by Asking at every visit. Give clear, strong, and personalized Advice about the importance of total cessation. Patients not willing to quit despite clinical advice may be uninformed, concerned about the effects of quitting or discouraged by previous relapses.

Pledge to Assist patients when they are ready to quit. Ask questions at each visit that help the patient identify reasons to quit and barriers to quitting. Motivational interventions for patients unwilling to quit at the present time are characterized by the “Five R's”:

Relevance
Risks
Rewards
Roadblocks
Repetition

The patient should be motivated about the relevance of quitting the smoking according to his present condition of exacerbation. He should be informed about potential complications in his health. If he is following the advice and quitting smoking, it should be appreciated and motivated him to continue. Also, identify the obstacles which do not let him quitting and help him to overcome it. If he is doing well repeat the same measures/interventions during each follow-up visit.

2. The important measure enhancing his condition is to stop smoking. As per the information given by him, he is following all the treatment measures except he is not quitting smoking. Thus his condition is gradually worsening from earlier.

A systematic planned Smoking cessation can improve his condition and help him to reduce the COPD attack episodes

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