Moreover, the landscape of the tobacco epidemic has dramatically evolved. The tobacco industry continues to oppose all tobacco-control efforts but is faced with a declining cigarette market. It has developed novel, noncombustible products and mass-marketed them specifically to recruit nonsmokers and youths, and to postpone quitting in regular smokers, while promoting the social acceptability of tobacco use [11–14]. However, our respiratory health community is at the forefront in treating current tobacco/ nicotine users, preventing new users, and striving to protect against SHS exposure. Notably, only large increases in population-level tobacco cessation will significantly reduce the global burden of tobacco in the short term [15]. Promoting tobacco cessation at a population-level requires a socially supportive environment as well as widespread effective treatments to overcome nicotine addiction. Implementing comprehensive public health policies with broad-reach healthcare interventions will have the greatest impact [9, 10]. This Monograph is a comprehensive overview of tobacco cessation, from health policy to health system reorientation and direct cessation treatments for patients. It confirms tobacco as the main cause of respiratory diseases, emphasising the role of respiratory healthcare providers in championing tobacco prevention and cessation. The Monograph opens with an overview of the tobacco epidemic and the global strategy to reducing tobacco disease burden, through the World Health Organization (WHO) Framework Convention on Tobacco Control [16]. It goes on to discuss tobacco use as a dependence and a chronic, often relapsing disorder, focusing on nicotine addiction and the harms of nicotine/tobacco beyond addiction [17]. A chapter dedicated to novel tobacco and nicotine products discusses whether they really do help smokers to quit and reduce tobacco harm, or whether they have the contrary effect, and undermine tobacco control [18]. Next, the Monograph focuses on tobacco-dependence treatment: a combination of behaviour counselling [19] and pharmacotherapy [20]. A chapter fully dedicated to motivational interviewing discusses the strategies and clinical tools that can be used to engage the smoker in behaviour change and to motivate the reluctant quitter without confrontation [21]. A further chapter in the section illustrates the pragmatic brief clinical models of smoking-cessation advice that can be integrated into everyday practice [19]. The incorporation of patient views and preferences in smoking-cessation respiratory care is also discussed. While no new classes of drugs to treat nicotine-addiction have been developed since 2007, the evidence of their effectiveness and safety, as well as more effective modalities, has been growing. Chapter 6 in this Monograph reviews the evidence of the effectiveness and safety of first-line licensed smoking-cessation pharmacotherapies [20]. However, regardless of the overwhelming evidence of its effectiveness and cost-effectiveness, tobacco cessation remains neglected in healthcare. A greater effort is needed to train healthcare providers and engage whole healthcare systems in tobacco cessation. Chapter 7 presents successful examples of system-level interventions, from primary to secondary care, in community settings and through international collaboration. The role of interdisciplinary healthcare teams, telemedicine and innovative broad-reach community approaches is also discussed [22]. The third section of the Monograph focuses on improving the care of patients who smoke. The chapters in this section consider different lung diseases and other comorbidities commonly associated with smoking. There are specific chapters on smoking cessation in xii
Previous Page Next Page