Letitia Trofor

Depression, anxiety and panic disorders in chronic obstructive pulmonary disease patients: correlations with tobacco use, disease severity and quality of life

BackgroundThe objective of this study is to assess anxiety, depression and panic disorders among patients diagnosed with COPD and to investigate their correlation with disease severity, quality of life as well as tobacco use.MethodsAn observational study was performed between January and September 2014 among 60 patients diagnosed with COPD. COPD staging according to GOLD criteria, while anxiety and depression were assessed using Hospital Anxiety and Depression Scale and panic attacks were evaluated based on ICD 10 criteria.ResultsAlmost 40% of the sample were smokers, the medium packs-years was 34.3 and the medium Fagerstrom score was 7.5. Overall, mean Modified Medical Research Council Dyspnea Scale (mMRC) was 2.86, mean COPD Assessment Test (CAT) score was 21.75 and study participants had 1.93 COPD exacerbations/year. Mean distribution of anxiety and depression symptoms scores among COPD subjects was 10.65 ± 3.5 and 9.93 ± 3.8, respectively. Smokers and ex-smokers had similar scores with regard to anxiety, depression or the presence of panic attacks. The results of the bivariate correlations indicated associations between anxiety, depression, panic attacks and disease severity, as well as poor quality of life of patients with COPD, regardless of their current tobacco use status.ConclusionsIn conclusion, the results of this study indicate that anxiety, depression and panic attacks were constant characteristics among COPD patients- regardless of their current tobacco use.

Impact of the Tobacco Treatment Guidelines for High RiskGroups (TOB.g): A pilot study among physicians specializing inCVD, Diabetes and COPD

INTRODUCTION The 2017 Tobacco Cessation Guidelines for High-risk Groups (TOB-G) is a comprehensive document on best practices for smoking cessation in clinical practice. The purpose of this pilot study was to assess physician satisfaction and changes in tobacco-related knowledge, self-efficacy and attitudes following exposure to training in the TOB-G guidelines for patients with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or diabetes. METHODS A pre-post pilot study was conducted. All participating physicians received an electronic or printed copy of the TOB-G guidelines for patients with CVD, COPD or diabetes. Physicians were also exposed to a one-day training focused on the key clinical practice recommendations from the TOB.g guidelines. Outcome measurement occurred via survey before, immediately following and 6 months after exposure to the training. RESULTS Fifty physicians participated in the TOB.g training session. High rates of participant satisfaction were documented (exceeded expectations 47.7%; met expectations to a great extent 52.3%). Significant increases in physician knowledge and self-efficacy were documented immediately following and 6 months after exposure to the guideline training session. Exposure to the training was associated with positive changes in some but not all tobacco-related treatment attitudes, however these were no longer significant at the 6-month follow-up. Lower knowledge, confidence and unfavourable attitudes were documented for aspects of treatment related to pharmacotherapy. CONCLUSIONS Positive changes in previously reported barriers to the delivery of tobacco treatment among physicians were documented following exposure to the TOB.g guidelines and training for patients with CVD, COPD or diabetes.

Smoking cessation for free: First long-term outcomes in three Romanian centres

Introduction: The reimbursed smoking cessation (SC) national program in Romania, covering three months pharmacotherapy and counselling, is routinely evaluating only end of treatment (EOT) abstinence. Aim: To assess abstinence rate, 12 months after quit date, by a long term telephone follow-up (LTFU) intervention and to evaluate participants9 compliance to LTFU, in a first such attempt in our centres. To correlate smoking characteristics with EOT and LTFU abstinence. Methods: A standard Romanian SC guideline telephone interview about smoking status, abstinence duration and willingness to be delivered relapse prevention counseling, was conducted in 832 subjects in the SC centers of Iasi, Cluj and Tg. Mures. Statistic analysis was used to find useful correlations for clinical practice. Results: Overal EOT abstinence was 53.4%, with significantly increased varenicline abstinence in women (r=-0,113, p=0,001) and in severely addicted smokers (r=0.23, p≤0,001). LTFU abstainers smoking profile at enrollement showed average 27.2±16.3SD packs-years and high dependence scores in 53.4%. LTFU smoking status showed 327 (39.3%) smokers, 155 (18.6%) abstinent and 350 (42.1%) unrated patients. A maximum abstinence duration of 154 days±180.1SD was reported even among the 327 still smokers. The reimbursed program had a positive impact at 12 months, as in LTFU 61.5% of smokers and 97.2% of no-smokers were willing to receive relapse prevention counseling. Conclusions: Providing smoking cessation for free had a positive long term effect on program participants, even if there was no intermediary contact between EOT and LTFU.

The problem of low rate-smokers: Smoking pattern and cessation outcomes

Introduction: Low-rate smokers, defined as no more than 5 cigarettes per day (CPD) or 1 – 5 CPD smokers are often a challenge to smoking cessation practitioners. Aim: To determine smoking cessation outcomes in low-rate smokers treated in our centre, in relation with pattern of smoking in this particular category of patients. Material and methods: Low-rate smokers included in a tobacco dependence 3 months pharmacological and counselling treatment program were evaluated for age, gender, smoking history, nicotine dependence score and co-morbidities. Abstinence rate was determined at 3 months end of treatment (3-EOT) and in 6 months follow-up (6 -FU) . Results: We analyzed 180 subjects, age average 35. 6 yrs, in majority women (70%), with various co-morbidities (psychiatric - 11 %, COPD- 5%, cardio-vascular – 4.2% ). At a CPD consumption ≤ 5, paradoxically, we found a moderate-severe degree of nicotine dependence in majority of subjects ( only in 30.5% the nicotine dependence Fagerstrom score was Conclusions: Even if low-rate smokers, quitting may be difficult in this category of patients, due to a particular smoking pattern and frequent moderate-severe nicotine dependence, resulting in lower than expected abstinence rates.