UKNSCC 2016 Melanie Perry The lung a magnificent

UKNSCC 2016 - Melanie Perry

The lung: a magnificent organ that needs lifelong attention COPD is a lung ailment that is characterized by a persistent Smoking is the main cause of COPD in at least 80% of cases blockage of airflow from the lungs COPD is preventable COPD is not curable, but treatment can slow the progress of the disease COPD accounts for over 140, 000 hospital admissions and over a million bed days COPD the second most common lung disease in the UK, after asthma It is essential to stop smoking to prevent the progression of COPD

Smoking cessation is the most effective intervention in stopping the progression of COPD, as well as increasing survival and reducing morbidity This is why smoking cessation should be the top priority in the treatment of COPD Melanie Perry 2016

Melanie Perry 2016

Counselling delivered by physicians and other health professionals significantly increases quit rates over self initiated strategies With more complex interventions quit rates can reach 20 -30% Melanie Perry 2016 ‘The GOLD report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs’

A ‘Hospital’ setting was used by 8, 306 people setting a quit date but had the highest success rate, (59 per cent) with 4, 867 people successfully quitting April – Dec 2015

Complex COPD Clinic The complex COPD service at Glenfield Hospital was established in 2013 with the aim of ensuring thorough and consistent assessment and treatment of patients with complex, advanced COPD in the Leics area (serving approximately one million people) Identifies patients High symptom burden High future health risk Potential need for specialist services… …continued smoking being one of the criteria Encourages shared decision making with the patient through a holistic approach

First Steps… March 2015 – approached by service lead to identify and discuss ways to support staff & patients 30 -35% prevalence 50+ pack years Staff unskilled Poor uptake referral High relapse rate Intensive support requested + training needs Melanie Perry 2016

Complex COPD Clinic Added Value Action Plan • Skills & confidence to advise. Outpatient staff have ongoing opportunistic training • Raises the profile & priority of smoking cessation improving relationship and referral rate • Using harm reduction techniques – significant benefits to physical & mental health NRT offered and supplied directly or • Patients are motivated to act immediately E-cigarette sample provided to try • Continuity is vital to maintaining the relationship of trust & advice thus reducing relapse rate & increasing adherence to programme All staff trained Level 1 – Brief Intervention Skills Stop Smoking Specialist sits in clinic alongside MDT All patients who smoke are seen for support with harm reduction & cessation advice Champix initiated with letter for GP Ongoing follow-up either by telephone, in clinic or home visit Melanie Perry 2016

Melanie Perry 2016 d it Qu 10 at e n 52 Va lid tio n> Cu td ow re du c t H. Vi si 30 m Ha r ni c/ cli p -u en se llo w be Fo to 42 nd ed te At ed re Ag ge d En ga Results… Complex COPD Clinic 60 50 No. of Patients 40 40 25 20 15 9 0

Melanie Perry 2016

Treatment Methods NRT, Champix & E-cig 1 Champix & E-cig 3 NRT & E-cig 3 4 E-cig only Champix only 2 NRT only 2 0 1 2 3 4 5 73% patients chose to use electronic cigarettes in their quit attempts Melanie Perry 2016

What we tell our patients… Melanie Perry 2016 13

Electronic Cigarettes They form part of a harm reduction strategy (NICE Guidance PH 45) An expert independent evidence review published by Public Health England (PHE) in Sept 2015 concludes that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking. The current best estimate is that ecigarettes are around 95% less harmful than smoking It is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK Royal College of Physicians Report 2016 Be open to e-cig use and provide advice on their use Behavioral support from SSS is likely to improve success Leicester City have found this to be as high as 20%+ It’s OK to use an e-cig and NRT/Champix providing the patient is receiving support Melanie Perry 2016 14

What the clinician’s tell us… “The main benefit of the service is the immediacy of the intervention in relation to the clinical consultation. This ensures any behaviour change that results from advice I give is acted on immediately and re-inforces the high priority given to smoking cessation. Smoking Cessation is the most important intervention & we can start the process here in the clinic on the same day. This sends a crucial message to the patient. It contrasts with the normal referral route which is completion of a referral card with an uncertain outcome and unclear timelines” Professor Mick Steiner – Respiratory Physician “It has more than proved its worth by the evidence of those that have remained “quit” Patients have said that they have found the service enormously beneficial. Having Melanie support them on their “cessation journey” has been integral in their ability to quit and remain quit” “Smoking cessation is such a specialist area & I feel supported and re-assured that the most current up to date information/guidance is available to us through Melanie’s interaction so when referring patients we can impart that trust and assurance onto them” Nicole Toms – Respiratory Nurse Specialist Melanie Perry 2016

What our patients tell us…the benefits 62 yrs, smoked 48 yrs 20+day Complex COPD, Switched to vaping + Champix After 2 wks quit, less SOBOE, 8 wks, <reliever meds, 6 -12 wks visible improvement 16 wks “reaping the benefits” 55 yrs, smoked 40 yrs COPD & SMI, Attempted quits +++, Quit after 5/12 HR ‘allowed to take time, no pressure, patience & encouragement…feel amazing’ 69 yrs, smoked from age 16 yrs old Complex COPD and DM t 2 Never tried to quit before only pregnancy Switched to e-cig only, never looked back Health…“far better” Convinced others to switch, money ++ Melanie Perry 2016

Promoting Better Outcomes Encouraging Respiratory patients to stop smoking is one of the most important components of their management At a local level, stop smoking services need their budgets protected and more should be invested in innovative stop smoking and awareness campaigns targeting communities with high smoking rates All patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity

Next Steps… Improvements – Robust data collection, Rolling out intensive support further – RAL, DAC, Thoracic Surgery Funding – BCT, LTC to secure future support Don’t be afraid of tackling specialised groups…forever fearless! Melanie Perry 2016

#foreverfearless Thank you for listening melanie. perry@leicester. gov. uk

Royal College of Physicians Report APRIL 2016 It is important to promote the use of ecigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK Provision of the nicotine that smokers are addicted to without the harmful components of tobacco smoke can prevent most of the harm from smoking The hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco