Article information
Resumo
A cessação tabágica é uma das melhores formas de melhorar o prognóstico dos doentes com DPOC. Baseados na evidência actualmente disponível, todos os profissionais de saúde devem ter um papel proactivo e contínuo na motivação para parar e no tratamento para a cessação de todos os fumadores. O tratamento deve incluir farmacoterapia combinada com suporte comportamental e deve integrar o seguimento da doença respiratória crónica como recomendado no Plano Nacional de Prevenção e Controlo da DPOC. Os pneumologistas e os restantes profissionais de saúde devem receber treino que garanta conhecimento, atitudes e capacidades necessários para fornecer estas intervenções ou para referenciar a especialistas na área.
No futuro próximo, unidades especializadas em tabagismo deverão fornecer assistência especializada, formação, investigação, divulgação e medidas de controlo na área de saúde de influência (hospital e cuidados de saúde primários).
Palavras-chaves:
Doença pulmonar obstrutiva crónica
cessação tabágica
unidades especializadas em tabagismo
Abstract
Smoking cessation is one of the most important ways of improving the prognosis of COPD patients. Based on currently available evidence professional health workers should take a proactive and continuous role with smokers, motivating them to stop smoking and providing treatment to aid smoking cessation. The treatment should include pharmacotherapy in addition to behavioural support and should be part of management of the patient's chronic respiratory condition, as the COPD National Prevention and Treatment Programme recommends. Respiratory physicians and other professional health workers should receive training to ensure they have the necessary knowledge, attitude and skills to undertake these initiatives or to refer the smokers to a suitable qualified specialist.
In the near future specialised smoking units should provide specific support, promote training, improve research and awareness and establish tobacco control measures in hospitals and primary health care centres.
Key-words:
Chronic obstructive pulmonary disease
smoking cessation
specialized tobacco units
Full text is only aviable in PDF
Bibliografia
[1.]
Programa Nacional de Prevenção e Controlo da Doença Pulmonar Obstrutiva Crónica. Circular Normativa n.° 04/DGCG de 17/03/2005. [disponível em http://www.dgs pesquisar: DPOC/circular normativa, acedido em 1/2/2008].
[2.]
J. Cardoso, R. Ferreira, J. Almeida, M. Santos, F. Rodrigues.
Prevalence of chronic obstructive pulmonary disease in Portugal.
Rev Port Pneumol, VIII (2002), pp. 269
[4.]
C. Jiménez-Ruiz, F. Masa, M. Miravitlles, R. Gabriel, J. Viejo, C. Villasante, V. Sobradillo.
Smoking Characteristics. Differences in attitudes and dependence between healthy smokers and smokers with COPD.
Chest, 119 (2001), pp. 1365-1370
[5.]
Haustein Knut-Olaf.
Epidemiology of tobacco dependence.
In Tobacco or Health- Physiological and social damages caused by tobacco smoking ed Springer, (2003), pp. 17-33
[6.]
C. Janson, N. Kunzli, R. Marco, S. Chinn, D. Jarvis, C. Svanes, J. Heinrich, R. Jogi, T. Gislason, J. Sunyer, U. Ackermann-Liebrich, J. Antó, I. Cerveri, M. Kerhof, B. Leynaert, C. Luczynska, F. NeuKirch, P. vermeire, M. Wjst, P. Burney.
Changes in active and passive smoking in the European Community Respiratory Health Survey.
Eur Respir J, 27 (2006), pp. 517-524
[7.]
Gouveia M, Borges M, Pinheiro L, Costa J, Paulo S, Carneiro A. Carga e custos da doença atribuível ao tabagismo em Portugal, 2007 [disponível em http://www.hospitaldofuturo.com/imagens/Carga%20e%20Custo%20da%20Doen%C3%A7a%20Atribu%C3%ADvel%20ao%20Tabagismo%20em%20Portugal.pps, acedido em 1/2/2008].
[8.]
WHO Report on the Global Tobacco Epidemic, 2008.
The MPOWER package.
World Health Organization, (2008),
[9.]
Nunes E, Candeias A, Mendes B, Pardal C, Fonseca J, Oliveira L, Rebelo L, Açafrão M, Rosas M, Santos M, Vinagre S. Programa-tipo de actuação em cessação tabágica. Circular normativa n.° 26/DSPPS de 28 Dezembro 2007: 1-74 [disponível em http://www.dgs pesquisar: cessação tabágica/circular normativa, acedido em 1/2/2008].
[10.]
Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
[11.]
P. Tønnesen, L. Carrozzi, K. Fagerstrom, C. Gratziou, C. Jimenez-Ruiz, S. Nardini, G. Viegi, C. Lazzaro, I. Campell, E. Dagli, R. West.
ERS Task Force Smoking cessation in patients with respiratory diseases. A high priority, integral component of therapy.
Eur Respir J, 29 (2007), pp. 390-417
[12.]
A. Cornette, I. Petitdemange, S. Briancon, C. Burlet, J.M. Polu.
Evaluation of smoking in chronic severe respiratory insufficiency patients treated with long-term oxygen at home.
Rev Mal Respir, 13 (1996), pp. 405-411
[13.]
M. Jarvis, H. Tunstall-Pedoe, C. Feyerabend, C. Vesey, Y. Saloojee.
Comparison of tests used to distinguish smokers from nonsmokers.
Am J Public Health, 77 (1987), pp. 1435-1438
[14.]
S. Sato, K. Nishimura, H. Koyama, M. Tsukino, T. Olga, T. Hajiro, M. Mishima.
Optimal cutoff of breath carbon monoxide for assessing smoking status in patients with asthma and COPD.
Chest, 124 (2003), pp. 749-1754
[15.]
M. Jarvis, J. Fidler, J. Mindell, C. Feyerabend, R. West.
Assessing smoking status in children, adolescents and adults: cotinine cut-points revisited.
Addiction, 103 (2008), pp. 1553-1561
[16.]
K. Fagerström, S. Rennard.
Treatment of tobacco dependence, pp. 219-228
[17.]
T.F. Heatherton, L.T. Kozlowski, R.C. Frecker, K.O. Fagerstrom.
The Fagerstrom test for nicotine dependence: a revision of the Fagerström tolerance questionnaire.
British Journal of Addiction, 86 (1991), pp. 1119-1127
[18.]
G. Lillington, C. Leonard, D. Sachs.
Smoking cessation.
Clin Chest Med, 21 (2000), pp. 199-208
[19.]
T. Laszlo, V. Priscilla, G. Lillington.
Achieving tobacco cessation: Current status, current problems, Future Possibilities.
Respiration, 69 (2002), pp. 381-384
[20.]
S. Reina, G. Damasceno, G. Orive.
El paciente que va a dejar de fumar.
Manual de prevencíon y tratamiento del tabaquismo, 3. ª ed, pp. 97-114
[21.]
M. Simmons, J. Connett, M. Nides, P. Lindgren, E. Kleerup, R. Murray, W. Bjornson, D. Tashkin.
Smoking reduction and the rate of decline in FEV1: results from the lung health study.
Eur Respir J, 25 (2005), pp. 1011-1017
[22.]
M. Ferrero, M. Mezquita, M. García.
Anexo 30. Manual de prevención y tratamiento del tabaquismo.
3.ª ed, GlaxosmithKline, S.A, (2006),
[23.]
D. Górecka, M. Bednarek, A. Nowiński, E. Puścińska, A. Goljan-Geremek, J. Zieliński.
Diagnosis of airflow limitation combined with smoking cessation advice increases stop-smoking rate.
Chest, 123 (2003), pp. 1916-1923
[24.]
J. Zielinski, M. Bednarek, D. Górecka, G. Viegi, S. Hurd, Y. Fukuchi, K. Lai, X. Ran, W. Ko, M. Liu, P. Zheng, S. Zhong, A. Vermeire.
Increasing COPD awareness.
Eur Respir J, 27 (2006), pp. 833-852
[25.]
T.J. Wilt, D. Niewoehner, R.L. Kane, R. MacDonald, A.M. Joseph.
Spirometry as a motivational tool to improve smoking cessation rates: a systematic review of the literature.
Nicotine Tob Res, 9 (2007), pp. 21-32
[26.]
J. Morris, W. Temple.
Spirometric “lung age” estimation for motivating smoking cessation.
Prev Med, 14 (1985), pp. 655-662
[27.]
C. Fletcher, R. Peto.
The natural history of chronic airflow obstruction.
Br Med J, 1 (1977), pp. 1645-1648
[28.]
G. Parkes, T. Greenhalgh, M. Griffin, R. Dent.
Effect on smoking quit rate of telling patients their lung age: the Stepquit2quit randomised controlled trial.
BMJ, (2008), pp. 1-7
[29.]
Diário da República, 1.ª série, n.° 156, 14 de Agosto de 2007 [disponível em: http://194.6.229.67/legislacaopdf/desporto/60/lei37_2007.pdf, acedido em 2/5/08].
[30.]
Rigotti N, Munafo M, Murphy M, Stead L. Intervention for smoking cessation in hospitalised patients (review). Cochrane Database of Systematic Reviews 2007. Published by John Wiley & Sons, Ltd.: 1-24.
[31.]
P. Pamplona.
Fumador internado? A intervenção apropriada.
Rev Port Pneumol, XIII (2007), pp. 801-826
[32.]
A.H. Lee, B. Afessa.
The association of nicotine replacement therapy with mortality in a medical intensive care unit.
Crit Care Med, 35 (2007), pp. 1517-1521
[33.]
A. Batra, G. Gelfort, M. Bartels.
The dopamine D2 receptor (DRD2) gene – A genetic risk factor in heavy smoking?.
Addict Biol, 5 (2000), pp. 431-438
[34.]
Sociedade Portuguesa de Pneumologia. Folheto DPOC – parar de fumar. 2003.
[35.]
L. Stead, R. Perera, T. Lancaster.
Telephone counselling for smoking cessation.
Cochrane Database Syst Rev, 3 (2006), pp. CD002850
[36.]
West R, Michie S. Engaging the Patient: A Fresh Look at behavioural approaches In Global Healthcare Alliance for treatment of tobacco dependence, 15 Novembro 2008.
[37.]
NICE public health guidance 10. Smoking cessation services in primary care, pharmacies, local local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. February 2008:1-87 [disponível em http://www.nice.org.uk/nicemedia/pdf/PH010guidance.pdf, acedido em 12/9/2008].
[38.]
Attitudes of Europeans towards tobacco. May 2007:1-104 [disponível em http://ec.europa.eu/health/ph_publication/eurobarometers_en.htm acedido em 12/9/2008].
[39.]
M. Jarvis, J. Wardle, J. Waller, L. Owen.
Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study.
BMJ, 326 (2003), pp. 1061
[40.]
S. Emery, E. Gilpin, C. Ake, A. Farkas, J. Pierce.
Characterizing and identifying “hard-core” smokers: implications for further reducing smoking prevalence.
American Journal of Public Health, 90 (2000), pp. 387-394
[41.]
H. McRobbie, C. Bullen, M. Glover, R. Whittaker, M. Wallace-Bell, T. Fraser.
New Zealand Guidelines Group New Zealand smoking cessation guidelines.
N Z Med J, 121 (2008), pp. 57-70
[42.]
R. Murray, W. Bailey, K. Daniels, W. Bjornson, Kurnow k, J. Connett, M. Nides, J. Kiley.
Safety of nicotine polacrilex gum used by 3,094 participants in the Lung Health Study.
Chest, 109 (1999), pp. 438-445
[43.]
C. Jiménez Ruiz, R. Pinedo, G. Orive, F. Martin, M. Ulibarri, C. Fernández, R. Hermosa, et al.
Nuevas formas de uso de la terapia sustitutiva con nicotina Análisis de su eficacia y seguridad en el tratamiento del tabaquismo.
Prevención del Tabaquismo, 10 (2008), pp. 102-115
[44.]
J. Henningfield.
Nicotine medications for smoking cessation.
N Engl J Med, 333 (1995), pp. 1196-1203
[45.]
Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating tobacco use and dependence. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service; 2000.
[46.]
Kaper J, Wagena EJ, Severens JL, Van Schayck CP. Healthcare financing systems for increasing the use of tobacco dependence treatment.The Cochrane database of systematic reviews, 2005 Issue 1 (acedido em Maio de 2008).
[47.]
Berta Mendes. Resultados das políticas de prevenção e cessação tabágicas na diminuição da morbilidade na DPOC In DPOC revisitada – 13.ª Reunião de Pneumologistas. Novembro-Dezembro 2007: 35–38.
[48.]
Smoke-free hospital european implementation guide. 09/2001 [disponível em http://ensh.aphp.fr/IMG/doc/Pt-ENSHimplementation.doc, acedido 2/5/08].
[49.]
C. Jiménez-Ruiz, S. Reina, B. Ferrero, G. Orive, L. Blasco, A. Viteri, F. Martín, S. Peña.
Grupo de trabajo del área de tabaquismo de la SEPAR Recomendaciones para la organización y funcionamento de las unidades especializadas en tabaquismo.
Arch Bronconeumol, 37 (2001), pp. 382-387
[50.]
P. Trullén, I. Herrero, M. Clemente, L. Escosa.
Abordaje de la prevención y el tratamiento del tabaquismo: a quién?, quando y cómo realizar la deshabituación tabáquica?.
Arch Bronconeumol, 40 (2004), pp. 63-73
[51.]
J. Granda, F. Carrión, S. Alonso, F. Márquez, J. Riesco, Í. Sampablo, F. Àlvarez, M. Barrueco, J. Carreras, C. Jiménez, I. Nerín, A. Trullén, J. Hermosa, P. Romero, L. Agudo, I. Sánchez, S. Solano, J. Álvarez-Sala.
Atención y prestación de servicios en materia de tabaquismo.
Arch Bronconeumol, 42 (2006), pp. 600-604
[52.]
Oshu, 2007 [disponívelemhttp://www.ohsu.edu/smokingcessation/pdf/TreatmentRecommendationsHealthProfessionals.pdf, acedido a 1 de Fevereiro 2009].
Copyright © 2009. Sociedade Portuguesa de Pneumologia
