SciELO - Scientific Electronic Library Online

 
vol.13 número6Tuberculose em profissionais de saúde de um serviço hospitalarLeptospirose pulmonar índice de autoresíndice de assuntosPesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Journal

Artigo

Indicadores

Links relacionados

  • Não possue artigos similaresSimilares em SciELO

Compartilhar


Revista Portuguesa de Pneumologia

versão impressa ISSN 0873-2159

Rev Port Pneumol v.13 n.6 Lisboa dez. 2007

 

Fumador internado? – A intervenção apropriada

 

In-patient smoker? – Providing appropriate intervention

 

Paula Pamplona 1

 

Resumo

O tabagismo é a causa de morte evitável mais frequente. Para além de provocar múltiplas doenças causadoras de internamentos, o tabagismo é também uma doença a tratar durante o internamento, não só para controlar a síndroma de abstinência do doente, sujeito a interrupção abrupta, mas também para cumprir a legislação que proíbe o uso de tabaco nos serviços de saúde, única forma eficaz de prevenir a exposição dos não fumadores ao fumo do tabaco presente no ambiente (FTA).

Tratar o fumador internado de forma apropriada é também aproveitar a janela de oportunidade para promover a cessação tabágica e não apenas a abstinência temporária.

Palavras-chave: Cessação tabágica, internamento, serviço de saúde sem tabaco.

 

 

Abstract

Tobacco use is the most avoidable cause of death. Other than provoking multiple diseases requiring hospitalisation, Tobacco Use is also a disease requiring management in the hospital setting, not only in terms of controlling the withdrawal symptoms of the patient, who has been abruptly prohibited from smoking, but also for fulfilling legislation which prohibits tobacco use in the health services, the only efficient way of preventing exposure of non-smokers to environmental tobacco smoke. Treating the in-patient smoker in an appropriate way also provides a window of opportunity for promoting not just a temporary but a complete smoking cessation.

Key-words: Smoking cessation, in-patient, smoke-free hospital.

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

Bibliografia

1. An international treaty for tobacco control.[edição online] 2003. Disponível na Wide World Web: www.who.int/features/2003/08/en/

2. World Bank. Curbing the Epidemic. Governments and the economics of Tobacco Control. Washington, DC: World Bank; 1999.        [ Links ]

3. The World Health Organization. The ICD-10 Classification of Mental, Behavioural Disorders. Geneva. World Health Organization, 1992.

4. International Classification of Diseases-9 – Clinical Modification. 2006. 9th revision.

5. West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Thorax 2000; 55:987-99.

6. Fiore M, Bailey W, Cohen S. A Clinical Practice Guideline for Treating Tobacco Use and Dependence. A US Public Health Service Report. Jama 2000; 283(24): 3244-54.

7. European Partnership to reduce Tobacco Dependence. WHO Evidence Based Recommendations on the Treatment of Tobacco Dependence. June 2001.

8. Instituto da Qualidade em Saúde. Norma de Orientação Clínica. Tratamento do uso e dependência do tabaco 2002.

9. National Institute for Clinical Excellence. Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. Technology Appraisal Guidance No. 39, Issue Date March 2002, Review Date March 2005, www.nice.org.uk.

10. Pamplona P. Intervenção na prática clínica. In: Pestana E (Eds.). Tabagismo – do diagnóstico ao tratamento, editora Lidel 2006, pp. 101-36.

11. Borges ML. Intervenção Psicológica na Dependência Tabágica. In: Pestana E (Eds). Tabagismo – do diagnóstico ao tratamento; Editora Lidel 2006, pp. 167-94.

12. Mendes B. Tratamento farmacológico do tabagismo. In: Pestana E (Eds.). Tabagismo – do diagnóstico ao tratamento; Editora Lidel 2006, pp. 137-66.

13. Jiménez-Ruiz C, Granda Orive J, Solano R, Valero C, Palácios R, Ferrero B. Recommendations on the Treatment of Tobacco Dependence. Arch Bronconeumol 2003; 39(11):514-23.

14. 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., pp. 1-24.

15. Prochaska J. DiClemente C. Stages and processes of self-change of smoking: Toward na integrative model of change. Journal of Consulting and Clinical Psychology 1983; 51:390-5.

16. Littell J, Girvin H. Stages of change. A critique. Behav Modif. 2002; 26(2):223-73.

17. Decreto lei n.º 226/83 de 27 de Maio.

18. Direcção-Geral de Saúde – Circular normativa n.º 9/DES – Consumo de tabaco nas instalações dos estabelecimentos de saúde. 28 Maio 2004.

19. Comissão das Comunidades Europeias. Livro verde. Por uma Europa sem fumo: opções estratégicas a nível comunitário, Janeiro 2007, pp. 1-34.

20. Santis M, Lucas C, Jesus L, Godinho S, Domingues F, Marques A, Costa F, Figueiredo A. Smoking cessation in hospital inpatients: 10 months experience. Rev Port Pneumol 2006; 12(6 Suppl 1):50-1.

21. Cornette A, Petitdemange I, Briancon S, Burlet C, Polu JM. Evaluation of smoking in chronic severe respiratory insufficiency patients treated with long-term oxygen at home. Rev Mal Respir 1996; 13(4):405-11.

22. Ferreira P, Carvalho L, Caetano F, Videira W, Mota L, Oliveira F. Internamento por exacerbação da Doença Pulmonar Obstrutiva Crónica – Análise da gravidade dos doentes, das exacerbações e dos critérios de internamento de acordo com o Projecto GOLD. Boletim do HPV 2003; XVI(3):105-10.

23. Schuermans D, Snoussi F, Deschepper E, Peys M, Schoonis A. Counselling for smoking cessation needed in one third of hospitalised respiratory patients. Eur Respir J 2006; 28(Suppl 50):838s.

24. Barrueco M, Jiménez Ruiz C, Palomo L, Torrecilla M, Romero P, Riesco J. Veracity of smokers’ reports of abstinence at smoking cessation clinics. Arch Bronconeumol 2005; 41(3):135-40.

25. Martinet Y. Bohadana A, Quantificação e marcadores do tabagismo. In O Tabagismo – da prevenção à abstinência Climepsi Editores 2003:87-90

26. Sato S, Nishimura K, Koyama H, Tsukino M, Olga T, Hajiro T, Mishima M. Optimal cutoff of breath carbon monoxide for assessing smoking status in patients with asthma and COPD. Chest 2003; 124(5):1749-54.

27. Chatkin J, Fritscher L, de Abreu C, Cavalet-Blanco D, Chatkin G, Wagner M, Fritscher C. Exhaled carbon monoxide as a marker for evaluating smoking abstinence in a Brazilian population sample. Prim Care Respir J 2007; 16(1):36-40.

28. Fagerström K, Rennard S. Treatment of tobacco dependence. In Pulmonary Rehabilitaion edited by Donner C, Ambrosino N, Goldstein R. 2005: 219-28.

29. Heatherton T, Kozlowski L, Frecker R, Fagerström K. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerence Questionnaire. Br J Adicct 1991; 86:1119-27.

30. Robert West ABC of smoking cessation – Assessment of dependence and motivation to stop smoking. BMJ 2004; 328:338-9.

31. Richmond R, Kehoe L, Webster I. Multivariate models for predicting abstention following intervention to stop smoking by general practioners. Addiction 1993; 88:1127-35.

32. Jiménez-Ruiz C, Masa F, Miravitlles M, Gabriel R, Viejo J, Villasante C, Sobradillo V. Smoking Characteristics. Differences in attitudes and dependence between healthy smokers and smokers with COPD. Chest 2001; 119:1365-70.

33. Walters N, Coleman T. Comparasion of the smoking behaviour and attitudes of smokers who attribute respiratory symptoms to smoking with those who not. British Journal of General Practice 2002; 52:132-4.

34. Jarvis MJ, Wardle J, Waller J, Owen L.Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study. BMJ 2003; 326(17):1061-3.

35. Emery S, Gilpin E, Ake C, Farkas A, Pierce J. Characterizing and identifying “hard-core” smokers: implications for further reducing smoking prevalence. Am J Public Health 2000; 90(3):387-94.

36. American College of Chest Physicians, American Thoracic Society, Asia Pacific Society of Respirology, Canadian Thoracic Society, European Respiratory Society. Smoking and health: a physician´s responsibility. A statement of the joint committee on smoking and health Eur Respir J 1995; 8:1808-11.

37. Ward M, Molyneux A. Smoke-free Hospitals – A practical guide from British Thoracic Society. 2005:1-21.

38. Nardini S, Bertoletti R, Rastelli V, Donner C. The influence of personal tobacco smoking on the clinical practice os Italian chest physicians. Eur Respir J 1998; 12:1450-3.

39. Henry R, Ogle K, Snellman L. Preventive Medicine: physician practices, beliefs, and perceived barriers for implementation. Fam Med 1987; 19:110-3.

40. Nardini S. Education and smoking cessation. In: Pulmonary Rehabilitation. Edited Donner and Decramer. Eur Respir Mon 2000 (5); 13:41-57.

41. Fichtenberg C, Glantz S. Effect of smoke free workplaces on smoking behaviour: systematic review. BMJ 2002; 325:1-7.

42. Aveyard P, West R. Managing smoking cessation. BMJ 2007; 335:37-41.

43. Lillington G, Colm L, Sachs D. Smoking cessation – Techniques and benefits. Clinics in Chest Medicine 2000; 21(1):199-208.

44. Rigotti N. Treatment of tobacco use and dependence. N Engl J Med 2002; 346(7):506-12.

45. Hughes J, Hatsukami D. Signs and symptoms of tobacco withdrawal. Arch Gen Psych 1986; 43:289-94.

46. Hughes J, Hatsukami. Effect of nicotine on the tobacco withdrawal syndrome. Psychopharmacology.1984; 83:82-7.

47. Piasecki T, Fiore M, McCarthy D, Baker T. Have we lost our way? The need for dynamic formulations of smoking relapse proneness. Addiction 2002; 97 (9):1093-108.

48. McBride M, Emmons M, Lipkus M, Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003; 18(2):156-70.

49. Moller M, Villebro N, Pederson T, Tonnesen H, Effect of preoperative smoking intervention on postoperative complications:a randomised clinical trial. Lancet 2002; 359(9301):114-7.

50. Lacasse Y, Maltais F, Goldstein R. Smoking cessation in Pulmonary Rehabilitation: goal or prerequisite? J Cardiopulm Rehabil 2002; 22(3):148-53.

51. Slama K, Chiang C, Enarson D. Tobacco cessation and brief advice. Int J Tuberc Lung Dis 2007; 11(6):612-6.

52. Chiang C, Slama K, Enarson D. Associations between tobacco and tuberculosis. Int J Tuberc Lung Dis 2007; 11(3):258-62.

53. Bates M, Khalakdina A, Pai M, Chang L, Lessa F, Smith K. Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Arch Intern Med 2007; 167(4):335-42.

54. Freund K, D’Agostino R, Belanger A, Kannel W, Stokes J. Predictors of smoking cessation: the Framingham Study. American Journal of Epidemiology 1992; 135: 957-64.

55. Canga N, De Irala J, Vara E, Duaso M, Ferrer A, Martinez-Gonzalez M. Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings. Diabetes Care 2000; 23:1455-60.

56. Gritz E. Smoking and smoking cessation in cancer patients. British Journal of Addiction 1991; 86: 549–554.

57. Gritz E, Carr C, Rapkin D, Chang C, Beumer J, Ward P. A smoking cessation intervention for head and neck cancer patients: trial design, patient accrual, and characteristics. Cancer Epidemiology, Biomarkers and Prevention 1991; 1: 67-73.

58. Walker M, Vidrine D, Gritz E, Larsen R, Yan Y, Govindan R, Fisher E. Smoking relapse during the first year after treatment for early-stage non-small-cell lung cancer. Cancer Epidemiol Biomarkers Prev 2006; 15(12):2370-7.

59. Department of Health and Human Services. Health benefits of smoking cessation. A report of the Surgeon General, Washington, DC. DHHS Publication No. (CDC) 90-8416, 1990.

60. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years‘observations on male British doctors. BMJ 2004; 328:1519.

61. Anthonisen N, Skeans M, Wise R, Manfreda J, et al. The effects of a smoking cessation intervention on 14,5 year mortality. Annals of Intern Med 2005; 142(4):233.

62. US Department of Health and Human Services. Office of the Surgeon General. The Health Consequences of smoking: A report of Surgeon General. Rockville, MD. 2004.

63. Gritz E, Vidrine D, Lazev A. Smoking cessation in cancer patients: Never too late to quit, in Given C, Given B, Champion V (Eds.). Evidence-based cancer care and prevention. New York. Springer Publishing Company 2003:103-140.

64. Murray R, Anthonisen N, Connett J, Wise R, Lindgren P, Greene P, Nides M. Effects of multiple attempts to quit smoking and relapses to smoking on pulmonary function. Lung Health Study Research Group. J Clin Epidemiol 1998; 51(12):1317-26.

65. Eagan T, Gulsvik A, Eide G, Bakke P. Remission of respiratory symptoms by smoking and occupational exposure in a cohort study. Eur Respir J 2004; 23:589-94.

66. Willemse B, Postma D, Timens W, ten hacken N. The impact of smoking cessation on respiratory symptoms, lung function, airway hiperresponsiveness and inflammation. Eur Respir J 2004; 23:464-76.

67. Troosters T, Gosselink R, Scholier D, Spruit A, Pitta F, Probst M, Decramer M. Pulmonary Rehabilitation in smokers with COPD.- ERS. Glasgow. ERJ 2004; 24 (48s):667.

68. Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction; meta-analysis of cohort studies. Arch Intern Med 2000; 160:939-44.

69. Lightwood J, Glantz S, Short-term economic and health benefits of smoking cessation: myocardial infarctation and stroke. Circulation 1997; 96:1089-96.

70. Sargent R, Shepard R, Glantz S. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ 2004; 328(7446):977-80.

71. World Health Organization Regional Office for Europe Copenhagen. European Strategy for Tobacco Control. 2002. www.euro.who.int/document/e77976.pdf. Sargent R, Shepard R, Glantz S. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ 2004; 328(7446):977-80.

72. World Health Organization. The right to healthy indoor air. Report of a WHO meeting, Copenhagen, Denmark; 2000. URL http://www.euro.who.int/air/activities/20030528_9

73. Ockene J, Kristeller J, Goldberg R, Ockene I, Merriam P, Barrett S, Pekow P, Hosmer D, Gianelly R. Smoking cessation and severity of disease: The coronary artery smoking intervention study. Health Psychology 1992; 11:119-26.

74. DeBusk R, Houston-Miller N, Superko H, Dennis C, Thomas R, Lew H, Berger W, Heller R, Rompf J, Gee D, Kraemer H, Bandura A, Ghandour G, Clark M, Shah R, Fisher L, Taylor C. A case-management system for coronary risk factor modification after acute myocardial infarction. Annals of Internal Medicine 1994; 120(9):721-9.

75. Dornelas E, Sampson R, Gray J, Waters D, Thompson P. A randomized controlled trial of smoking cessation counseling after myocardial infarction. Preventive Medicine 2000; 30:261-8.

76. Lewis S, Piasecki T, Fiore M, Anderson J, Baker T. Transdermal nicotine replacement for hospitalized patients: A randomized clinical trial. Preventive Medicine 1998; 27(2):296-303.

77. Miller N, Smith P, DeBusk R, Sobel D, Taylor C. Smoking cessation in hospitalized patients – Results of a randomized trial. Archives of Internal Medicine 1997; 157:409-15.

78. Simon J, Solkowitz S, Carmody T, Browner W. Smoking cessation after surgery – A randomized trial. Archives of Internal Medicine 1997; 157:1371-6.

79. Taylor C, Houston-Miller N, Killen J, DeBusk R. Smoking cessation after acute myocardial infarction: Effects of a nurse-managed intervention. Annals of Internal Medicine 1990; 113:118-23.

80. Nezami E, Sussman S, Pentz M. Motivation in Tobacco Use Cessation Research. Substance Use and Misuse 2003; 38(1):25-50.

81. Lancaster T, Stead L. Self-help interventions for smoking cessation. Cochrane Database Syst Rev 2005; 20(3):CD001118.

82. Cunningham J, Ferrence R, Cohen J, Adlaf E. Interest in self-help materials among a general populationsample of smokers. Addict Behav 2003; 28(4):811-6.

83. Sood A, Ebbert J, Sood R, Stevens SR. Complementary treatments for tobacco cessation: a survey. Nicotine Tob Res 2006; 8(6):767-71.

84. Zhu S, Christopher M, Anderson B, Tedeschi G, Rosbrook B, Johnson B, Byrd M, Gutiérrez-Terrell E. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med 2002; 347:1087-93.

85. Stead L, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2006; 3:CD002850.

86. Mermelstein R, Hedeker D, Chi Wong S. Extended Telephone Counseling for Smoking Cessation: Does content matter? Journal of Counsultg and Clinical Psychology 2003; 71,3:565-574.

87. Cochrane Tobacco Addiction Group. Online www.dphpc.ox.ac.uk/cochrane_tobacco/index.html.Oxford: Department of Primary Health Care, University of Oxford

88. Andrew Molyneux, ABC of smoking cessation – Nicotine replacement therapy BMJ 2004; 328: 454-456.

89. Sweeney C, Fant R, Fagerstrom K, McGovern J, Henningfield J. Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability. CNS Drugs 2001; 15(6):453-67.

90. Schneider N, Koury M, Cortner C, Olmstead R, Hartman N, Kleinman L, Kim A, Chaya C, Leaf D. Preferences among four combination nicotine treatments Psychopharmacology 2006; 187(4):476-85.

91. Murray R, Bailey W, Daniels K, Bjornson W, Kurnov K, Connet J, Nides M, Kiley J. Safety of Nicotine Polacrilex Gum used by 3 094 participants in the Lung Health Study. Chest 1996; 109:438-45.

92. Henningfield J, Fant R, Buchhalter A, Stitzer M. Pharmacotherapy for nicotine dependence. CA Cancer J Clin 2005; 55(5):281-99.

93. Fant R, Henningfield J, Shiffman S. Strahs K, Reitberg D. A pharmacokinetic crossover study to compare absorption characteristics of three transdermal nicotine patches. Pharmacol Biochem Behav 2000; 27:479-82.

94. Fagerström K, Sachs D. Medical management of tobacco dependence: a critical review of nicotine skin patches. Current Pulmonol 1995; 16:223-38.

95. Prosise G, Bonnet M, Berry R, Dickel M. Effects of abstinence from smoking on sleep and daytime sleepiness. Chest 1994; 105(4):1136-41.

96. Wetter D, Fiore M, Baker T, Young T. Tobacco withdrawal and nicotine replacement influence objective measures of sleep. J Consult Clin Psychol 1995; 63(4):658-67.

97. Staner L, Luthringer R, Dupont C, Aubin H, Lagrue. Sleep effects of a 24-h versus 16-h nicotine patch: A polysomnographic study during smoking cessation. Sleep Med 2006:7: 147-54.

98. Benowitz N, Gourlay S. Cardiovascular Toxicity of nicotine: Implications for nicotine replacement J Am Coll Cardiol1997; 29:1422-31

99. Hubbard R, Lewis S, Smith C, Godfrey C, Smeeth L, Farrington P, Britton J., Use of nicotine replacement therapy and the risk of acute myocardial infarction, stroke, and death. Tob Control 2005; 14(6):416-21.

100. Joseph A, Norman S, Prochazcha A, Westman E, Steele B, Sherman S, Cleveland M, Antonnucio D, Hartman N, McGovern P. The Safety of Transdermal Nicotine as an Aid to Smoking Cessation in Patients with Cardiac Disease. N Engl J Med 335:1792.

101. Meine T, Patel M, Washam J, Pappas P, Jollis J. Safety and effectiveness of transdermal nicotine patch in smokers admitted with acute coronary syndromes. Am J Cardiol 2005; 15;95(8):976-8.

102. Tashkin D, Kanner R, Bailey W. Smoking cessation in patients with chronic obstructive pulmonary disease. Lancet 2001; 357:1571-1575

103. Rigotti N, Thorndike A, Regan S, McKool K, Pasternak R, Chang Y, Swartz S, Torres-Finnerty N, Emmons K, Singer D. Bupropion for smokers hospitalized with acute cardiovascular disease. Am J Med 2006; 119(12):1080-7.

104. Hughes J, Stead L, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2007; (1):CD000031.

105. Cahill K, Stead L, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochran Cochrane Database Syst Rev 2007; (1):CD006103.

106. TØnnesen P, Carrozzi L, Fagerstrom K, Gratziou C, Jimenez-Ruiz C, Nardini S, Viegi G, Lazzaro C, Campell I, Dagli E, West R. ERS Task Force. Smoking cessation in patients with respiratory diseases. A high priority, integral component of therapy. Eur Respir J 2007; 29: 390-417.

107. Keating G, Siddiqui A. Varenicline – A review of its use as an aid to smoking cessation therapy. CNS Drugs 2006; 20(11):945-60.

108. Ranney L, Melvin C, Lux L, McClain E, Lohr K. Systematic review: smoking cessation intervention strategies for adults and adults in special populations. Ann Intern Med 2006; 145(11):845-56.

 

 

1 Assistente hospitalar graduada de Pneumologia.

Departamento de Pneumologia do Hospital de Pulido Valente, EPE

Director: Dr. Jaime Pina

Hospital de Pulido Valente, EPE

Alameda das Linhas Torres, 117

1769-001 Lisboa

Tel: 351 217 548 500

Fax: 351 217 548 215

Recebido para publicação/received for publication: 07.07.23

Aceite para publicação/accepted for publication: 07.09.11