Here is some good news for those unfortunate patients suffering from a serious condition known as chronic obstructive pulmonary disease, or COPD. It’s a complex disorder but the main features are shortness of breath with cough, phlegm and chest tightness as the lungs are progressively damaged; the result may be fatal. The biggest risk factor for getting COPD is cigarette smoking so it’s obvious what a smoker should do if he or she has been given this diagnosis.
Easier said than done! Or so it may appear. Here we have the absurd situation where smoking is literally killing these patients and they may say they can’t stop. Well, unless someone has a death wish – and respiratory failure is not a pleasant way to die – I don’t believe someone can’t stop smoking. I have had a number of patients with the COPD under my care and when they realised the state they were in, even if they didn’t want to avail themselves of my method of smoking cessation, they just stopped. It’s similar to the situation of a smoker who gets a heart attack: they usually quit forthwith.
Now there has been a new study, reported in the journal Thorax in May 2017, undertaken by six researchers from the UK, Germany, The Netherlands and the USA, that shows, apparently, that giving the drugs varenicline or bupropion to smokers with COPD – those who by implication are unable to quit on their own in spite on of this serious diagnosis – is safe, in that these drugs ‘do not appear to be associated with an increased risk of cardiovascular events (heart attacks and strokes), depression or self-harm (suicide attempts) in comparison with (so-called) nicotine replacement therapy.’
Smoking is a voluntary activity. Yet the orthodox approach of medical workers involved in the care of these patients is that they can only offer nicotine products or drugs to help them stop killing themselves. But even if they use these drugs or nicotine products they still have to stop smoking!
It’s not generally realised that offering drugs or nicotine products as smoking cessation ‘aids’ is inherently discouraging and may make quitting more difficult. This is because these treatments imply that it’s too difficult to quit on your own. Even if you’re suffering from COPD, and obviously the smoke is going into the very place where the trouble is, namely, the lungs, there’s an unspoken collusion that these poor people can’t stop without medical intervention.
Psychologically this is a disaster: it gives the patient an in-built excuse for failure. Like all smokers, even though dying from this smoking-induced disease is a real possibility, they still don’t really want to stop. They can say, therefore, that they tried the drugs or nicotine products and they didn’t work, so in a sense they have permission to carry on smoking!
What, then, should be done?
First of all, it is a ludicrous situation, is it not, that people with a potentially life-threatening illness largely caused by smoking, are able to go into any corner shop or supermarket and buy a pack of cigarettes, no questions asked. Pictures of diseased lungs and patients with breathing holes in their throats (tracheostomies) do nothing to put off those COPD patients who continue to smoke. It is, therefore, not lack of information about the harmful effects of smoking that is the reason many people start or continue smoking.
Why, then do they do it?
Children and teenagers start smoking because they see other people smoking, either older people whom they wish to emulate, or their peers whom they wish to impress. Horrible pictures on the packs make very little impression. ‘Lung cancer happens to older people – it doesn’t apply to me.’ Or they think of themselves as invulnerable – which is understandable and even normal at that age. The ‘graphic health warnings’ may even act as an incentive to smoke, as a dare. What is absurd is that cigarettes are on sale at all.
There’s a glaring inconsistency in that cigarettes, in packs emblazoned with warnings not to smoke, are nonetheless freely available. I have even had young people say to me, ‘If cigarettes were really so dangerous they wouldn’t be allowed!’ This is a good point, but how do you respond to it? By saying that government is either lying or being irresponsible?
And why do older smokers continue to smoke in spite of knowing the dangers? Because they are addicted to the nicotine in cigarettes. This statement, however, is not an adequate answer to the question. We can put it succinctly like this: the only reason smokers smoke is because they believe they are unable to quit.
Text © Gabriel Symonds