Smoking addiction in chronic obstructive pulmonary disease: Integrating neurobiology and phenomenology through a review of the literature

Del consumo ocasional del tabaco a la adicción a la nicotina

Introducción. El consumo ocasional de nicotina puede generar una dependencia o adicción, siendo detectable mediante modificaciones en los mecanismos neurobiológicos. Objetivo. Contextualizar del consumo a la adicción e identificar teóricamente el  mecanismo neurobiológico de transición del consumo regular del tabaco a la adicción de la nicotina. Metodología. Se realizó una búsqueda de artículos en inglés y español usando diferentes bases de datos y combinaciones de palabras clave, se seleccionaron los artículos que describieran las características de los procesos neurobiológicos implicados en el uso o consumo intermitentedel tabaco a la adicción a la nicotina como el tema principal. Resultados. El número de investigaciones relacionados a este tema es reducido, aún más en relación con la descripción de los procesos y cambios neurales de la adicción a la nicotina. La adicción a las drogas es un proceso neuroconductual complejo que altera los circuitos del sistema de motivaciónrecompensa del cerebro, por la disminución de la dopamina y la afectación en la regulación del glutamato en los ganglios basales y extensión de la amígdala se asocia con el craving, la anticipación y el déficit en la función ejecutiva. Conclusiones. El tabaco está considerado como una droga legal, por lo que su consumo pareciera ser inofensivo. Sin embargo, las evidencias muestran que su consumo a largo plazo tiene consecuencias graves en la salud de los individuos. El entender cómo cambia el hábito de fumar ocasionalmente al consumocrónico nos hace más conscientes sobre las adaptaciones en el cerebro.

Patients and families realising their future with chronic obstructive pulmonary disease-A qualitative study

AIMS AND OBJECTIVES

To gain insight into the lived experience of learning about having chronic obstructive pulmonary disease for patients and their families.

BACKGROUND

Chronic obstructive pulmonary disease often progresses for years. Adjustment to declining health is gradual, and the disease may have developed considerably when health care is sought and people are diagnosed. Reaching patients at early stages is necessary to delay progression of the disease.

DESIGN

Interpretive phenomenology.

METHODS

Data were collected in four family focus group interviews (N = 37) and a subsample of eight family-dyad interviews. Patients were eight men, and 14 women aged 51-68 years. Majority of the patients (n = 19) were at GOLD grades II and III, with three at grade IV. The family members were eight men, and seven women aged 29-73 years. Data were collected between June-November 2012.

RESULTS

Five, not mutually exclusive themes, revealed a long and arduous process of learning about and becoming diagnosed with chronic obstructive pulmonary disease and how unaware participants were of the imminent threat that the disease imposes on life. The themes were as follows: burden of shame and self-blame, enclosed in addiction, living in parallel worlds, realising the existence of the disease and a cry for empathy.

CONCLUSIONS

Learning about and realising the existence of chronic obstructive pulmonary disease and what it entails at present time and in the future was bleak for the participants. The patients tended to put aside the thought of being a person with chronic obstructive pulmonary disease and defer actions that might halter progression of the disease, particularly to quit smoking.

RELEVANCE TO CLINICAL PRACTICE

Individuals and families need support early in the disease process to realise and accept the existence of chronic obstructive pulmonary disease and particularly to deal with the challenges that nicotine addiction, shame and self-blame present. Increased public awareness about this enormous, but hidden, health problem is necessary.

Embodying cognition: working with self-control in cerebral palsy

During the last decades, research on cognition has undergone a reformation, which is necessary to take into account when evaluating the cognitive and behavioural aspects of therapy. This reformation is due to the research programme called Embodied Cognition (EC). Although EC may have become the theoretical authority in current cognitive science, there are only sporadic examples of EC-based therapy, and no established framework. We aim to build such a framework on the aims, methods and techniques of the current third-wave of CBT. There appears to be a possibility for cross-fertilization between EC and CBT that could contribute to the development of theory and practice for both of them. We present a case-study of an EC-based model of intervention for working with self-control in cerebral palsy. We centre the results of the study and its discussion on how we should understand and work with self-control in a more general sense from both an EC and a CBT perspective. We end by elaborating the five learning objectives and present suggestions for follow-up reading.

European Non-Communicable Respiratory Disease Research, 2002-13: Bibliometric Study of Outputs and Funding

This study was conducted in order to map European research in chronic respiratory diseases (CRDs). It was intended to assist the European Commission and other research funders to identify gaps and overlaps in their portfolios, and to suggest ways in which they could improve the effectiveness of their support and increase the impact of the research on patient care and on the reduction of the incidence of the CRDs. Articles and reviews were identified in the Web of Science on research in six non-communicable respiratory diseases that were published in 2002-13 from 31 European countries. They represented only 0.8% of biomedical research output but these diseases accounted for 4.7% of the European disease burden, as measured by Disability-Adjusted Life Years (DALYs), so the sub-field is seriously under-researched. Europe is prominent in the sub-field and published 56% of the world total, with the UK the most productive and publishing more than France and Italy, the next two countries, combined. Asthma and Chronic Obstructive Pulmonary Disease (COPD) were the diseases with the most publications and the highest citation rates. They also received the most funding, with around two acknowledgments per paper (in 2009-13), whereas cystic fibrosis and emphysema averaged only one. Just over 37% of papers had no specific funding and depended on institutional support from universities and hospitals.

A new instrument to predict smoking cessation among patients with chronic obstructive pulmonary disease: an observational longitudinal study of the Trying To Quit smoking questionnaire

The Trying To Quit smoking questionnaire (TTQ), was developed to measure pressure-filled mental states, use of destructive pressure-relief strategies and ambivalent thoughts about quitting smoking among patients with COPD. The aim of this study was to evaluate whether the TTQ (available in an extended and in a reduced version) can be used to predict smoking cessation outcomes in smokers with COPD. As higher TTQ scores indicate higher degree of psychological distress, we hypothesised that TTQ scores at baseline would be negatively correlated with the probability of making a quit attempt, reducing the intensity of smoking and achieving complete abstinence during the 3 months. Smokers with COPD were recruited during planned or unplanned visits to primary healthcare centres, and 109 completed the TTQ at baseline and 85% participated in the follow-up after 3 months. Logistic regression was used to measure the association between the original (19 items) and the brief (14 item) version of TTQ scores and three outcomes: making at least one quit attempt, reducing the intensity of smoking and achieving complete abstinence. In a primary analysis among all the participants higher total score in the original version of TTQ was significantly associated with a lower probability of quit attempts. In a secondary analysis of subgroups of patients classified according to their readiness to quit, high TTQ scores at baseline were associated with lower probability of complete abstinence among patients not ready to quit (adjusted odds ratio (OR)=0.72; 95% confidence interval (CI)=0.53–0.99). Among patients ready to quit, high score on pressure-filled mental states was associated with lower probability of quit attempts (OR=0.78; 95% CI=0.66–0.94) but with higher probability of reduced smoking (OR=1.32; 95% CI=1.05–1.66). Ambivalent thoughts were associated with lower probability of all outcomes, but estimates were not statistically significant. Destructive coping strategies were inconsistently associated with the outcomes. TTQ in its original version and two of its subscales predicted smoking cessation outcomes in the anticipated direction. Therefore, this instrument may be useful in tailoring smoking cessation counselling for patients with COPD.

Effectiveness of a partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease: a pragmatic randomized controlled trial

AIMS

To evaluate the effectiveness of a 6-month, partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease.

BACKGROUND

Self-management is a widely valued concept used to address contemporary issues of chronic health problems. Findings of self-management programmes for people with chronic obstructive pulmonary disease are inconclusive.

DESIGN

Pragmatic randomized control trial.

METHODS

Patients, 45-65 years old, with mild and moderate chronic obstructive pulmonary disease were invited with a family member. Experimental group (n = 48) participated in a 6-month, partnership-based self-management programme consisting of: (a) three to four conversations between nurse and patient-family member; (b) 6 months of smoking cessation; and (c) interdisciplinary team-patient-family member group meeting. Control group (n = 52) received usual care. Data were collected at months zero, six and 12. The trial lasted from June 2009-March 2013.

RESULTS

Patients with mild and moderate chronic obstructive pulmonary disease who participated in the partnership-based self-management programme perceived less intrusiveness of the disease and its treatment than patients in the control group. Patients in the experimental group did not have better health-related quality of life, less anxiety or depression, increased physical activity, fewer exacerbations or better smoking status than patients in the control group. Patients in both groups found participation in the research useful and important.

CONCLUSION

The partnership-based self-management programme had benefits concerning perception of the intrusiveness of chronic obstructive pulmonary disease and its treatment on lifestyles, activities and interests for young patients with the disease in its early stages. High satisfaction in control group, low family attendance and the relatively short treatment period may explain the less than expected benefits of the programme.