RESEARCH PAPER
Why do smokers diagnosed with COPD not quit smoking? - a qualitative study
Britt-Marie Eklund 1, 2,  
Siv Nilsson 2,  
Linnea Hedman 1  
,  
 
 
More details
Hide details
1
The OLIN-studies, Norrbotten County Council, Luleå, Sweden
2
Department of Health Science, Luleå University of Technology, Luleå, Sweden
Publish date: 2012-10-22
 
Tobacco Induced Diseases 2012;10(October):17
KEYWORDS:
ABSTRACT:
Background:
Chronic Obstructive Pulmonary Disease (COPD) is currently one of the most widespread chronic lung diseases and a growing cause of suffering and mortality worldwide. It is predicted to become the third leading cause of death in the near future. Smoking is the most important risk factor, and about 50% of smokers develop COPD. Smoking cessation is the most important way to improve prognosis. The aim of the study was to describe difficulties of smoking cessation experienced by individuals with COPD who are unable to stop smoking.

Material and Methods:
Ten smokers (five women) with COPD, GOLD stage II, participated in semi-structured interviews in 2010. The data were analyzed using qualitative content analysis. The participants were recruited from the Obstructive Lung Disease in Northern Sweden (OLIN) studies.

Results:
The participants lives were governed by a lifelong smoking habit that was difficult to break although they had knowledge about the harmful effects and the consequences of COPD. The participants described incidents in their lives as reasons for never finding the time to quit smoking. Demands to quit smoking from other people could lead to continued smoking or get them started again after cessation as they did not want to be patronized. They wanted to receive support from relatives and care providers but they wanted to make the decision to quit on their own.

Conclusions:
For successful smoking cessation, it is important to understand the difficulties smokers are experiencing that influence their efforts to quit smoking. To achieve a successful lasting smoking cessation it might be more effective to first ensure that the smoker has the right internal motivation to make the decision to quit, then assist with smoking cessation.

CORRESPONDING AUTHOR:
Linnea Hedman   
The OLIN-studies, Norrbotten County Council, Luleå, Sweden
 
REFERENCES (37):
1. Global Strategy for the Diagnosis, Management and Prevention of COPD: Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2011. Available from: http://www.goldcopd.org/. Accessed September 2012
2. Lindberg A, Jonsson AC, Rönmark E, Lundgren R, Larsson LG, Lundbäck B: Ten-year cumulative incidence of COPD and risk factors for incident disease in a symptomatic cohort. Chest 2005, 127:1544–52. 10.1378/chest.127.5.1544.
3. Lindberg A, Bjerg A, Rönmark E, Larsson LG, Lundbäck B: Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med 2006, 100:264–72. 10.1016/j.rmed.2005.04.029.
4. Jansson S, Andersson F, Borg S, Ericsson A, Jönsson E, Lundbäck B: Costs of COPD in Sweden according to disease severity. Chest 2002, 122:1994–2002. 10.1378/chest.122.6.1994.
5. Lundbäck B, Lindberg A, Lindström M, Rönmark E, Jonsson A, Jönsson E,Larsson L, Andersson S, Sandström T, Larsson K: Not 15 but 50% of smokers develop COPD?–Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med 2003, 97:115–22. 10.1053/rmed.2003.1446.
6. Godtfredsen NS, Prescott E: Benefits of smoking cessation with focus oncardiovascular and respiratory comorbidities. Clin Respir J 2011, 5:187–194. 10.1111/j.1752-699x.2011.00262.x.
7. Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, Conway WA, Enright PL, Kanner RE, O’Hara P: Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994, 272: 1497-1505. 10.1001/jama.1994.03520190043033.
8. Fletcher CM: The Natural History of Chronic Bronchitis and Emphysema: An Eight-Year Study of Early Chronic Obstructive Lung Disease in Working Men in London. 1976, Oxford. New York: Oxford University Press.
9. Pelkonen M, Notkola IL, Tukiainen H, Tervahauta M, Tuomilehto J, Nissinen A: Smoking cessation, decline in pulmonary function and total mortality: a 30 year follow up study among the Finnish cohorts of the Seven Countries Study. Thorax. 2001, 56: 703-707. 10.1136/thorax.56.9.703.
10. Au DH, Bryson CL, Chien JW, Sun H, Udris EM, Evans LE, Bradley KA: The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med. 2009, 24: 457-463. 10.1007/s11606-009-0907-y.
11. Stratelis G, Molstad S, Jakobsson P, Zetterstrom O: The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD. Scand J Prim Health Care. 2006, 24: 133-139. 10.1080/02813430600819751.
12. Quist Paulsen P: Cessation in the use of tobacco - pharmacologic and non-pharmacologic routines in patients. Clin Respir J. 2008, 2: 4-10. 10.1111/j.1752-699X.2007.00038.x.
13. Tonnesen P, Mikkelsen K, Bremann L: Nurse-conducted smoking cessation in patients with COPD using nicotine sublingual tablets and behavioral support. Chest. 2006, 130: 334-342. 10.1378/chest.130.2.334.
14. Fagerstrom KO, Kunze M, Schoberberger R, Breslau N, Hughes JR, Hurt RD, Puska P, Ramstrom L, Zatonski W: Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers. Tob Control. 1996, 5: 52-56. 10.1136/tc.5.1.52.
15. Davila EP, Zhao W, Byrne M, Webb M, Huang Y, Arheart K, Dietz N, Caban-Martinez A, Parker D, Lee DJ: Correlates of smoking quit attempts: Florida Tobacco Callback Survey, 2007. Tob Induc Dis. 2009, 5: 10-10.1186/1617-9625-5-10.
16. Wilson JS, Fitzsimons D, Bradbury I, Stuart Elborn J: Does additional support by nurses enhance the effect of a brief smoking cessation intervention in people with moderate to severe chronic obstructive pulmonary disease? A randomised controlled trial. Int J Nurs Stud. 2008, 45: 508-517. 10.1016/j.ijnurstu.2006.10.001.
17. Wilson JS, Elborn JS, Fitzsimons D: ‘It’s not worth stopping now’: why do smokers with chronic obstructive pulmonary disease continue to smoke? A qualitative study. J Clin Nurs. 2011, 20: 819-827. 10.1111/j.1365-2702.2010.03319.x.
18. Lindberg A, Lundbäck B: The Obstructive Lung Disease in Northern Sweden Chronic Obstructive Pulmonary Disease Study: design, the first year participation and mortality. Clin Respir J. 2008, 2 (Suppl 1): 64-71. 10.1111/j.1752-699x.2008.00086.x.
19. Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24: 105-112. 10.1016/j.nedt.2003.10.001.
20. Elo S, Kyngäs H: The qualitative content analysis process. J Adv Nurs. 2007, 62: 107-115. 10.1111/j.1365-2648.2007.04569.x.
21. O’Loughlin J, Kishchuk N, DiFranza J, Tremblay M, Paradis G: The hardest thing is the habit: a qualitative investigation of adolescent smokers’ experience of nicotine dependence. Nicotine Tob Res. 2002, 4: 201-209. 10.1080/14622200210123000.
22. Hu MC, Davies M, Kandel DB: Epidemiology and correlates of daily smoking and nicotine dependence among young adults in the United States. Am J Public Health. 2006, 96: 299-308. 10.2105/AJPH.2004.057232.
23. Van Gucht D, Van den Bergh O, Beckers T, Vansteenwegen D: Smoking behavior in context: where and when do people smoke?. J Behav Ther Exp Psychiatry. 2010, 41: 172-177. 10.1016/j.jbtep.2009.12.004.
24. Kouvonen A, Kivimaki M, Virtanen M, Pentti J, Vahtera J: Work stress, smoking status, and smoking intensity: an observational study of 46,190 employees. J Epidemiol Community Health. 2005, 59: 63-69. 10.1136/jech.2004.019752.
25. Pisinger C, Jorgensen T: Weight concerns and smoking in a general population: the Inter99 study. Prev Med. 2007, 44: 283-289. 10.1016/j.ypmed.2006.11.014.
26. Hilberink SR, Jacobs JE, Schlosser M, Grol RP, de Vries H: Characteristics of patients with COPD in three motivational stages related to smoking cessation. Patient Educ Couns. 2006, 61: 449-457. 10.1016/j.pec.2005.05.012.
27. Wagena EJ, Kant I, Huibers MJ, van Amelsvoort LG, Swaen GM, Wouters EF, van Schayck CP: Psychological distress and depressed mood in employees with asthma, chronic bronchitis or emphysema: a population-based observational study on prevalence and the relationship with smoking cigarettes. Eur J Epidemiol. 2004, 19: 147-153. 10.1023/b:ejep.0000017825.07470.41.
28. Di Marco F, Verga M, Reggente M, Maria Casanova F, Santus P, Blasi F, Allegra L, Centanni S: 2006. Respir Med. 2006, 100: 1767-1774. 10.1016/j.rmed.2006.01.026.
29. Yang T, Fisher KJ, Li F, Danaher BG: Attitudes to smoking cessation and triggers to relapse among Chinese male smokers. BMC Publ Health. 2006, 6: 65-10.1186/1471-2458-6-65.
30. Tomson T, Toftgard M, Gilljam H, Helgason AR: Symptoms in smokers trying to quit. Tob Induc Dis. 2006, 3: 44-58. 10.1186/1617-9625-3-2-44.
31. Vangeli E, West R: Sociodemographic differences in triggers to quit smoking: findings from a national survey. Tob Control. 2008, 17: 410-415. 10.1136/tc.2008.025650.
32. Wells S, de Lusignan S: Does screening for loss of lung function help smokers give up?. Br J Nurs. 2003, 12: 744-750. 10.12968/bjon.2003.12.12.11337.
33. Larabie LC: To what extent do smokers plan quit attempts?. Tob Control. 2005, 14: 425-428. 10.1136/tc.2005.013615.
34. Vogt F, Hall S, Marteau TM: Examining why smokers do not want behavioral support with stopping smoking. Patient Educ Couns. 2010, 79: 160-166. 10.1016/j.pec.2009.10.007.
35. May S, West R, Hajek P, McEwen A, McRobbie H: Social support and success at stopping smoking. J Smok Cessat. 2007, 2: 47-53. 10.1375/jsc.2.2.47.
36. Holloway I, Wheeler S: Qualitative Research in Nursing and Healthcare. 2010, Wiley-Blackwell, Chichester, West Sussex: Ames, Iowa, 2010.
37. Polit D, Beck C: Developing a Sampling Plan. Nursing Research. 2008, Philadelphia: Lippincott Williams and Wilkins, 9.
 
CITATIONS (12):
1. Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD)
Michael L. Stellefson, Jonathan J. Shuster, Beth H. Chaney, Samantha R. Paige, Julia M. Alber, J. Don Chaney, P. S. Sriram
Health Communication
2. Tobacco Use Disorder Among Patients With Smoking-related Chronic Medical Disease
Ajay Manhapra, Robert Rosenheck
Journal of Addiction Medicine
3. Difficulties Quitting for Smokers with and without a Respiratory Disease and Use of a Tailored Intervention for Smoking Cessation – A Qualitative Study
Camille Alexis-Garsee, Hazel Gilbert, Martha Burton, Olga van den Akker
Journal of Smoking Cessation
4. Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”?
Kamran Siddiqi, Omara F. Dogar, Najma Siddiqi
International Journal of Population Research
5. Chronic Obstructive Pulmonary Disease Is Not Associated with KRAS Mutations in Non-Small Cell Lung Cancer
Ali Saber, Anthonie J. van der Wekken, Gerald S. M. A. Kerner, Maarten van den Berge, Wim Timens, Ed Schuuring, Arja ter Elst, Anke van den Berg, T. Jeroen N. Hiltermann, Harry J. M. Groen, Melanie Königshoff
PLOS ONE
6. Experiences of COPD patients with existing smoking cessation programs and their preferences for improvement - a qualitative analysis
I. Aumann, L. Tedja, J. M. Graf von der Schulenburg
Tobacco Induced Diseases
7. Low nicotine dependence and high self-efficacy can predict smoking cessation independent of the presence of chronic obstructive pulmonary disease: a three year follow up of a population-based study
Anne Lindberg, Benjamin Niska, Caroline Stridsman, Britt-Marie Eklund, Berne Eriksson, Linnea Hedman
Tobacco Induced Diseases
8. Creating a balance between breathing and viability: experiences of well-being when living with chronic obstructive pulmonary disease
Caroline Stridsman, Karin Zingmark, Anne Lindberg, Lisa Skär
Primary Health Care Research & Development
9. A qualitative study of women's experiences of living with COPD
Simen A. Steindal, Jane Österlind, Kristin Halvorsen, Therese Schjelderup, Ellen Kive, Liv Wergeland Sørbye, Alfhild Dihle
Nursing Open
10. Increased risk of lung cancer among patients with bronchiectasis: a nationwide cohort study
W.-S. Chung, C.-L. Lin, W.-H. Hsu, C.-H. Kao
QJM
11. Experiences of tobacco smoking and quitting in smokers with and without chronic obstructive pulmonary disease-a qualitative analysis
Eva A. M. van Eerd, Mette Bech Risør, Carolien R. van Rossem, Onno C. P. van Schayck, Daniel Kotz
BMC Family Practice
12. The experiences of smoking cessation among patients with chronic obstructive pulmonary disease in Australian general practice: a qualitative descriptive study
Kylie Vuong, Oshana Hermiz, Husna Razee, Robyn Richmond, Nicholas Zwar
Family Practice
eISSN:1617-9625