RTs seem the logical choices to
head smoking cessation programs, but does their training equip
them for this role?
Are respiratory therapists the best
choice for providing smoking cessation information and
intervention? The natural initial response to that question is
“Yes, of course.” Respiratory therapists have the specialized
training and experience it takes to evaluate a patient’s
smoking history, discuss respiratory anatomy and physiology,
and teach patients about the pathophysiology of
smoking-related lung disease. Both the US Department of
Labor’s Bureau of Labor Statistics and the American
Association for Respiratory Care include smoking cessation
counseling in their definitions of “respiratory therapist.”
But I think we are seriously deluding ourselves
if we assume that RTs are the de facto go-to guys when it
comes to smoking cessation, and we need to make a sincere and
objective self-evaluation of our qualifications.
Unfortunately, there is no one specialty within the health
care team that has been consistently and adequately trained in
smoking cessation. We are well educated and experienced in
treating the outcomes of smoking, and we are prepared to
manage the diseases and medical conditions caused by smoking.
Whether addressing an acute exacerbation of COPD in the
emergency department, helping identify a lung cancer via
bronchoscopy, or designing a weaning protocol for a chronic
lung patient on a ventilator, our training and experience
ensure that our patients who have smoking-related disease will
receive the best of care.
But when it comes to integrating smoking
cessation protocols into our plan of care, we still have a lot
of work to do. For one thing, most respiratory therapists
received little or no training in smoking cessation when they
were students in school, and we are not alone in our lack of
education. Such training in medical and nursing schools has
been similarly lacking. Research has documented that tobacco
intervention training in US medical schools is seriously
inadequate. In one study, only 21% of practicing physicians
said they received adequate training to help their patients
stop smoking. A study in
JAMA1 documented that 69% of medical
schools surveyed did not require clinical training in smoking
cessation techniques and that 31% of the schools averaged less
than 1 hour of instruction per year in these techniques.
Our day-to-day patient care naturally focuses on
providing the necessary treatment regimes to address the
patient’s medical condition, with minimal focus on the cause
of the condition. After all, no one is admitted to the
hospital specifically for nicotine dependence or because they
require smoking cessation support. So we treat the condition
and ignore the cause. Once upon a time, when a patient
indicated a desire to quit smoking, our typical response was
to wish them the best of luck. That is no longer good enough.
Every respiratory therapist needs to become
familiar with the Ask, Advise, and Refer regime to assess each
patient’s readiness to quit, and directly refer them to
immediately accessible support. For example, every state has a
quit line that can be accessed by simply calling (800)
QUITNOW. Every respiratory therapist should at least be able
to provide their patients with that phone number. In addition,
we need to:
• Integrate smoking cessation into hospital
patient care protocols so that providing assessment and
support is not a hit-and-miss affair.
• Provide respiratory therapists the tools, the
time, and the training to become effective at supporting our
patients’ desire to quit. Patients who say they don’t want to
quit should receive information about the benefits of
• Employ a specially trained respiratory
therapist at every hospital to serve as a smoking cessation
coordinator, providing both inpatient and outpatient smoking
cessation counseling, and to serve as an instructor and
resource for the entire health care team.
• Integrate tobacco dependence education
throughout each year of medical, nursing, and respiratory
school curricula, including specific training in nicotine
addiction, smokeless tobacco intervention, cultural issues,
nicotine replacement therapy, and emerging pharmaceutical
• Quit smoking. It is difficult for clinicians to
give credible cessation advice when their lab coat smells like
It is a mistake to think that RTs can go it alone
in providing comprehensive smoking cessation support. The most
effective programs involve several different health care
professionals, including physicians, respiratory therapists,
nurses, and social workers. They work together to coordinate
and plan for the screening, intervention, and counseling
necessary to help patients quit. Respiratory therapists should
be leading the way, but I have actually heard RTs and
respiratory department heads say, “Let nursing do it.” That
attitude has to change.
There is a widespread belief among both
administrators and clinicians that smoking intervention is
ineffective because patients do not typically quit as the
result of a single 3-minute intervention. This is a result of
a fundamental misunderstanding of the quitting process and of
how to measure success. Long-term smoking cessation success is
an arduous journey consisting of many little steps. Our goal
is to assess where the patient is on the continuum of change,
and facilitate a step in the right direction. If we encounter
a patient who is in a precontemplative stage and get him to
simply begin thinking about quitting, that is a huge success.
Patients who indicate a strong desire to quit, are ready to
set a quit date, and are entering the action phase need extra
assistance. That is why an on-site smoking cessation
coordinator is so valuable.
Although smoking remains the number-one
preventable cause of death and disability, most clinicians
still have not integrated smoking cessation support into their
patient care routines. Seventy percent of the 46 million
smokers in the United States say they would like to quit; no
other clinical intervention can offer a larger potential
benefit than smoking cessation support. Isn’t it time we gave
our patients the kind of comprehensive help they deserve?
To begin making a difference in your individual
patient care practice or to integrate smoking cessation
protocols into your hospital policy, the place to start is at
the Centers for Disease Control and Prevention Tobacco
Information and Prevention Source (TIPS) Web site, www.cdc.gov/tobacco/index.htm. It includes
the Clinical Practice Guidelines that every hospital should
employ, and a mother lode of resources for smoking cessation.
Respiratory therapists can either demonstrate leadership now,
or lose an important opportunity to expand our scope of
practice. Are respiratory therapists the best clinicians to
provide smoking cessation information and intervention? The
answer to that is up to us.
John A. Wolfe, RRT, CPFT, is
a clinical specialist at North Colorado Medical Center,
Greeley, Colo, and a member of the RT’s advisory board.
1. Ferry LH, Grissino LM, Runfola PS. Tobacco
dependence curricula in US undergraduate medical education.
JAMA. 1999; 282(9):825-829.