Helping Patients Stop Smoking

With recent changes to healthcare in this country, there is an even greater focus on public health awareness and prevention of illness and smoking cessation tops the list. There is a growing emphasis on educating respiratory care practitioners to show leadership in implementing smoking cessation.

Respiratory therapists are in a unique position to promote the health of their patients by encouraging smoking cessation. In order to best prepare for this role, therapists should be introduced to the topic beginning in school. With proper education, RTs can provide patients with current information about tobacco use, consequences of tobacco use and strategies for quitting.

Program Points

Students in the respiratory therapy program at the University of Missouri in Columbia, Mo., first learn about tobacco education/smoking cessation in the unit on cardiopulmonary pharmacology. “There is an emphasis on the fact that since nicotine/tobacco addiction is not a short-term problem, we shouldn’t approach smoking cessation as if it’s something everyone can do if they just have enough willpower,” said Jennifer L. Keely, MEd, RRT-ACCS, assistant clinical professor of respiratory therapy at the School of Health Professions of University of Missouri.

Established in 1967, The University of Missouri’s respiratory therapy program prepares graduates for the advanced practitioner level, registered respiratory therapist (RRT), and students graduate with a bachelor of health science in respiratory therapy.

“While we know there is a small percentage of the population that does not develop more nicotine receptors in the brain in response to smoking, the majority of smokers’ brains change in response to nicotine exposure,” relayed Keely.

Students need to learn that there is truly a physiologic response to smoking, she explained. Once they have gained that knowledge, the students learn that a comprehensive program comprised of nicotine replacement therapy, support groups, and occasionally, pharmacologic aids such as nicotine receptor blockers antidepressants, is the best way to accomplish smoking cessation.

Patients with a corresponding respiratory illness have a greater and more urgent need to overcome their tobacco addiction. Respiratory therapists are in a position to take a proactive and continuing role with smokers in motivating and assisting them to quit.


The program at University of Missouri offers clinical, administrative, education and research opportunities. The curriculum exposes students to traditional respiratory care in a hospital setting and introduces the latest approaches in sleep medicine, air transport, pulmonary rehabilitation, asthma education, smoking cessation, service learning and research. The program endeavors to prepare advanced respiratory care practitioners, develop learners who will effectively engage in professional leadership roles, and provide an environment where research and service are expectations.

University of Missouri students continue to learn about smoking cessation during their senior year in the pulmonary rehabilitation class, Keely told ADVANCE. In this class, students apply what they have learned by role-playing different ways to interact with patients regarding lifestyle choices that affect their health, such as smoking.

“One activity the students particularly enjoy in this online class is the opportunity for one student (playing the RT) to talk to another student (playing a grumpy COPD patient) about smoking cessation,” Keely shared. “They really get into their roles!”

In the program’s community and patient education class, students have the opportunity to develop educational tools for the topic of their choice, which is sometimes smoking cessation. “This class facilitates the development of students’ abilities to research and design education materials such as pamphlets and booklets for patient use,” said Keely.

Students also have the opportunity to help teach smoking cessation classes during the pulmonary rehabilitation clinical rotations. “Hands-on learning is a very effective way to process new information, so it’s great when students get those opportunities,” Keely shared.

In the Field

“The recent changes to our healthcare system demand a greater focus on public health awareness and prevention of illness,” Keely said. “We do our best to educate students about current smoking cessation practices while they are with us, but it is just as important to teach them how to be lifelong learners so they can stay up-to-date once they are done with school.”

Seven million people recently gained access to healthcare this year through the Affordable Health Care Act. “It’s likely that many of these people have not had regular medical care and/or health education and many of them will have will have respiratory-related issues that are exacerbated or caused by smoking,” Keely said. “So our role and the impact we can have is more important than ever.”

Keely and her colleagues at the University of Missouri prepare graduates to tailor educational tools to learners’ needs and develop educational materials that will truly be useful to their patients, whether that means developing videos, pamphlets or face-to-face exercises.

“New graduates are entering the respiratory care profession during a time of great transition,” Keely observed. “It is essential that the next generation of RTs have solid patient education skills and keep their knowledge of smoking cessation aids up to date.”

Since the University of Missouri campus went smoke-free last summer, there have been more opportunities to inform student and faculty smokers about smoking cessation programs in a way that is non-confrontational and non-judgmental.

“With the prospect of the Advanced Practice Respiratory Therapist (APRT) credential on the horizon, it will be more important than ever to teach our students to be effective facilitators for smoking cessation,” Keely said. “It’s an exciting opportunity.”

Rebecca Mayer Knutsen is on staff at ADVANCE. Contact [email protected]

Smoking Cessation Guideline

The U.S. Public Health Service developed a simple intervention in 1996 to help smokers quit. The “5 A’s” intervention is a guideline for healthcare providers to open a conversation with patients about their tobacco habits. In less than five minutes, as reported by the Robert Wood Johnson Foundation, healthcare professionals can significantly increase their patients’ quit attempts and successes with the following five steps:

1. Ask about tobacco use: Identify and document tobacco use status for every patient at every visit.
2. Advise to quit: In a clear, strong and personalized manner, urge every tobacco user to quit.
3. Assess willingness to make a cessation attempt: Is the tobacco user willing to make a cessation attempt at this time?
4. Assist in cessation attempt: For patients willing to make a cessation attempt, use appropriate counseling and pharmacotherapy to help them quit. For others, provide motivational interviewing to boost quitting readiness.
5. Arrange follow-up: Schedule follow-up contact, preferably within the first week after the cessation date and refer to additional follow-up care as needed.
-Rebecca Mayer Knutsen

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