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N006. A Crohn's smoking cessation programme – Initial results

F. Bredin1, T. Goodwin2, M. Parkes1

1Addenbrooke's Hospital, Cambridge, United Kingdom; 2Cambridgeshire Primary Care Trust, Cambridge, United Kingdom

Background: Despite advances in medical management Crohn's disease (CD) remains hard to treat, with significant impact on quality of life. Smoking is a proven risk factor for more severe disease and need for surgery. Of all the disease modifying strategies available smoking cessation remains the most effective – smokers have a 2-fold risk of surgery over non-smokers – but this reverses in just 1 year after quitting. However, many with CD continue to smoke.

Cessation interventions are usually limited to brief advice and patients often report failed attempts to quit. Smoking cessation should have a much higher priority – an intervention as powerful as a step up in medication.

Aim: To assess the acceptability, feasibility and effectiveness of a smoking cessation programme offered to people with CD.

Method: The programme consists of a standard 7 week course of behaviour change therapy with NRT (nicotine replacement therapy) or varenicline, run by a local stop smoking specialist together with additional input from an IBD Nurse aimed at addressing issues of particular concern for those with CD. This extra content includes; information regarding the link between smoking and CD, dietary advice, stress management and relaxation techniques. At every session the IBD nurse is available to answer questions individually e.g. in the event of a flare. Places were offered to smokers with CD attending the outpatient clinic, together with close friends/partners with the agreement of the group.

Results: Two programmes have been completed so far; the combined results are shown in the table.

 CDNon-CD
Started95
Completed/dropped out6/32/3
Quit rate – completers (3 months)83%100%
Quit rate – non-completers (3 months)0%0%
First group still quit at 10 months100%100%

Although some initially expressed doubts concerning group sessions, all those who completed reported that the support of others with CD was invaluable and the extra content of the sessions useful. Holding the sessions in familiar surroundings (hospital) with a known IBD Nurse was appreciated.

Reasons for non-completion:

  • Hospitalisation (1)
  • Work commitments (2)
  • Decided to make individual quit attempt (3)

Conclusion: Completing the full programme is an effective smoking cessation method, acceptable and beneficial to participants with Crohn's. The benefits extend beyond quitting smoking to an increased knowledge of disease management and support gained from other members of the group.

It is estimated that with experience each programme would take 15–20 hours of IBD Nurse time over the 7 week period. Increasing the group numbers would make this more cost-effective by drawing on a larger pool of smokers e.g. by offering the programme across neighbouring hospitals. Also, knowing the Crohn's population and judging the ‘readiness to quit’ of patients is important.

From the point of view of the smoking cessation advisor – this has been a very interesting pilot scheme and could potentially be applied to other conditions e.g. coronary heart disease.