Has the opportunity gone up in smoke?

Just after the release of the 2000 clinical practice guidelines “Treating Tobacco Use and Dependence,” I remember reading a stirring editorial written by Sam Giordano. The title was “What’s That Sound?” In the editorial, Giordano urged respiratory therapists (RTs) to become conversant with the guidelines and to “seize this incredible opportunity to add value” to the services provided by RTs. I recently re-read this editorial and was struck by how familiar many of the themes in this now 13-year-old editorial rang. Some examples: As a country, we are unable to control healthcare costs. Healthcare reform is underway. Reducing health risks, such as tobacco use—the primary avoidable cause of morbidity and mortality in the United States—could eventually reduce the demand on healthcare services, resulting in more judicious use of healthcare resources.1 How much, I wonder, has really changed in the past 13 years? Giordano also warned the reader that smoking cessation interventions will go forward “with or without” RTs as the healthcare professional who assumes the role of the smoking cessation specialist. He built the case for why this role is a good fit for our profession, and suggested that the sound we hear is “opportunity knocking.” It is time, he said, for RTs to have a leadership role in targeting the number one health risk in our country, because it is the “smart thing to do” and it’s also the “right thing to do”!1 Since Giordano wrote that editorial there has been a plethora of evidence available in the literature about the efficacy and cost-effectiveness of tobacco cessation interventions. Yet there has been very little written about the efficacy of the RT’s role in providing those tobacco cessation interventions. And, unfortunately, most of what has been published does not demonstrate strong empirical support for the role of the RT in this area. Motivated by re-reading this editorial, I searched the literature over the past 15 years for studies in which the role of the RT as a smoking cessation specialist was characterized. I found a study that showed favorable attitudes among almost 400 RT students and practitioners about having a role in tobacco treatment and other prevention counseling2; another study demonstrated that the RT was actually ineffective as a tobacco counselor, compared to usual care3; a pilot study found that RTs were effective facilitators in a smoking cessation program for parents of children in a children’s hospital4; and an excellent review and 2 compelling editorials, all of which implored RTs to assume the role of a smoking cessation counselor.5-7 To my knowledge, this is the extent of what has been published since Mr Giordano’s editorial in 2000 about the RT’s role in tobacco control and prevention! Thus, I have concluded that the number of RTs who provide smoking cessation counseling in the United States is relatively small and those who do assume this role, however passionately they approach it, are not disseminating their work.