Smoking Cessation in Chronic Obstructive Pulmonary Disease Management

Purpose Statement

Most chronic bronchitis patients are addicted to smoking despite the adverse effects of the behavior on the respiratory system. This project evaluates the efficacy of Electronic Nicotine Delivery Systems ENDS as an aid tool for smoking cessation among chronic bronchitis patients.

Background Information

Chronic bronchitis is a Chronic Obstructive Pulmonary Disease (COPD) that causes long-term bronchitis, commonly triggered by smoking. Chronic bronchitis is a respiratory problem mainly caused by exposure to smoking, affecting about a third of patients with COPD. Most patients suffering from chronic bronchitis are addicts of persistent smoking, which alleviates the symptoms of COPD. Chronic bronchitis is not a stable phenotype, and active smoking increases the severity of the condition. Smoking cessation is the most effective way to decrease respiratory symptoms and airway hyper-responsiveness. Physicians recommend smoking cessation to chronic bronchitis patients, warning them about the lung damage and airway blocking caused by smoking. However, addicted patients find it difficult to cope with cessation and are unlikely to quit smoking despite the health implication. Addicted COPD patients have a high depression rate and physical dependency upon nicotine due to more prolonged exposure to tobacco; hence unable to quit smoking after diagnosis.

Significance of Study

The high prevalence of chronic bronchitis among persistent cigarette smokers exposes them to potential risk factors for the disease symptoms. Chronic bronchitis is COPD causing suffering and mortality worldwide, mainly among cigarette smokers. COPD is predicted to be the third leading cause of mortality globally. Despite knowledge of the harms of smoking, chronic bronchitis patients cannot quit cigarette smoking due to the addictive nature of nicotine. According to Weaver et al. (2018), 50% of patients diagnosed with COPD continue with smoking behavior after various interventions such as counseling. It is, however, crucial for smokers with chronic bronchitis to quit smoking before they irreversibly damage their respiratory health. Smoking cessation tools are therefore necessary to curb the high nicotine dependence among chronic bronchitis patients.

The use of ENDS to assist smokers quit has become a controversial topic. A study by Weaver et al. (2018) indicated that ENDS are practical cessation tools with positive impacts on the frequency and duration of smoking. Unlike regular cigarettes, ENDS do not burn tobacco leaves but instead vaporize a solution with nicotine, which delivers nicotine more effectively and quickly. The efficiency of ENDS to deliver nicotine limits smoking frequency, giving smokers a better chance of quitting. Contrastingly, the American Academy of Family Physicians (AAFP) found that ENDS users have lower odds of quitting smoking at 9.4% compared to the 18.9% for smokers who did not use ENDS (AAFP, 2018). This project will evaluate the efficacy of ENDS in helping chronic bronchitis patients quit smoking in COPD management.

The objective of this study is to gather recent and comprehensive evidence on the efficacy of long-term ENDS use in smoking cessation among chronic bronchitis patients. Smoking cessation mitigates the risk of premature death, improves health, and improves the quality of life. Nicotine in cigarettes accelerates the progression of COPD, reducing the patients’ life expectancy. Compared to other alternatives such as Nicotine Replacement Therapy, Bupropion, and varenicline, smokers are more likely to adopt ENDS as a treatment for addiction (CDC, 2020). Moreover, abandoning cigarette smoking can add as much as ten years to life expectancy. The project will reduce the adverse health effects of smoking among patients with COPD.


Tobacco smoking is the number one risk of infecting chronic bronchitis. The American Lung Association (ALA) indicates that about 85 to 90 percent of people diagnosed with chronic bronchitis have a cigarette smoking history. Cigarette smoke contains more than 7,000 chemicals that harm the lungs’ immunity, block air passages, destroy air sacs, and cause inflammation of air tubes (Shi et al., 2020). Although the restricted airflow is simultaneous, the airflow restriction caused by smoking is irreversible, posing long-term respiratory infections and potentially death. Accelerated decline in lung function leads to regular coughs, production of yellowish-gray sputum, fatigue, breath shortness, slight fever, and respiratory failure in smokers. Therefore, chronic bronchitis patients addicted to smoking are the most vulnerable population to COPD. The trial participants will include chronic bronchitis patients addicted to cigarette smoking and hence most susceptible to COPD.

The population involved in the project will include males and females adults aged over 30 years. All interested respondents will give informed consent to participate in the survey. The exclusion and exclusion criteria will be used in selecting participants to achieve reliable and reproducible results while minimizing the likelihood of harm to the subjects. The inclusion criteria are chronic bronchitis patients who smoke a minimum of five cigarettes daily and are interested in quitting smoking. The test population should be U.S citizens with respiratory symptoms and have stable emotional conditions. The exclusion criteria will include severe mental illness that limits group treatment, lack of willingness to quit smoking, and ongoing smoking cessation treatment.


Subjects enrolled in my study will apply ENDS as a tool for smoking cessation in COPD management. The Food and Drugs Association approved using and marketing of ENDS products as a more acceptable and safer cigarette alternative (FDA, 2021). Chronic bronchitis patients who smoke combustible cigarettes will switch to ENDS products to successfully quit smoking. The project is progressive cessation by reduction of smoking frequency over time, leading to abstinence. A Randomized Control Trial RCT will provide the prospective measure of the effectiveness of ENDS as a treatment for cigarette addiction.

Participants in the project will have a follow-up evaluation of their smoking frequency and ENDS use. Before the trial, project respondents will be trained on the practical usage of ENDS and the significance of quitting. During the intervention, participating patients are not allowed to explore alternative quit smoking options. All participants’ readiness to quit will be assessed to qualify for sampling. Additionally, participants are not allowed to use combustible cigarettes during treatment. The intervention will educate all correspondents on how to handle triggers and cravings for smoking. Moreover, participants will learn the nicotine withdrawal symptoms and how to manage them. Qualitative and quantitative data on ENDS use will indicate its impact on limiting smoking desire and hence smoking.


The reference group to compare with the treatment intervention will be chronic bronchitis patients committed to quitting smoking using regular combustible cigarettes. Control will allow the project to mitigate the effects of factors other than the one being experimented with. The control variables in the project include the type of cigarette and infection by chronic bronchitis. All control participants must be infected with chronic bronchitis and will record their smoking data throughout the intervention. The comparison respondents will not be engaged in any other smoking cessation treatment. Comparisons are significant to compare the treatment and draw conclusions.

Expected Outcomes

The ENDS treatment intervention is expected to aid chronic bronchitis patients with smoking cessation. The treated participants will likely record a high number of COPD patients who have successfully quit smoking. Data collected from the treatment and control populations will be compared to record the efficacy of ENDS. Essential outcome measures for the project include the frequency of smoking, duration of quitting smoking, desire for smoking over the trial period, and continuous abstinence after quitting. The frequency of smoking in the treated group is expected significantly decline to lead to cessation compared to the control group.

Treated participants are supposed to quit smoking during the intervention and not display recidivism afterward. There are expected risks for nicotine withdrawal symptoms, including anxiety, anger, irritability, and cravings for cigarettes. After successful smoking cessation, lower effects of COPD symptoms are expected. Overall, the project aims to decrease the difficulties experienced by individuals diagnosed with chronic bronchitis which cannot quit smoking.


The project will be conducted over a 12-month period. The first two months will prepare, recruit, and train study participants. Addiction treatment using ENDS will then be implemented over the next six months. Data will be collected throughout the project to get complete study results. After treatment, a three months follow-up will be conducted on those who will have achieved complete smoking cessation.


AAFP. (2018). Ends not effective as a tobacco cessation method, says study. Home.

CDC. (2020). Smoking cessation-the role of healthcare professionals and Health Systems. Centers for Disease Control and Prevention.

FDA. (2021). FDA permits the marketing of e-cigarette products, marking the first authorization of its kind by the agency. U.S. Food and Drug Administration.

Shi, H., Tavárez, Z. Q., Xie, Z., Schneller, L. M., Croft, D. P., Goniewicz, M. L,& Li, D. (2020). Association of flavored electronic nicotine delivery system (ENDS) use with self-reported chronic obstructive pulmonary disease (COPD): Results from the Population Assessment of Tobacco and Health (PATH) study, Wave 4. Tobacco-induced diseases, 18.

Weaver, S. R., Huang, J., Pechacek, T. F., Heath, J. W., Ashley, D. L., & Eriksen, M. P. (2018). Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015–2016. PloS one, 13(7), e0198047.

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