1. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Helping people quit smoking A treatment for COPD

2. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team How do we get there? Our attitudes; why they matter and what influences them What works long term and is cost effective? Issues for London What can we all do now?

3. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team 1950’s- 60’s Our attitudes; why they matter and what influences them

4. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team 1970s: WHO takes a position and our behaviour changes Our attitudes; why they matter and what influences them

5. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team 2007 Our attitudes; why they matter and what influences them

6. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team

7. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Rate of death per 1000 person years Cause of death Anthonisen NR, Skeans MA, Wise RA; Manfreda J, Kanner RE and Connett JE for the Lung Health Study Research Group*Ann Intern Med. 2005;142:233-239. What works long term and is cost effective?

8. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team What works long term and is cost effective? Fletcher, Peto: Br Med J 1977; 1 :

9. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team 1 year abstinence % QALY £ Usual care1.4 Minimal counselling2.614,735 Intensive counselling67,149 Intensive counselling + pharmacotherapy 12.32,092 Systematic Review of 9 studies Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mo¨lken MPMH. Thorax 2010: 65:711-718 A cost effective intervention in COPD What works long term and is cost effective? Tiotropium QALY £7112 Eur J Health Econ. 2007 June; 8(2): 123135

10. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team What works long term and is cost effective?

11. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Issues for London

12. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team 54.37% of the UK Bangladeshi population live in London ONS 2001 Issues for London

13. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team The 1:2.5–5 dose equivalence between cannabis joints and tobacco cigarettes for adverse effects on lung function is of major public health significance. Thorax 2007;62:1058-1063 In 2000, of those aged 11 to 15 years in England, 12 per cent were using cannabis. In England and Wales, 25 per cent of those aged 16 to 19 were using cannabis Boreham R and Shaw A (eds) (2001) Smoking, Drinking and Drug Use Among Young People in England in 2000 Issues for London

14. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team Our NHS trusts and practices What message are we projecting about smoking? Do we go beyond the incentives provided? How are you doing at 4 weeks, 1 year, beyond ? Are you a champion for smoking in your trust, practice, PCT, consortia. What is our data on COPD and smoking. How do we know if we are making a difference What can we all do now?

15. Improving the experience of all Londoners with COPD and minimising the impact of the disease London Respiratory Team A ‘no-smoking practice’ Brief intervention Moderate intervention Intense intervention > 5 mins <1 min 2-5 mins IPCRG Smoking cessation guidance for primary care 2007Adapted from Litt J, et al. Asia Pacific Fam Med. 2003; 2: 175-9 What can we all do now?