Smoking Cessation Counselling for Newly Diagnosed COPD
Your Role — Nurse
Respiratory Outpatient Clinic
Your 62-year-old patient has just been diagnosed with moderate chronic obstructive pulmonary disease (COPD) following spirometry (FEV1/FVC ratio 0.58, FEV1 55% predicted). The patient has a 45-pack-year smoking history and currently smokes 15-20 cigarettes per day. The GP has referred the patient for smoking cessation counselling. This is your first meeting.
- •Establish the patient's current smoking history (how many per day, when do they smoke most, how long have they smoked, previous quit attempts). Assess nicotine dependence using the Fagerström test (time to first cigarette in the morning is the strongest predictor).
- •Explore the patient's understanding of the link between smoking and COPD. Use the diagnosis as a 'teachable moment' — patients are more motivated to change around the time of diagnosis.
- •Assess readiness to change using the stages of change model (pre-contemplation, contemplation, preparation, action, maintenance). Use motivational interviewing: explore ambivalence, elicit the patient's own reasons for quitting, avoid confrontation.
- •Discuss smoking cessation options: nicotine replacement therapy (patch, gum, inhalator, lozenge, nasal spray), prescription medications (varenicline/Champix, bupropion/Zyban), and behavioural support (local NHS stop smoking service, Smokefree National Helpline). Explain that combination therapy (patch + short-acting NRT) is most effective.
- •Agree on a quit date (ideally within 2 weeks). Discuss practical strategies: removing smoking triggers, identifying alternatives, managing cravings (the 4 Ds — Delay, Deep breathe, Drink water, Do something else). Arrange follow-up within 1 week of quit date.
The Interlocutor
Played by the actor / assessor
You are 62 years old and have been told you have COPD. You've smoked since you were 17 — about 15-20 cigarettes a day. You've tried to quit a few times before but always started again. You know you should stop but you enjoy smoking and it helps you cope with stress.
- •When asked, say you smoke about 15-20 a day. Your first cigarette is within 10 minutes of waking up — it's the one you crave most.
- •Say you've tried quitting before — cold turkey, patches, even hypnotherapy. The longest you lasted was three months. You started again during a difficult time at work.
- •When asked, say you're worried about the COPD diagnosis. Your father had emphysema and died from it. You don't want that to happen to you.
- •Say you're not sure if you're ready to quit right now — smoking is your only pleasure and you're stressed about the diagnosis.
- •Say you'll think about setting a quit date. You're willing to try the NHS stop smoking service and maybe the patches again, but this time with the gum as well.
Sample Role-play
Good morning Mr Davies. I am Rachel the respiratory nurse. Your GP asked me to see you after you were diagnosed with COPD. How are you feeling about everything?
It has been quite a shock to be honest. My father actually died from emphysema and I really do not want that to happen to me.
I am sorry to hear about your father and I can understand why that would make this diagnosis particularly difficult for you. The most important thing you can do for your COPD is to address the smoking because quitting is the only thing that actually slows down how quickly the disease progresses over time. Can you tell me about your smoking habits?
I have been smoking about fifteen a day since I was seventeen. I tried quitting cold turkey twice but I only lasted about a week each time.
I want you to know that Cold turkey has the lowest success rate of any quitting method and that is not your fault of any quitting method so please do not feel that you failed personally. The most effective approach is combination nicotine replacement therapy — using a patch to manage the background cravings plus gum or an inhalator for the sudden strong urges — together with one-to-one support. This combination is almost twice as effective as using patches alone and the NHS provides this service completely free.
I did not know you could use patch and gum together.
Your lung function test showed your lungs are working at about fifty-five percent of what we would expect for your age. The good news is that stopping smoking now will stabilise your lung function and slow the decline significantly. It is not too late to make a real difference. I am going to refer you today and we can set a quit date together for two weeks from now.
I am scared I will fail again like I did before.
That is understandable and it is a very common fear. What I can tell you is that most people try several times before they succeed and each attempt brings you closer. The difference this time is that you will have professional support with the right combination of treatments. I am going to refer you to the NHS stop smoking service today and we can set a quit date together for two weeks time. In the meantime try the four Ds when you get a strong craving — Delay for ten minutes Deep breathe Drink water and Do something else to distract yourself.
What if the cravings are too strong to handle?
The 4 Ds are designed for exactly that situation. Delay for ten minutes because the urge will pass. Deep breathe slowly. Drink a glass of water. Do something else to distract yourself. Having the gum or inhalator ready for emergencies also helps. Most cravings only last five to ten minutes.
Will I need medication if I cannot quit smoking?
Two weeks sounds achievable. I will try this time.
How long will the cravings last?
The physical cravings from nicotine withdrawal usually peak in the first week and reduce significantly after two to four weeks. The psychological habit of reaching for a cigarette can take longer. The 4 Ds and the NRT will help you manage both types of cravings.
What if I gain weight after quitting smoking?
I will refer you to the stop smoking service today. Here is my card if you need any support before your quit date. Take care.
Useful Phrases
Clinical Background
COPD is a progressive lung disease primarily caused by smoking. The diagnosis is a key teachable moment for smoking cessation. NICE guidelines recommend: combination NRT (transdermal patch plus short-acting product) or varenicline as first-line pharmacotherapy. Behavioural support combined with pharmacotherapy is more effective than either alone. The Fagerström Test for Nicotine Dependence helps guide treatment intensity — time to first cigarette within 30 minutes of waking indicates high dependence.
Common Mistakes to Avoid
- ✕Lecturing or being judgemental — this triggers defensiveness and reduces engagement.
- ✕Asking the patient to quit 'cold turkey' — this has the lowest success rate.
- ✕Minimising how difficult quitting is — acknowledge that nicotine withdrawal is real and challenging.