The pandemic and the ever-increasing popularity of alternative tobacco products have “affected” smoking cessation clinics at public hospitals in our country.

During the pandemic, most smoking cessation clinics have either temporarily closed or significantly reduced their operations. “During the pandemic, the fact that most pulmonologists were working in COVID clinics, combined with most hospitals shutting down their regular clinics for long periods of time, effectively resulted in most of them being understaffed or out of business. clinics”, indicates “K” Ms. Paraskevi Katzaunou, Associate Professor of Pulmonology at EKPA School of Medicine, former President of the Smoke Control Group of the European Lung Society and Head of the Smoking Cessation Clinic (Pulmonology and Respiratory Deficiency Unit, 1st Intensive Care Clinic). In the same context, professor of pulmonology at the Faculty of Medicine of the University of Thessaly and director of the pulmonology clinic at Larissa University Hospital Konstantinos Gurgulyanis notes that “the decline in attendance at smoking cessation clinics was 70%-80% during the pandemic. The clinics mainly dealt with the patients we referred from the clinics, ie. smokers who have had pneumonia, or smokers who have been diagnosed with chronic obstructive pulmonary disease. And he adds that “after the pandemic, the world did not return. It’s like he’s taken the effort to quit smoking out of his life.”

Smoking cessation efforts are also being undermined by the “fashion” for alternative tobacco products. “While this has not been measured, we are now seeing a significant number of people smoking e-cigarettes and heated cigarettes. This is facilitated by loopholes in the legislation and extremely active advertising with messages about a “safer” product compared to a classic cigarette, while the word “safe” should not be used,” says Ms Katzaunou. He continues: “We know that in the UK sales of smoking cessation medicines have fallen and the use of e-cigarettes has risen. It can be said that smokers who are afraid of the health consequences of smoking, instead of seeking medical help to quit smoking completely, resort to alternative tobacco products.”

“experimental people”

Pulmonologists and related scientific communities such as the Hellenic Society of Pulmonologists and the European Society oppose the use of these products. As Mr. Gurgulianis points out, “it has not been proven to be a way to quit smoking, and it is too early to know about their health effects. It took regular cigarettes about 400 years of smoking before we knew they caused lung cancer. In fact, in the beginning there were publications that it is useful for tuberculosis and the larynx. Therefore, from 2011, when the electronic cigarette first appeared in China, until today, not enough time has passed for someone to say that there is data. After all, the position of pulmonologists is such that this is the wrong way to inhale toxic substances. We strive for clean air without pollution and a clean environment. In this sense, we are against electronic cigarettes and heated cigarettes.”

“The drop in attendance at smoking cessation clinics was 70%-80% during the pandemic. Then the world never returned. It’s like he’s taken the effort to quit smoking out of his life.”

In the same vein, Ms Catsaunow emphasizes that “for new tobacco products, the long-term consequences of their use are unknown. What we know from studies that have been done primarily in experimental animals and in cell cultures is that they are also harmful and cause inflammation, which is a key mechanism associated with the development of lung cancer. It seems that the harm is less compared to the classic cigarette, but in the aggregate it is not known what kind of disease it will cause and when. It can be said that those who now use these products are experimenters.” Ms. Katsaunow also draws attention to the way these products are presented. According to him, “this is perhaps the only harmful product that consumers and manufacturers consider acceptable, because compared to the classic cigarette, it is considered less harmful.”

Neither Ms. Katzaunou nor Mr. Gurgulyanis consider e-cigarettes or heated cigarettes to be a way to quit smoking. “All products that use inhaled nicotine are addictive. When we inhale nicotine, after a few seconds, through the pulmonary circulation, it concentrates in large quantities in the brain and causes addiction. This mechanism is common to classic, e-cigarettes and heated cigarettes,” notes the professor, while Mr. Gurgulianis elaborates that “in smoking cessation clinics, we do not recommend e-cigarettes as a way to quit smoking. What we do is evaluate his addiction and increase incentives to stop. For example. if someone marries at an advanced age with young children, it will be a strong incentive to tell them that by smoking they are depriving their children of years with their father.”

The list of smoking cessation clinics in ESY departments, which is posted on the website of the Ministry of Health with data for 2019, includes 81 clinics. Some no longer work. Those certified by the Hellenic Lung Society were 39 before the pandemic. “Most have recovered. But we know, for example, that the clinic at Lamia Hospital was closed because a colleague quit,” says Ms Katzaunou.

Significantly, Cismanoglio no longer operates a smoking cessation clinic. At Trikala Hospital, the doctor’s office is closed, as is Konstantinopoulio, Nea Ionia. “It closed one or two months ago,” the employee explained to the question “K”. Currently, the waiting time in many doctors’ offices has decreased, in contrast to about a decade ago, when in most cases it lasted up to three months. On Monday, May 22, even on weekdays, there were free appointments at the smoking cessation clinic of Agios Savvas Hospital. At the Alexandroupoli hospital one could make an appointment within a week, and at the Karditsa hospital one could make an appointment for free within 3-4 days. At Eugenideo, home to one of the oldest and most famous smoking cessation clinics, the average waiting time is 2-3 weeks, and at the University of Rio, the first available appointment was scheduled for June 19th. On the contrary, there were no vacancies at Attikon until the end of June, and at the University of Heraklion we were told that “an appointment for next Monday has just been cancelled. The next free one is in July. Evangelismos Clinic, the largest in Attica, run by Ms. Katsaunou, is one of the few with a waiting time of three months.

On the occasion of World No Tobacco Day (31 May), experts highlight the need to step up the call to quit smoking. “For smokers to return to smoking cessation clinics,” they note. Ms. Catsaunow emphasizes that “there should be a central notification from the state that the clinics are working, and there should be reinforcement, because the people who run them do it at the same time as working in the clinics, with difficulties and a shortage of staff.”

Smoking cessation clinics have very high success rates, but…

Yannis Sturaitis, who turned 70 today, remembers January 29, 2011 as “the day he didn’t smoke”. It was the first day he quit smoking.

“This story began 12.5 years ago,” he tells K. “I went to evangelism with my wife to get tested. I heard from colleagues that the hospital has a smoking cessation unit, and since I had breathing problems while I was waiting for my wife, I asked and found out. So, I signed up for a Monday. I strictly followed what the doctors told me. The clinic is doing very correct and systematic work. I would say that the whole process was organized. I quit smoking not abruptly, but in stages, initially with medication and constant monitoring. And thank God, since January 29, 2011, I no longer took it in my mouth.
Mr. Sturaitis started smoking at the age of 20 when he joined the army. “But I started with heavy cigarettes. And the work I did didn’t help. I was a French roulette fan at Parnit. There was smoking in the hall, as if I smoked too. At that time there were no ventilation holes. Then I worked on the frosting. All this worsened the condition of my lungs,” he notes and adds: “I used to climb the stairs and on the first five steps I stopped to rest and catch my breath.” In Evangelism, he was diagnosed with COPD. “In many ways. My lung worked at 36%,” he notes.

Prior to going to the Evangelismos Department of Pulmonology and Respiratory Failure Quit Clinic, he made at least 5-6 attempts with various methods (acupuncture, etc.) and spent a lot of money to quit smoking. Only once, and quite by accident, did he manage to tear it apart for six months.

Increased odds

A smoker who tries to quit cigarettes on his own only succeeds 3%-5%. On the contrary, this percentage for Greece ranges from 40% to 60% when smoking cessation is carried out with the help of specialized health professionals in special clinics. As Paraskevi Katsaunou, head of the Evangelismos smoking cessation clinic, Associate Professor of the Department of Pulmonology, points out to K, “the results of the Greek smoking cessation clinics are very high. In our practice, the success rate is over 60%, while in the international literature it is about 35-40%. The reason is that it has specialized medical staff. For example, in the United Kingdom and other countries, because the healthcare system pays dearly for doctor’s hours, it runs programs with nurses who, despite their specialization, can only provide nicotine replacement therapy. They cannot administer other medications or run a comprehensive addiction treatment program.”

Today, Mr. Sturaitis climbs the mountain with difficulty, but he walks. He has trouble swimming, but he goes to sea. “I mean that I am functioning. I don’t live at home on oxygen. That’s why I owe a big debt to the doctors of Evangelism. At the end of our conversation, I asked him if he would have any problem if I passed by name what he described to me. He answered me effortlessly, “Yes. If it helps people, I have no problem.”

Greece in 2022