New Anti-Cigarette Treatment
FDNY Smokes Out a Problem

By GINGER ADAMS OTIS

COMMON SENSE AND INNOVATION: Dr. David Prezant, the Fire Department's Chief Medical Officer, said its efforts to combat tobacco addiction combined psychological counseling with medications to provide the same amount of nicotine without the other harmful additives in cigarettes.

The smoking cessation program started by the Fire Department nearly five years ago was designed to offer individualized help to members like Firefighter Carl Punzone, who after three years cigarette-free returned to his pack-a-day habit while detailed to recovery efforts at Ground Zero.

But a study outlining the methodology and success of the FDNY program, coauthored by FDNY Chief Medical Officer David Prezant and smoking cessation expert Matthew Bars, has the potential to change how tobacco dependency is treated nationwide and around the world.

'Enormous Impact'

Dr. David P. L. Sachs, director of the Center for Pulmonary Disease Prevention in Palo Alto, Ca. and a leading expert on smoking cessation, said that some of the methods adopted by the FDNY and detailed in CHEST, the magazine of the American College of Chest Physicians, have been around for a while, but scientific proof of their efficacy was lacking.

DR. DAVID SACHS: A potential breakthrough.

"What makes this study so relevant is that while I believe that the kind of individualized approach used by the FDNY is very important, none of us other doctors have had the time and resources to mount a study to try and show that. And that's what they did in the Bars/Prezant paper. Assuming that a double-blind study could confirm the findings, the impact could be enormous," Dr. Sachs asserted.

What Dr. Prezant and his co-authors were able to demonstrate in their paper was a 50-percent treatment effectiveness among even the heaviest smokers - results that Dr. Sachs said were unheard of in prior studies.

Dr. Prezant described the FDNY's approach to smoking cessation as a blend of common sense and innovation.

A Different Approach

"Instead of using the standard recipe of 'Put the patch on and don't smoke,' or 'Chew gum and don't smoke,' we tried to use multiple medications to increase the amount of nicotine participants got to match the amount of their nicotine usage," he explained. "That was coupled with psychological counseling - not intense psychotherapy, but general counseling to help participants get a grip on the mental aspects of addiction and quitting."

The FDNY never developed any formal anti-smoking programs prior to Sept. 11, and smoking was common in firehouses and among firefighters and Emergency Medical Service personnel for years. But as the dangers of smoking became better-known, many, like Firefighter Punzone, quit cold turkey during the 1990s.

"I grew up smoking, just picked it up as a kid and did it for like 25, 30 years, 17 of them on the job," said Mr. Punzone, who is now retired. "I stopped in 1998 and thought that was it, until I was down at Ground Zero, going through the rubble every day, and the stress of it got to me, I guess. Somebody there had a pack of cigarettes, and I grabbed one and that was it - I was back in the habit."

A Negative Impact

He wasn't alone, either. FDNY figures show that of the 15 percent of FDNY personnel who smoked on Sept. 11, 29 percent increased their tobacco use. Twenty-three percent of the department's ex-smokers resumed the habit.

"We had to do something about that, because every prior environmental disaster shows us that it's the smokers who have the higher rate of cancer and illness over non-smokers," said Dr. Prezant. "Instead of watching and saying, 'We hope you don't have a problem in the future,' we decided to something constructive for their future."

It didn't take long for health problems to emerge for Firefighter Punzone. He developed respiratory infections and had difficulty breathing. Still, he couldn't put down the cigarettes.

In 2004, while on light duty because of his damaged lungs, Mr. Punzone decided he was ready to try a second time. Spurred on by two colleagues who were already enrolled, he joined the FDNY smoking cessation program.

A Menu of Treatments

He met with counselors to discuss his average tobacco intake so they could prescribe proper amounts of medication; as a heavy smoker, he was given multiple ways to curb his nicotine cravings, including patches, inhalers and other medications.

Psychological counseling was also part of his recovery. He spoke privately to a therapist and in groups with other smokers about what triggered his nicotine urges, and how best to handle them.

Now, about to be smoke-free for two years Aug. 1, Mr. Punzone doesn't plan on backsliding again. "I am happy to say that while my lungs haven't gotten any better, they certainly have not gotten worse, and for that I'm grateful," he said. "I got in the right mental space where I was ready to quit, and the program was there to help me get through it."

A Toxic Disease

Dr. Sachs and Dr. Prezant both noted that modern medicine has been slow to acknowledge smoking as a medical disease. Nicotine is highly addictive and the body quickly gets used to its daily dose - much like caffeine, said Dr. Sachs.

"Both stimulate the central nervous system, although nicotine's a bit stronger than caffeine, but neither one is toxic in and of itself," he said. "The problem with nicotine is that there's no safe delivery system - we get it into the body generally through cigarettes, which contain about 5,000 other chemicals that are highly toxic."

Dr. Prezant's study showed that dosing patients with nicotine in amounts that matched those previously obtained through smoking didn't result in any adverse health effects. The department has maintained a 37-percent rate of smoking abstinence after 12 months in the program among its approximately 280 participants.

Affected His Breathing

Although some FDNY personnel, like Probationary Firefighter Rommel Arias, have joined the program, stopped smoking and then - for a variety of reasons - resumed the habit, they're always welcome to try again.

"I got back into the program just the other day," said Firefighter Arias, who began smoking cigarettes at age 19 while in the Army. He joined the cessation program after failing a breathing test needed to start his probationary training at Randalls Island in January, and soon was able to run a mile and a half in 9 minutes and 36 seconds.

"I could immediately feel the physical improvement when I quit," he said. But after being placed on light duty this spring following an injury to his shoulder, he went back to his 20 cigarettes a day, mostly "out of boredom and frustration." Then he got a call from his smoking cessation counselor. It was a routine checkup, but Firefighter Arias decided to confess.

'Didn't Make Me Feel Bad'

"It was good, because he didn't make me feel bad about not being able to make it the first time, and he encouraged me to come back in and talk to a counselor and get some more patches to try again," said Mr. Arias.

Despite everything that's known about the dangers of smoking, Dr. Sachs said, very few people struggling with cigarette dependency get the kind of support offered to Firefighters Arias and Punzone.

According to the National Institutes of Health, of the 44.5 million adult smokers in the U.S., 70 percent want to quit and 40 percent make serious attempts every year. Fewer than 5 percent succeed in any given year.

A Guide for Physicians

"My biggest hope for the study [on the FDNY smoking cessation program] is that it will encourage other physicians, nationwide and worldwide, to start adopting this kind of approach and practice today," said Dr. Sachs. "I can't speak for other countries, but under our laws, a licensed physician or surgeon is free to prescribe whatever medications are available to treat the disease. I'd like to see more physicians do that, and more people get the support and help they need to conquer smoking."

The FDNY smoking cessation program is available for all department employees, and family members who want to quit with them can also join. For more information, call: 718-999-1942.