An integrated public health strategy to manage chronic respiratory disease and reduce smoking in Vietnam: a pilot study

There are three interventions 1. Chronic respiratory disease intervention A syndromic approach to diagnosis and treatment for patients with COPD/asthma. The treatment algorithm consists of three steps. Step 1 treatment uses as-needed budesonide/formoterol (160/4.5ug per dose) inhalation for relieving day-to-day respiratory symptoms. Step 2 includes twice daily and as-needed budesonide/formoterol (160/4.5ug per dose) inhalation. Patients who require step 3 treatment will be referred to a higher level health facility for respiratory specialist evaluation. Treatment will be stepped up when a patient is not under good symptom control or had an exacerbation, providing that the patient uses the inhaler treatment correctly. After recruitment, all patients start with step 1 treatment. At 4 weeks, patients will return to the clinic for evaluation and decision on the treatment step. When returning for clinical assessment, patients are asked to bring back inhalers for evaluating treatment adherence and inhaler technique. The treating physician will also decide the time for the next clinical evaluation, when the decision on treatment step will take place again. All recruited patients will follow the treatment algorithm for one year. The decision on staying in the same step, stepping up or down, is determined by treating physician based on the patient's symptom control, exacerbation, adherence to suggested treatment, and inhaler technique. For example, a patient under treatment step 1 had an exacerbation 2 weeks before this visit. The patient has a good inhaler technique and has been following the treatment step 1, evaluated by the treating physician. The physician should step up to treatment from step 1 to step 2. 2. Health facility smoking cessation intervention Implementation of smoke-free hospital policy Hospital leaders are responsible for formulating rules and implementing smoke-free hospital policy, with assistance from research staff. Smoke-free hospital policy includes the prohibition of smoking and selling tobacco products on the hospital premises. The regulations will be announced and all members in the hospital should follow, including patients and visitors. Training for healthcare workers to provide brief advice on smoking cessation A one-off 2-hour smoking cessation workshop will be held by research staff to train healthcare workers on brief intervention to patients. The workshop will include a lecture and practice of brief intervention using 5A's approach. Healthcare workers who are smokers are encouraged to quit. After commencing the intervention, research staff will conduct regular visits to monitor the implementation. Issues identified will be raised and discussed with hospital leaders. 3. Patient smoking cessation intervention Smoking cessation brief advice provided by healthcare workers at district facilities. After the above-mentioned smoking cessation workshop, healthcare workers at the outpatient clinic, emergency department, and inpatient department will ask patients about smoking behaviour. For patients who are current smokers, healthcare workers will advise them to quit and invite them to join a follow-up smoking cessation programme. Follow-up smoking cessation programme Smokers who consent to join the programme will receive follow-up quitline counselling for 9 times (1 day, 1 week, 2 weeks, 3 weeks, 4 weeks, 3 months, 6 months, 9 months, and 12 months after recruitment). Participants can also call the quitline if they need extra support. The follow-up programme also contains text messages to help participants quit smoking. The text message service is integrated with quitline counselling. The service lasts for 3 months, starting with one text per day and decreasing over time.