Introduction:
Smoking cessation is the most effective intervention to stop disease progression in high risk categories of smokers like cardiovascular (CVD), diabetes and COPD patients. The “TOB G” project has implemented a set of specialized guidelines in a pilot program for such patients, developed in the Clinical Hospital of Pulmonary Diseases of Iasi, Romania. Aim and objective: To determine the real world effectiveness and barriers of the TOB-G guideline recommendations among 150 smokers enrolled in the pilot TOB G running in Romania.

Material and Methods:
Smokers with CVD, diabetes and COPD willing to quit smoking were recruited from the hospital’database and enrolled in the pilot TOB G. They were delivered a smoking cessation counselling intervention consisting of 4 sessions either in-person or by telephone. Abstinence rate was assessed at 1, 2 and 6 months, with careful observation of the barriers and inconvenients arising from pilot implementation in a real life clinical setting.

Results:
150 patients were enrolled. Smoking abstinence was documented at the 6-month follow-up with 36.0% abstinent in the CVD group (biochemically validated in 22%), 63.3% (40.8% validated) in the diabetes group and 64% ( 51.6% validated ) in COPD group, respectively. The major pilot implementation barriers were observed in the severe COPD smokers, in smokers with mild CVD and in smokers uncompliant to diabetes care.

Conclusions:
The TOBG Guidelines for CVD, diabetes and COPD patients proved feasible to implement and produced significant increases in patient smoking abstinence and in disease outcomes. Future research is needed to improve the guidelines applicability in real life clinical settings.

Funding:
The research describes activity performed in the TOB-G EU project Grant Agreement Number 664292