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Smoking Cessation

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Smoking Cessation Dr Kumar Gaurav Sharma MD, PGDCC Cardiologist Prime Hospitals Hyderabad Cigarette smoking is the single most important cause of disease and ... – PowerPoint PPT presentation

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Title: Smoking Cessation


1
Smoking Cessation
  • Dr Kumar Gaurav Sharma
  • MD, PGDCC
  • Cardiologist
  • Prime Hospitals
  • Hyderabad

2
Cigarette smoking is the single most important
cause of disease and premature death in INDIA
3
Health Effects of Smoking
  • Heart disease
  • Lung disease COPD, asthma
  • Cancer
  • Lung, ENT, pancreas
  • Cervix, colorectal
  • Skin (squamous cell)
  • Vascular disease - impotence
  • Stroke
  • Cataracts
  • Gum disease
  • Dementia
  • Early menopause
  • Osteoporosis
  • Wound healing
  • Anxiety
  • Miscarriage
  • SIDS
  • Hearing loss
  • Rheumatoid arthritis
  • Macular degeneration
  • Tooth decay
  • Depression
  • Multiple sclerosis

4
Smoking in INDIA.
  • 25 of adults
  • 1/3 are women
  • rate hasnt dropped in 1990s
  • 1.3 million quit each year
  • 3,000 teens start each day
  • adolescent smoking increasing
  • more ex-smokers than current smokers

5
Involuntary smoking is a cause of disease in
non-smokers
6
Smoking kills more people each year than
  • alcohol
  • cocaine
  • crack
  • heroin
  • homicide
  • suicide
  • car accidents
  • fires
  • AIDS

C O M B I N ED!!!
7
Whats in a cigarette?
  • 4,000 chemicals
  • tar
  • carbon monoxide
  • nicotine

8
The benefits of quitting
Within hours.......
9
Within months .......
Years .......
10
The cycle of change
Relapse
Pre- contemplation
Maintenance
Cycle of change
Do you smoke?
Contemplation
Action
Have you considered quitting?
Determination
11
The cycle of change
Not yet considered quitting
  • Explain importance of cessation
  • Offer help as and when they want it.

Be a positive partner Focus on the positive
health effects of cessation
Ambivalent to cessation
Pre- contemplation
  • Move them closer to a cessation attempt
  • Understand how you can help

Be a positive partner Let them describe their
doubts and fear of failing Identify how to plan
a quit attempt Offer the ongoing medical support
Contemplation
12
The cycle of change
Ready to make a cessation attempt
Pre- contemplation
  • Provide support for a quit attempt

Be supportive and enthusiastic! Give time to
planning the attempt Set a quit date Discuss
problems of withdrawal
Contemplation
Determination
13
Action! a cessation attempt
  • Be available to support the quit attempt

Pre- contemplation
Congratulate! Arrange review (even if relapse)
Contemplation
Action
Determination
14
Maintain!
Pre- contemplation
Maintenance
  • Maintain smoke-free

Be positive! Support over time Emphasise
health benefits
Contemplation
Action
Determination
15
Smokers may move backwards or forwards, to and
fro across the cycle many times before finally
quitting
Relapse
Pre- contemplation
Maintenance
Cycle of change
Contemplation
Action
Determination
16
(No Transcript)
17
A
The 5 As
Ask Assess Advise Assist Arrange
18
The 5 As
ASK about smoking status
ASSESS motivation and nicotine dependence
ADVISE on coping strategies
ASSIST the quit attempt
ARRANGE follow up
World Health Organization. The Tobacco Atlas.
http//www.who.int/tobacco/statistics/tobacco_atla
s/en
19
Nicotine withdrawal Duration
20
Nicotine withdrawal the 4 Ds
Drink water slowly
Deep breathe.
Do something else (eg exercise)
Delay acting on the urge to smoke
21
Nicotine replacement
  • Begin NRT on the quit date, (apply patches the
    night before)
  • Use a dose that controls the withdrawal symptoms
  • NRT provides levels of nicotine well below
    smoking
  • Prescribe in blocks of two weeks
  • Arrange follow up to provide support
  • Use a full dose for 6 to 8 weeks then stop
  • or reduce the dose gradually over 4 weeks.

NRT increases the odds of quitting about 1.5 to 2
fold
22
Pharmacotherapy
Pharmacotherapy behavioural counselling
improves long-term quit rates
Smokers of 10 or more cigarettes a day who are
ready to stop should be encouraged to use
pharmacologial support as a cessation aid
Nicotine replacement
  • Begin NRT on the quit date, (apply patches the
    night before)
  • Use a dose that controls the withdrawal symptoms
  • NRT provides levels of nicotine well below
    smoking
  • Prescribe in blocks of two weeks
  • Arrange follow up to provide support
  • Use a full dose for 6 to 8 weeks then stop
  • or reduce the dose gradually over 4 weeks.

NRT Nicotine patches
  • Patches provide a slow, consistent release of
    nicotine throughout the day
  • Available in various shapes and sizes,
  • Common side effects with patches include skin
    sensitivity and irritation

23
NRT Nicotine nasal sp
  • Nasal sprays more closely mimic nicotine from
    cigarettes
  • Common side effects with nasal sprays include
    nasal and throat irritation, coughing and oral
    burning

NRT Nicotine gum
  • Instruct the patient to chew and park
  • Absorption may be impaired by coffee and some
    acidic drinks
  • Common side effects with gum include
    gastrointestinal disturbances and jaw pain
  • Dentures may be a problem!
  • Nicotine Tabs
  • Nicotine tablets deliver 2-mg or 4-mg dosages of
    nicotine over 30-minutes
  • Common side effects with gum include burning
    sensations in the mouth, sore throat, coughing,
    dry lips, and mouth ulcers

Bupropion
  • Begin bupropion a week before the quit date
  • Normal dose 150mg bd, (reduce in elderly,
    liver/renal disease)
  • Contra-indicated in patients with epilepsy,
    anorexia nervosa, bulimia, bipolar disorder or
    severe liver disease.
  • The most common side effects are insomnia (up to
    30), dry mouth (10-15), headache (10), nausea
    (10), constipation (10), and agitation (5-10)
  • Interaction with antidepressants, antipsychotics
    and anti-arrhythmics

24
Nortryptiline
  • Tri-cyclic antidepressant
  • Not licensed for smoking cessation
  • Low cost
  • Side-effects include sedation, dry mouth,
    light-headedness, cardiac arrhythmia
  • Contra-indicated after recent myocardial
    infarction

Varenicline
  • Begin varenicline a week before the quit date,
    increasing dose gradually.
  • Alleviates withdrawal symptoms, reduces urge to
    smoke
  • Common side effects include nausea (30),
    insomnia, (14), abnormal dreams (13), headache
    (13), constipation (9), gas (6) and vomiting
    (5).
  • Contra-indicated in pregnancy
  • New drug

Nicotine replacement and buproprion should always
be used in conjunction with behavior modification
25
Aspects of Addiction
  • Physical
  • Psychological
  • Behavioral
  • MENTAL HEALTH
  • Psychotic disorders are associated with three
    times the risk being a heavy smokers (35 vs 9)
  • Smoking may alleviate symptoms of psychosis
  • Smoking and depression are related
  • The antidepressants, bupropion and nortriptyline
    are effective in assisting smoking cessation
  • Bupropion interacts with other antidepressants

People with mental health problems are more
likely to smoke than those without mental illness
26
Behavior modification
  • review reasons for quitting (index card)
  • identify triggers (4 day diary)
  • plans to avoid or cope with each trigger
  • change habit packs only, different brands
  • develop support system (tell everyone)
  • self rewards (day, week, month, year)
  • written commitment to quit day


27
Conclusions
  • We havent started winning the war
  • All smoking patients should be counseled
  • Always use pharmacological interventions
  • Be public health advocates
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