Other : osteoporosis, cataracts, gum disease, gastric and duodenal ulcers
The Benefits of Quitting Compared to smokers … Stroke risk is reduced to that of a person who never smoked after 5 to 15 years of not smoking. Cancers of the mouth, throat, and esophagus risks are halved 5 years after quitting. Cancer of the larynx risk is reduced after quitting. Coronary heart disease risk is cut by half 1 year after quitting and is nearly the same as someone who never smoked 15 years after quitting. Chronic obstructive pulmonary disease risk of death is reduced after you quit. Lung cancer risk drops by as much as half 10 years after quitting. Ulcer risk drops after quitting. Bladder cancer risk is halved a few years after quitting. Peripheral artery disease goes down after quitting. Cervical cancer risk is reduced a few years after quitting. Low birthweight baby risk drops to normal if you quit before pregnancy or during your first trimester
The U.S. Public Health Service has set goals to reduce smoking in our country by the year 2010.
cut smoking rates among high school aged youth from 22% to 16%.
cut smoking rates among all adults from 23% to 12%.
increase the number of 1° care providers who routinely provide smoking cessation counseling for their patients who smoke by 75%
If these goals are met ~ 7.1 million early deaths will be prevented after 2010 !!!
Addictive Nature of Nicotine
Addictive characteristics of nicotine are a result of its action on the nicotinic acetylcholine receptors
nicotine reaches the brain within 10 seconds upon inhalation
Nicotine is known for its ability to both stimulate and depress the CNS
small rapid doses produce alertness and arousal
long drawn out doses induce relaxation and sedation
Tobacco use is more likely to lead to dependence than any other drug
Among those who ever tried one cigarette, approximately 1/3 rd develop nicotine dependence
Similar to addiction associated with cocaine, amphetamines and opiates, nicotine addiction is a “chronic relapsing medical condition” that warrants clinical intervention.
Clinical Intervention for Smoking Cessation
Smoking cessation is the most important, cost effective preventive clinical intervention that healthcare providers can offer to their patients that smoke.
At least 70% of smokers see their primary care clinician annually which means that many practitioners are missing a prime opportunity to improve the health of their smoking patients
Primary care providers play a KEY role in the identification, assessment and treatment of smokers.
It is essential for smoking cessation to be implemented into the clinical setting during each patient visit!
Non-Pharmacotherapies (Behavioral Therapies)
Brief counseling (< 3 min)
Support groups Web Sites Quit-lines
Types of Behavioral Therapy
“ 5A” Model
Ask (about smoking)
Advise (to stop)
Assess (will to stop)
Assist (will to stop)
Arrange (f/u visits)
“ 5R” Model
Risks (of tobacco use)
Rewards (of quitting)
Roadblocks (to cessation)
Repetition (every visit)
Other – social support groups, group/individual counseling, pamphlets, books, U.S Dept Health and Human Services telephone quit line 1-800-QUIT NOW, websites: www.smokefree.com , www.WayToQuit.com , also many pharmacotherapies now offer support plans with purchase of their product.
Apply- clean, dry, nonhairy site on trunk or upper outer arm. Rotate 21mg per day 6wks,14mg per day 2wks, then 7mg per day for 2 wks 21mg/24 hr 14mg/24hr 7mg/24 hr OTC Nicotine Nicoderm CQ (remove after 16-24 hrs) Apply to clean, dry, nonhairy site on hip or upper outer arm. Rotate 15mg for 6 wks, 10mg for 2 wks, then 5mg for 2 wks. 15mg/16 hr 10mg/16 hr 5mg/16 hr OTC Nicotine Nicotrol Step-Down patch (remove after 16 hrs) 20min puffing releases 4mg c 2mg nicotine abs. (2 cigs) ~6-16 cartridges/ day up to 12wks, then reduce over 12wks (Tx up to 6 months) 10mg/ cartridge 4mg del Rx Nicotine (inhalation) Nicotrol Nicotine Inhaler No sniff, inhale, swallow spray 1-2 doses/hr. Max 5/hr& 40/day (2 sprays is one dose) (Tx up to 3 months) .5mg/spray Rx Nicotine Nicotrol Nicotine Nasal Spray Avoid food/ acidic drinks for 15min before and after use. 1 piece q 1-2hr 6wks, 1q 2-4hrs 3 wks, then 1q 4-8hrs 3 wks 2mg 4mg OTC Nicotine Nicorette Gum Commit Lozenge Nicotine Polacrilex Gum/ Lozenge Nicotine Transdermal Patch