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  • Smoking Cessation Kevin Scott Ferentz, MD Associate Professor Department of Family Medicine Univ. of Maryland School of Medicine
  • Cigarette smoking is the single most important cause of disease and premature death in the United States
  • 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
  • Smoking in the U.S.
    • 25% of adults
    • men = women
    • rate hasn’t dropped in 1990’s
    • 1.3 million quit each year
    • 3,000 teens start each day
      • adolescent smoking increasing
    • more ex-smokers than current smokers
  • Involuntary smoking is a cause of disease in non-smokers
  • Smoking kills more people each year than
    • alcohol
    • cocaine
    • crack
    • heroin
    • homicide
    • suicide
    • car accidents
    • fires
    • AIDS
    C O M B I N ED!!!
  • What’s in a cigarette?
    • 4,000 chemicals
    • tar
    • carbon monoxide
    • nicotine
  •  
  • Health benefits after quitting
    • cough, DOE resolve in weeks
    • exercise tolerance improves rapidly
    • bladder cancer: 50% reduction in 5 years
    • lung cancer: 50% reduction in 10 years
    • heart disease: 50% reduction in 1 year!
    • No excess risk of heart disease by 10-15 years
    • vascular disease: 50% reduction in 5 years
    • mortality - same as never smokers by 10-15 yrs
  • Non-health reasons for quitting
    • COST!!!
    • inconvenience
    • self-esteem
    • role model
  • Common concerns
    • Withdrawal
      • short lived
    • Cravings
      • last 3-5 minutes, diminish rapidly
    • Tension
      • validate, normalize
      • find other ways to cope
    • Weight gain - not inevitable!
      • 1/3 gain: 5-8 lbs.
  • Three Aspects of Addiction
    • Physical
    • Psychological
    • Behavioral
  • 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
  • Pharmacological treatment
    • nicotine replacement - “methadone for the smoker”
      • gum
      • patches
      • nasal spray
      • inhaler
    • bupropion
    • all decrease cravings, withdrawal
    • 20-25% quit rates at 1 year
  • Nicotine replacement and buproprion should always be used in conjunction with behavior modification
  • Conclusions
    • We haven’t started winning the war
    • All smoking patients should be counseled
    • Always use pharmacological interventions
    • Be public health advocates
  •