Tobacco cessation advice

1. Tobacco cessationadvice
 Are you a smoker?
 How manycigarettesdoyousmoke eachday?
 How soonafterwakingupin the morningdoyou have yourfirstcigarette?
 Have you evertriedtostop smoking?
 Are you interestedinstoppingnow?
Patientswhoreportsmokingmore than20 cigarettesperdayand whohave theirfirstcigarette within
30 minutesof wakingupinthe morningare likelytobe heavilydependentuponnicotine andwill
require more specialisedandintensivesupport.
Reasonsforquittingsmoking
• Reduce riskof halitosis
• Improve appearance — lessstainingonteeth,betterskintexture
• Save money
• Feel betterandmore energetic
• Breakdependence ontobacco
• Reducedriskof cancersand heartdisease
• Betterperiodontalhealth— greaterchance of retainingteethforlife
• Reducedriskof oral cancers
• Improvedsuccesswithsurgical treatments
Assistance forthose wishingtoquitshouldfocusonthe followingpoints:
 Negotiate aquitdate — smokersneedtime toprepare
 Reviewpastexperiencesof quitting — identifywhathelpedandhinderedprogressinthe past
 Identifyanypotential problemsaheadandplanhow these canbe dealtwith
 Stressthe importance of enlistingthe supportof friends,familyandcolleagues — their
assistance isessential
 Explore the value of usingnicotine replacementtherapyandBupropion(Zyban)
 Give detailsof telephone supportlineswhichcanprovide ongoingsupportandencouragement
Bupropion(Zyban),althoughoriginallydevelopedasananti-depressantinthe US hasnow beenlicensed
as a pharmaceutical treatmentfortobaccodependence.
Nicotine replacementtherapy(NRT)
 can helppeople cope betterwiththeircravingsfornicotine,particularlymoderatesmokers.
 The use of NRT doublesapersonscessationsuccessrate.
 A range of NRT productsare available includingpatches,gums,nasal sprays,inhalatorsand
microtabs.
 NRT worksby providinglowdosesof nicotine;withoutthe otherharmful chemicalspresentin
tobacco smoke,tothe brainin orderto replace the nicotine fromcigarette smoke.
 This approachaimsto reduce the cravingfor nicotine andease orpreventthe withdrawal
symptomsassociatedwithstoppingsmoking.
What are the typesof NRT available?
Nicotine replacementproductcomesinseveral formsandstrengthstoaccommodate the different
needsandlevel of nicotineaddictionof the smokers.Beloware the 5 differenttypesof nicotine
productsavailable inthe market:
1. Nicotine gum
2. Nicotine inhaler
3. Nicotine lozenge
4. Nicotine nasal spray*
5. Nicotine patch
*Not available inMalaysia
 These nicotine productsare designedwithdifferentnicotinedeliverymechanismintermof
pace andsite of absorption.
 The nicotine gum,inhaler,lozengeandnasal spraydelivernicotine tothe brainmore quickly
comparedto patch,but lessrapidlythansmokingcigarettes.
 Nicotine isabsorbedthroughthe buccal mucosamembrane fromthe gum, lozenge andinhaler,
where asthroughthe nasal mucosamembrane forthe nasal spray.
 In contrast,nicotine patchesdelivernicotine doseslowlyandpassivelywhichiswhyitisusually
usedwithcombinationof otherNRTproducts.

2. What are the special precautions?
CardiovascularDiseases –NRT isnot an independentriskfactorforacute myocardial events.
NRT shouldbe usedwithcautionamongparticularcardiovascularpatientgroupswhichinclude
those inthe immediate (within2weeks) ppostmyocardial infarctionperiod,thosewithserious
arrhythmias,andthose withunstable anginapectoris.
Pregnancy – Pregnantsmokersshouldbe encouragedtoquitwithoutmedication.NRThasyet
to be shownbeingeffective fortreatingtobaccodependence inpregnantsmokersandhasnot
beenevaluatedinbreastfeedingpatients.