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  1. 1. Smoking Cessation Kevin Scott Ferentz, MD Associate Professor Department of Family Medicine Univ. of Maryland School of Medicine
  2. 2. Cigarette smoking is the single most important cause of disease and premature death in the United States
  3. 3. Health Effects of Smoking <ul><li>Heart disease </li></ul><ul><li>Lung disease – COPD, asthma </li></ul><ul><li>Cancer </li></ul><ul><ul><li>Lung, ENT, pancreas </li></ul></ul><ul><ul><li>Cervix, colorectal </li></ul></ul><ul><ul><li>Skin (squamous cell) </li></ul></ul><ul><li>Vascular disease - impotence </li></ul><ul><li>Stroke </li></ul><ul><li>Cataracts </li></ul><ul><li>Gum disease </li></ul><ul><li>Dementia </li></ul><ul><li>Early menopause </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Wound healing </li></ul><ul><li>Anxiety </li></ul><ul><li>Miscarriage </li></ul><ul><li>SIDS </li></ul><ul><li>Hearing loss </li></ul><ul><li>Rheumatoid arthritis </li></ul><ul><li>Macular degeneration </li></ul><ul><li>Tooth decay </li></ul><ul><li>Depression </li></ul><ul><li>Multiple sclerosis </li></ul>
  4. 4. Smoking in the U.S. <ul><li>25% of adults </li></ul><ul><li>men = women </li></ul><ul><li>rate hasn’t dropped in 1990’s </li></ul><ul><li>1.3 million quit each year </li></ul><ul><li>3,000 teens start each day </li></ul><ul><ul><li>adolescent smoking increasing </li></ul></ul><ul><li>more ex-smokers than current smokers </li></ul>
  5. 5. Involuntary smoking is a cause of disease in non-smokers
  6. 6. Smoking kills more people each year than <ul><li>alcohol </li></ul><ul><li>cocaine </li></ul><ul><li>crack </li></ul><ul><li>heroin </li></ul><ul><li>homicide </li></ul><ul><li>suicide </li></ul><ul><li>car accidents </li></ul><ul><li>fires </li></ul><ul><li>AIDS </li></ul>C O M B I N ED!!!
  7. 7. What’s in a cigarette? <ul><li>4,000 chemicals </li></ul><ul><li>tar </li></ul><ul><li>carbon monoxide </li></ul><ul><li>nicotine </li></ul>
  8. 9. Health benefits after quitting <ul><li>cough, DOE resolve in weeks </li></ul><ul><li>exercise tolerance improves rapidly </li></ul><ul><li>bladder cancer: 50% reduction in 5 years </li></ul><ul><li>lung cancer: 50% reduction in 10 years </li></ul><ul><li>heart disease: 50% reduction in 1 year! </li></ul><ul><li>No excess risk of heart disease by 10-15 years </li></ul><ul><li>vascular disease: 50% reduction in 5 years </li></ul><ul><li>mortality - same as never smokers by 10-15 yrs </li></ul>
  9. 10. Non-health reasons for quitting <ul><li>COST!!! </li></ul><ul><li>inconvenience </li></ul><ul><li>self-esteem </li></ul><ul><li>role model </li></ul>
  10. 11. Common concerns <ul><li>Withdrawal </li></ul><ul><ul><li>short lived </li></ul></ul><ul><li>Cravings </li></ul><ul><ul><li>last 3-5 minutes, diminish rapidly </li></ul></ul><ul><li>Tension </li></ul><ul><ul><li>validate, normalize </li></ul></ul><ul><ul><li>find other ways to cope </li></ul></ul><ul><li>Weight gain - not inevitable! </li></ul><ul><ul><li>1/3 gain: 5-8 lbs. </li></ul></ul>
  11. 12. Three Aspects of Addiction <ul><li>Physical </li></ul><ul><li>Psychological </li></ul><ul><li>Behavioral </li></ul>
  12. 13. Behavior modification <ul><li>review reasons for quitting (index card) </li></ul><ul><li>identify triggers (4 day diary) </li></ul><ul><li>plans to avoid or cope with each trigger </li></ul><ul><li>change habit: packs only, different brands </li></ul><ul><li>develop support system (tell everyone) </li></ul><ul><li>self rewards (day, week, month, year) </li></ul><ul><li>written commitment to quit day </li></ul>
  13. 14. Pharmacological treatment <ul><li>nicotine replacement - “methadone for the smoker” </li></ul><ul><ul><li>gum </li></ul></ul><ul><ul><li>patches </li></ul></ul><ul><ul><li>nasal spray </li></ul></ul><ul><ul><li>inhaler </li></ul></ul><ul><li>bupropion </li></ul><ul><li>all decrease cravings, withdrawal </li></ul><ul><li>20-25% quit rates at 1 year </li></ul>
  14. 15. Nicotine replacement and buproprion should always be used in conjunction with behavior modification
  15. 16. Conclusions <ul><li>We haven’t started winning the war </li></ul><ul><li>All smoking patients should be counseled </li></ul><ul><li>Always use pharmacological interventions </li></ul><ul><li>Be public health advocates </li></ul>

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