SMOKING CESSATION DEATH IN OLD AGE IS INEVITABLE, BUT DEATH BEFORE OLD AGE IS NOT Sir Richard Peto, 2006 THE RISK IS BIG ¬ABOUT HALF OF SMOKERS ARE KILLED ¬THOSE KILLED IN MIDDLE AGE LOSE 10, 20, 30 OR MORE GODD YEARS www.deathsfromsmoking.net STOPPING SMOKING WORKS ¬EVEN IN EARLY MIDDLE AGE (40y) THOSE WHO STOP, AVOID MOST OF THEIR RISK OF BEING KILLED BY TOBACCO ¬STOPPING BEFORE MIDDLE AGE WORKS EVEN BETTER IMMIDIATE CHANGES ¬WITHIN 20 - 30 MINUTES: ¬THE BLOOD PRESURE AND HEART RATE DROP TO THE REST VALUES ¬THE SKIN TEMPERATURE (LEGS) RAISES BY 2^o C SHORT-TERM CHANGES ¬WITHIN 6 – 8 HOURS ¬COHb LEVELS WILL DROP TO THE NORMAL VALUES (< 1%) ¬WITHIN 72 HOURS ¬PULMONARY FUNCTIONS WILL IMPROVE (MAXIMAL EXPIRATION) MIDDLE-TERM CHANGES ¬WITHIN 2 MONTHS ¬MALE SPERM DAMAGES CAUSED BY SMOKING WILL BE REPAIRED ¬WITHIN THE 1st TRIMESTER ¬THE RISK OF PREGNANCY PROBLEMS AND FETUS POOR DEVELOPMENT WILL DECREASED MIDDLE-TERM CHANGES ¬WITHIN 1st YEAR ¬THE BLOOD LIPID PROFILE WILL BE IMPROVED, ¬THE PARAMETERS OF HEMO-COAGULATION WILL BE IMPROVED ¬THE RISK OF AC. CARDIAC ISCHEMY WILL BE DROPPED LONG-TERM CHANGES ¬WITHIN 5 YEARS ¬THE RISK OF CVD DEATH WILL BE SIMILAR AS FOR NEVER-SMOKERS ¬THE RISK OF SMOKING-RELATED CANCERS WILL START THE DECREASED TRENDS LONG-TERM CHANGES ¬WITHIN 10 – 20 YEARS ¬THE RISKS OF SMOKING-RELATED CANCER´S DEATH WILL BE SUBSTANTIALLY DECREASED, ALMOST TO THE LEVELS FOR NEVER SMOKERS CONCLUSIONS ¬THE RISK IS BIG ¬STOPPING SMOKING WORKS: EFFECTIVE SUPPORT OF SMOKING CESSATION WILL CHANGE THE DEATH EPIDEMY WITHIN 10-20 YEARS BUT ¬SMOKING IS HIGHLY DEPENDENT DISEASE – Dg. F 17 ¬BOTH PFARMACOLOGIC/PHYSICAL ¬AND BEHAVIORAL ADDICTION TOLERABILITY ¬THE SAME DOSIS CAUSES LOWER EFFECTS = ¬FOR THE SAME EFFECTS THE INCREASED DOSIS IS NECESSARY WITHDRAWAL SYMPTOMS ¬EXCITABILITY, NERVOUS, STRESSED ¬ATTENTION DISABILITY ¬COGNITIVE PROBLEMS ¬DEPRESSION ¬ANXIETY WITHDRAWAL SYMPTOMS ¬POORER WEIGHT CONTROL -> OVERWEIGHT ¬EXPECTORATION ¬CONSTIPATION WS – TIMING ¬WITHIN 2 HOURS AFTER THE LAST CIGARETTE ¬WAVES WITH DIFFERENT FREQUENCY AND POWERTY ¬SEVERAL DAYS – WEEKS – MONTHS - YEARS WS - CAUSES ¬LACK OF NICOTINE ¬LACK OF SOCIAL CONTACTS ¬CRAVING FOR SMOKING ¬INCREASED FOOD INTAKE ¬DECREASED BASAL METABOLISM WITHDRAWAL SYMPTOMS ¬ARE NOT HARMFUL FOR HEALTH ¬ARE THE MANIFESTATION OF THE DRUG ELIMINATION ¬ARE THE MOST FREQUENT CAUSE OF RELAPS WHAT TO DO? ¬KEEPING SMOKERS´ RIGHTS: - TO BE INFORMED ABOUT HAZARD - TO BE AVOIDED FROM RISK SITUATIONS - TO BE MOTIVATED TO DECISSION - TO BE SUPPORTED IN THEIR EFFORT TO STOP SMOKE WHAT IS THE BEST WAY? ¬THE „4A“ PROGRAMME: ¬ASK ¬ADVICE ¬ASSIST ¬ARRANGE FOLLOW-UP 1. ASK EVERY PATIENT: ¬ DO YOU SMOKE? ¬ HOW MUCH CIGARETTES DAILY? ¬ HOW MANY YEARS? ¬ AT WHICH AGE DID YOU START? ¬ AT WHICH MORNING TIME DO YOU LIGH YOUR FIRST CIGARETTE? ¬ WOULD YOU LIKE TO STOP? ¬ HAVE YOU SOME EXPERIENCES WITH STOPPING? 1A: CONGRATULATION ¬TO EVERYBODY WHO: ¬HAS NEVER SMOKE, ¬HAS STOPPED TO SMOKE: - ASK HIM/HER ABOUT PROBLEMS, - SUPPORT HIS/HER EFFORT TO BE NON-SMOKER 2. ADVICE ¬TO EVERY SMOKE TO STOP, because ¬FAMILY HISTORY (HEREDITARY VULNERABILITY) ¬SMOKER´S HEALTH HISTORY ¬CURRENT HEALTH STATUS ¬SOCIAL IMAGE, MODEL ROLE ¬HIS/HER CHILDREN HEALTH ADVICE IS ESSENTIAL ¬PEOPLE KNOW THE SMOKING HAZARD IN GENERAL ¬PEOPLE FEEL PERSONAL IMMUNITY AGAINST THE DAMAGES ¬SUCH FEELINGS ARE FALSE, ERROR AND VERY DANGEROUS SUPPORT OF ADVICE ¬USE THE BOOKLETS, LEAFLETS, PICTURES, … ¬FOR TARGET POPULATION OF SMOKERS (CHILDREN, TEENAGERS, PREGNANT WOMEN, WORKERS, MINORS, SENIORS…) ¬RECOMMEND THE SPECIAL OFFICE 3. ASSIST WITH THE START ¬ASSESSMENT OF DEPENDENCE -> THINKING ABOUT TREATMENT ¬CHOICE THE STRONGEST MOTIVE ¬CHOICE A DAY „D“ ¬EVALUATE THE RISK SITUATIONS: „TO KILL TIME“, „PLEASURE“, „STRESS“ ASSIST - continue ¬CHOICE THE REPLACEMENT IN THE RISK SITUALIONS: WHAT TO DO WITHOUT CIGARETTE? ¬THE DIFFICULT AVAILABILITY ¬CHANGE THE ATTITUDES: CIGARETTE IS NOT A FRIEND, BUT THE WORST ENEMY MEDICAL SUPPORT - NRT ¬CHEWING GUMS: - NICORETTE – 2, 4 mg: RULES FOR RIGHT CHEWING ¬PATCHES: - NICORETTE – 16 hours – 5, 10, 15 mg - NIQUITINE – 24 hours – 7, 14, 21 mg NRT - continue ¬INHALATORS ¬SUBLINGUAL TABLETS ¬(NASAL SPREY) SAFETY AND HAZARD ¬DECREASED WITHDRAWAL SY. ¬SLOW RELEASE OF NICOTINE WITHOUT VASOCONSTRICTION ¬CROSS PLACENTAL BARRIERE ¬ANTENATAL ACTIVATION nAChRs -> NEUROTERRATOGENIC EFFECTS ¬MULTIPLE CARCINOGENICITY BUPROPION ¬ANTIDEPRESSIVE DRUGS: ZYBAN, WELLBUTRINE ¬COMBINATION WITH NRT VARENICLINE - CHAMPIX ¬AGONIST OF NICOTINE: ¬- > RELEASE OF DOPAMINE - > ¬- > CIGARETTE IS NOT SOURCE OF PLEASURE AFTER UNSUCCESSFUL ATTEMPT(s), ONE WEEK BEFORE STOPPING CONTRAINDICATIONS ¬PREGNANCY AND LACTATION – NO EXPERIENCES YET ¬CHILDREN, ADOLESCENTS – NO EXPERIENCES YET VACCINATION ¬AFTER UNSUCCESSFUL ATTEMPTS: THE HIGH-MOLECULAR COMPLEX ¬ OF NICOTINE + ANTIBODIES = > ¬IMPOSSIBILITY TO REACH THE BRAIN 4. ARRANGE FOLOW-UP ¬RELAPS MAY BE STRESSFUL FOR SMOKER ¬REPEATED ENHANCE OF SMOKER´S RECENT MOTIVATION TO STOP ¬BETTER ARRANGEMENT CONCLUSION ¬ THE RISK IS BIG ¬ STOPPING SMOKING WORKS ¬ THE EARLIER START OF STOPPING, THE BETTER RESULTS - FOR SMOKER - FOR SMOKER´S RELATIVES - FOR THE WHOLE SOCIETY ¬ NOT FOR THE TOBACCO COMPANIES