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 BENEFITS * WITHIN 20 - 30 MINUTES: *THE BLOOD PRESURE AND HEART RATE DROP TO THE REST VALUES *THE SKIN TEMPERATURE (LEGS) RAISES BY 2° C SHORT-TERM BENEFITS * WITHIN 6-8 HOURS *COHb LEVELS WILL DROP TO THE NORMAL VALUES (< 1%) * WITHIN 72 HOURS * PULMONARY FUNCTIONS WILL IMPROVE (1 sec forced expiration) MIDDLE-TERM BENEFITS * WITHIN 2 MONTHS *MALE SPERM DAMAGES CAUSED BY SMOKING WILL BE REPAIRED * WITHIN THE 1st TRIMESTER *THE RISK OF PREGNANCY PROBLEMS AND FETAL BODY POOR DEVELOPMENT WILL DECREASE MIDDLE-TERM BENEFITS * WITHIN 1st YEAR *THE BLOOD LIPID PROFILE WILL BE IMPROVED, *THE PARAMETERS OF HEMO-COAGULATION WILL BE IMPROVED *THE RISK OF AC. CARDIAC ISCHEMY and STROKE WILL BE DROPPED LONG-TERM BENEFITS * 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 BENEFITS * WITHIN 10 - 20 YEARS *THE RISKS OF SMOKING-RELATED CANCER'S DEATH WILL BE SUBSTANTIALLY DECREASED, ALMOST TO THE LEVELS FOR NEVER SMOKERS Figure 3. Effects of stopping smoking at various ages on the cumulative risk (%) of death from lung cancer l>y age 75, calculated hy combining results from the 1990 study with mortality rates for men in the UK in 1990 18 T-1 Aye CONCLUSIONS * THE RISK IS BIG * STOPPING SMOKING WORKS: EFFECTIVE SUPPORT OF SMOKING CESSATION WILL CHANGE THE DEATH EPIDEMY WITHIN 10-20 YEARS so... *WHY SOME PEOPLE TAKE TOBACCO LEAVES, ROLL THEM IN PAPER, LIGH THEM and * INHALE THE DANGEROUS SMOKE * ??? • • • BECAUSE * SMOKING IS HIGHLY DEPENDENT DISEASE -Dg. F 17 *BOTH PHARMACOLOGIC/PHYSICAL * AND BEHAVIORAL ADDICTION * DEVELOPED MOSTLY DURING CHILDHOOD MECHANISMS OF ACTION * ACTIVATION OF „NICOTINIC" RECEPTORS * RELEASE OF NEUROTRANSMITTERS DOPAMINE, SEROTONINE * ACTIVATION OF SYMPATIC SYSTEM and SUPRARENAL GLANS => ADRENALINE, NORADRENALINE, ACTH SUBJECTIVE PERCEPTION *WELL BEING * COPING THE STRESS * SHORT-TIME INCREASING OF THE PERFORMANCE RELEASE OF DOPAMINE * INITIATE MANY DAILY-LIFE EVENTS: - SEX, FOOD, - SUCCESS - FRIENDLY ENVIRONMENT - CHILDREN'S BEHAVIOR, SMOKERS ARE: * AT THE BEGINNING: * UNHAPPY, UNSUCCESSFUL PEOPLE *LAZY PEOPLE * LATER ON: * DEPENDENT PEOPLE CRITERIA OF ADDICTION * USING THE DRUG LONGER THAN EXPECTED * USING THE DRUG DESPITE OF HEALTH PROBLEMS * THE MOST TIME A DAY IS SPENT BY EFFORT TO OBTAIN THE DRUG /or BY USING THE DRUG CRITERIA - continue *USER NEGLETS SOME ACTIVITIES WHERE USING OF DRUG IS BANNED * SHORT-TERM ABSTINENCE RESULTS TO THE REPEATEDLY OCCURED RELAPSE TOLERABILITY *THE SAME DOSE CAUSES LOWER EFFECTS = *FOR THE SAME EFFECTS THE INCREASED DOSE IS NECESSARY WITHDRAWAL SYMPTOMS (WS) * 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 „5A" PROGRAMME: 1. ASK 2. ADVICE 3. ASSESS 4. ASSIST 5. 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 SMOKER 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. ASSESS THE LEVEL OF DEPENDENCE *FAGERSTROM S QUESTIONNAIRE: *6 QUESTIONS * MAXIMUM 10 „BAD POINTS" *4 LEVELS OF DEPENDENCE *LOST OF AUTONOMY *- THINKING ABOUT TREATMENT 4. ASSIST WITH THE START * HELP TO CHOICE THE STRONGEST MOTIVE *INICIATE TO 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 NICOTIN IS A COMPLEETE CARCINOGEN * PARTIALLY METABOLITES TO NNK => INITIATOR OF CARCINOGENICITY * REVASCULARISATION OF CARCINOMA/METASTASES TISSUES => HIGHER PROGRESSION BUPROPION ❖ANTIDEPRESSIVE DRUGS: ZYBAN, WELLBUTRINE ❖ COMBINATION WITH NRT VARENICLINE - CHAMP IX * AGONIST OF NICOTINE: * - > RELEASE OF DOPAMINE - > *- > CIGARETTE IS NOT SOURCE OF PLEASURE AFTER UNSUCCESSFUL ATTEMPT(s), ONE WEEK BEFORE STOPPING CONTRAINDICATIONS * PREGNANCY AND LACTATION-EXPERIENCES YET * CHILDREN, ADOLESCENTS - NO EXPERIENCES YET NEW RECOMMENDATION ❖TO EXCLUSE PERSONS WITH PSYCHIATRIC DISORDERS ❖ NEUROPSYCHOLOGICAL OBSERVATION OF VARENICLINE USERS ❖ CARDIOVASCULAR EVENTS VACCINATION * AFTER UNSUCCESSFUL ATTEMPTS: THE HIGH-MOLECULAR COMPLEX * OF NICOTINE + ANTIBODIES = > * IMPOSSIBILITY TO REACH THE BRAIN FIRST RESULTS: *5 DOSES of 400 ug *IN ONE MONTH INTERVALS * BIVALENT VACCINE NEXT RESEARCH ❖ OPTIMAL TIME-SCHEDULE ❖ OPTIMAL DOSES with the respect to ❖ GENETIC POLYMORPHISM of CYP2A6 ❖ QUICK RELEASE OF NICOTIN ❖ COMBINATION ❖NEW TREATMENT ❖NEW (safe sources of) ADDICTION RELAPS *T0 TRY „ONLY ONE" PUFF *COFEE, VINE * FRIENDS * SEEK THE MORE PLEASURE * STRESS 5. 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 Self mutilation by smokinq th»s patent hod all lour limbs amputated foi a Buerger s tvpe of arteritis. Hischi.ui- tif hottftl was maov . ut of a coot hanger by one of his fnrmis on the \Vard MY RECOMMENDATION *FOR NO - SMOKERS: *DO NOT START TO SMOKE *DO NOT ALLOW TO BE A VICTIM OF REGARDLESS SMOKERS MY RECOMMENDATION * FOR SMOKERS: * DO RESPECT THE NO-SMOKERS' RIGHTS TO BREATHE THE CLEAN AIR !!! * DO CLEAN THE TOXIC WASTAGE (butts) *DO MAKE THE RIGHT DECISION (TO STOP SMOKE) * DO KEEP IT BECAUSE ... * THE LIFE WITHOUT TOBACCO IS * MORE FREE * MORE MODERN *MORE CLEAR * MORE AROMATIC *MORE SENSUOUS *MORE ....