Smoking cessation The best is STOP NOW! •„ People do not like smoking at all, but they cannot stop to do it.“ • Their disease has the international code • F 17 Who is a smoker (S)? •Current regular S. – at least 1 cigarette daily •Occassional S. - less than 1 cigarette daily •Former S. – does not smoke now, during lifelong smoked more than 100 cigarettes •Never S. – does not smoke now, during lifelong smoked less than 100 cigarettes •Similar rules are for smoking of pipe, water pipe, cigar, e-cigarettes, heated-not burn tobacco How to evaluate the dependence? 2. •Fagerstrőm´s questionnaire is the most often method (6 very simple questions, 10 penalty marks) • •For a brief orientation: history of smoking -How many cigarettes daily? < 15 > (light x heavy S.) -At which age did you start to smoke daily? -When do you light your first cigarette after waking-up? • < 30 min > •ATTENTION! Answers must include also using water pipes and e-cigarettes Fagerströmův test Why to stop smoke? •PHYSICIAN´S BASIC DUTY IS ADVICE and MOTIVATE TO STOPPING SMOKING •* PERSONIFICATION THE PATIENT´S INDIVIDUAL RISK •Health reasons: (hereditary vulnerability for serious diseases, current health status, better condition, breathing, less respirátory infections, better sexual functions – men, healthy pregnancy, better health for newborns and children) •Beauty (white teeth, face without wringles, smell) •Social reasons (partner, children, job, economy) Stopping smoking works •Within 20 min – decreasing of HR and BP •Within 8 hours – CO elimination, decreasing COHb levels to 1% •Within 72 hours – better lung functions (FEV1) •Within 1st y: risk of ac. CVD decreases signific. •After 5 y: the CVD risk as for never S. •After 10 -15y: oncological risk similar to never S. Recommendations •Make the reasons „FOR and ANTI“ • Choose Day D •Establish strong personal motivation •Adopt breathing methods, exercises •Change stereotypical situations •Seek for family/friends support •Think and plan reward Withdrawal symptoms •craving •Bad mood, depression, excitation, aggressivity, angry, anxiety •Sleep disturbance, headache •Increased appetite •Problems with attention and copy with stress • • Remember •Craving disappers within 20 seconds •Levels and frequency of withdrawal symptoms continually decrease •Ask for support and help •Smoking cannot remove your crisis, but enlarges it! Drugs for support • •AFTER THE PSYCHOLOGICAL MOTIVATION •* Nicotine replacemtnt therapy: (chewing gums, sticks, spray, inhalator, subling. tablets) •BUPROPION (Zyban, Welbutrin) – antidepresant •VARENIKLIN (Champix) – nicotine agonist •ALTERNATIVE (yoga, acupuncture, hypnosis) – effects like placebo • •E-cigarety , iQOS ??? •They are not drugs, but another forms of tobacco products. Evaluation of effects •Time of abstinence at least 1 year •Only 2% of smokers are able to stop withouth help •* Physician´s participation is essential due to personification of the risk Better behavioral treatment •Needs psychosocial approach by •Educated specialist •Advisory offices, Centers The healh professionals use 5A Programme •Ask – smoking history •Advise – STOP SMOKE, because…. •Assess – the level of dependence, willing for change •Assist – motivation, preparation, drugs •Arange follow up – support, seek for relaps, restart the proces of cessation Centers in Brno •Clinic of respirátory dis. and TBC, FH Brno – Bohunice •Int. Cardiology FH Brno – Bohunice •1st. Int. Cardiology FH FNUSA •Masaryk´s Oncology Institute – Bakešův pavilon When smoker does not stop… • Recommend to increase the intake of antioxidants and trace elements: •vitamín E, C •selen •manganese •zinc •Extracts from Ginko biloba • • For more informations: •http://www.kurakovaplice.cz •http://www.odvykani-koureni.cz •http://www.dokurte.cz/download/doporuceni_pro_lecbu_zavislosti_na_tabaku.pdf •http://slzt.cz/odborna-doporuceni •http://www.stop-koureni.cz