TOBACCO CESSATION

Presented By Mrs. Sivalakshmi .M.sc (Nsg) Lecturer

STATE TOBACCO CONTROL CELL DIRECTORATE OF PUBLIC HEALTH & PREVENTIVE MEDICINE GOVERNMENT OF TAMILNADU

THEME
FRAMEWORK CONVENTION ON TOBACCO CONTROL

INCIDENCE

Globally . tobacco kills -5.4 million people every year

 >80%

of the death occur due to tobacco usage India 8-9 lakhs death 40% cancers due to tobacco

TOBACCO TYPES
TOBACCO TYPES

Smoked cigarettes,beedies)

Inhaled (snuff)

Chewed (gutka,khaini,etc)

CONSTITTUES OF TOBACCO SMOKE

EFFECTS OF TOBACCO

Tobacco

kills in three main ways..

 Cancer

of lung , liver , oral cavity , throat, larynx, pancreas and stomach, oesophagus.

 Cardio-vascular

diseases (IHD,

stroke).

 Respiratory

disease (COLD ,bronchitis,

pneumonia)

.and is linked over 50 conditions.

Such us
Impotency Lower

fertility Birth defects in children Blindness Brain shrinkage Immune system impairment

 Decreased

lung function Osteoporosis Reduced sperm count Tuberculosis Increased sperm abnormalities Depression Hearing loss and so on..

STAGES OF DEVELOPMENT OF ADDICTION

Forming

attitudes and beliefs about

tobacco Trying tobacco Experimenting with tobacco Regularly using tobacco Becoming addicted to tobacco This process generally takes about 3 years.

The addiction triangle to assess treatment needs

behavioral

Physical

psychological

BEHAVIORAL:
(habit training) 1.change routine 2. break use patterns 3. find substitutes

Physical
stimulation tension

reduction

Craving

1. NRT 2. exercise 3. relaxation therapy

Psychological
pleasurable

relaxation tension reduction craving 1. relaxation 2.Excecise 3. thought stopping 4. stress management

BENEFITS OF QUIT SMOKING

AFTER

20 MINS--- Heart rate & blood pressure comes to normal AFTER 8 HOURS---CO level comes to normal WITHIN 2 to 3 WEEKS circulation will improve lung function increases upto 30% . WITHIN 6 to 9 MONTHS--- experiences less coughing, sinus congestion, less tiredness and shortness of breath.

 AFTER

ONE YEAR----risk of coronary heart disease is reduced to 50%. AFTER 5 YEARS---- stroke risk is reduced AFTER 10 YEARS--- cancer risk is reduced WITHIN 15 YEARS ----- your risk of dying from a heart attack is equal to a person who never smoked

COMPREHENSIVE MULTI COMPONENT STRATEGY

1.Education 2.Legislation 3.Regulation 4.Enforcement 5.Taxation 6.Other fiscal measures 7.Economic alternatives 8.Support for cessation 9.Community mobilization

demand reduction tobacco control supply reduction

SOLUTIONS TO THE PROBLEM:

about tobacco use ADVICE to quit ASSESS commitment and barriers to change ASSIST users to committed to change ARRANGE- follow up to monitor progress
ASK

COMMON SMOKING SIGNALS:

Wake

up

 Toilet

rituals

 Coffee

or tea

 After

meals

 Drinking

alcohol

 Driving

 Seeing

others smoke

 Tension/

anxiety

 Finishing

task

 Before

starting task

 To

relax / take a break

 To

concentrate

 Studying

 Watching

TV

PHARMACOTHERAPY:
For every patients ,

Nicotine replacement therapy

non-nicotine medications (anti craving effects)

SPECIAL CONSIDERATIONS:
/ BF women cigarette is less harmful than tobacco use Smokers with CV or pulmonary disease cautioned not to use tobacco while using NRT. It develops severe angina and serious arrhythmias .
Pregnant

NRT:
To

reduce withdrawal symptoms. NRT alone is not the answer. Behaviour modification is an important aspect of any behaviour change. NRT is gradually decreased so that little withdrawal should occur.

NICOTINE GUM:
Acts

via buccal absorption 4mg of nicotine released from a resin by chewing

 Scheduled

dosing ( piece of 4mg/gum/hour) Duration of treatment 4-6 weeks. Start weaning after 2 -3 months .

PRECAUTIONS:
Pregnancy Lactation CVD Peripheral

vascular disease

 Endocrine

disorders Oral or pharyngeal inflammation or oesophagus Gastric ulcers.

NICOTINE PATCH:
(6 -12WEEKS) Trans-dermal formulations. Dosage 21-22 mg/24hr patch.
15

mg/16 hr patch. Patches are applied in the morning .

4 to 6 weeks 14 mg/24hr or 10mg /16 hrs. Next 2 to 4 weeks 7mg/24hrs or 5 mg / 16 hrs.

After

NON- NICOTINC AGENTS

Bupropion

Hydrochroride sustained release tablets.

used

along with NRT as first line therapy .(affects nor-adrenaline and dopamine levels in the brain) dosage 150mg, twice daily interval at least 8 hours. Initially it should be started with 150mg of single dose daily. If client is adequately tolerated , an increase to the 300 mg/day.

 Recommended

as early as day 4 of

dosing Set quit date for 1-2 weeks after beginning bupropion treatment. continue 150mg BID for 7 to 12 weeks after quit date. For maintenance therapy , consider 150mg BID for upto 6months
CONTRAINDICATIONS:
Seizure

disorders. Eating disorders.

 SELEGELINE
Changes

HYDROCHLORIDE-

dopamine level. Dosage 5 mg twice daily.

CLONIDINE
suppresses

: ( second line drug)

sympathetic activity. Available in the forms of pills & patch . Dose: 0.2 to 0.4 mg/day. Side effects: sedation and postural hypotension.

COPING WITH WITHDRAWAL EFFECTS

PHYSICAL ADDICTION :

- 4Ds to remember Delay the thought , Drinking water Distract yourself Deep breathing excercies 2. Insomnia - avoid caffeinated drinks after 6 p.m
1. Craving

3. constipation Eat plenty of fibre (carrots)

4. Weight gain Exercise regularly and avoid fatty foods.

PSYCHOLOGICAL ADDICTION:
and triggers avoid smokers, smoking areas and passive smoking. anxiety - practice relaxation techniques depression think of your positive moments and the benefits of quitting. lack of concentration take frequent breaks conditioned routine- break the routine
cues

SOCIAL ADDICTION:
1.lack of assertiveness practice assertive behaviour

2. peer pressure learn to say NO assertively.

TREATMENT ALGORITHM :
1ST VISIT:
ASK , ADVICE & ASSESS Current stage of change. Help him to set a quit date approximately 1-2 weeks from the day. Advice use of bupropion or selegaline . Advice about changes in life style. Advice regarding changes in tobacco use patterns.

2ND VISIT:
Just

before or immediately after the quit

date. Review progress and problems Monitor medication effects /side effects Inform about management of withdrawal symptoms

3RD VISIT:
Preferably

after a week Review progress and problems Monitor medication effects / side effects Review of dealing with high risk situation

SO WE NEED A POSITIVE ATTITUDE