Smoking (Nicotine, Cigarettes)

Last updated 03.11.12

 

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Features

-  21% Australians >14yrs are smokers (21% men, 18% women)

-  19,000 deaths/yr in Aus

-  Peak incidence 20-29yrs old

-  Increased incidence in mental health & indigenous population

-  Relapse common 3-4 times before successful

 

 


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Smoking History

 

Details

-  What smoked: cigarettes, pipes, cigars, marijuana + tobacco

-  Current

-  #/day

-  How long after waking before 1st cigaratte

-  Pack years

-  1 pack = 20 cigarettes

-  Year started to year stopped x packs/day

-  Smoking Cessation

-  Single puff = relapse

-  QUITLine 137848

-  Previous attempts

-  What has helped in past

-  How, when, why?

-  How long for?

-  Why failed/started again?

-   Partner, work, friends, social/drunk

-   Side effects: weight gain, depression, irritability

-   Danger situations

-  Environment

-  Who with? Why? Where? When?

 

Level of Dependance

-  Low

-  No smoking within 1hr of waking

-  < 10/day

-  Low to Moderate

-  No smoking within 1hr of waking

-  0-20/day

-  Moderate

-  1st cigarette within 5min of waking

-  20-30/day

-  High

-  Wake at night to smoke

-  1st cigarette within 5min of waking

-  30+/day

 

 

 

Effects Top

Effects of Smoking on Health

 

General

-  19,000 deaths/yr in Aus

-  80% of drug related deaths

-  Skin ageing

-  Hair loss

-  Macular degeneration

-  Impotence (Infertility)

-  Osteoporosis

-  Passive smoking effect

-  Children

-  Asthma, resp illness

-  Likelihood of smoking

 

Cancer

- Pancreatic

- Cervical

- Lung

- Mouth, throat, oesophageal

 

Pregnancy (personal & passive)

- Spontaneous miscarriage

- Stillbirth

- Abnormal fetal development

- IUGR

- Placental abruption

- Premature delivery

- Infant asthma, bronchitis

- SIDS

 

Surgical complications

-  Poor wound healing

-  Many surgeons recommend 6/52 abstinence prior to Sx

 

Cardio

-  AMI, stroke, PVD

-  Cardiomyopathy

 

Resp

-  COPD, asthma

-  Lung Ca

-  Increased URTI & LRTI

 

GIT

-  Increased relapse of Crohns Disease

-  Improved S/S of Ulcerative Colitis

-  Mouth, throat, oesophageal, pancreatic Ca

 

 

 

Benefits Top

Health Benefits of Smoking Cessation

 

-  Patient may get apthous ulcers when quiting

-  1/52

-  BP & HR return to normal

-  1-3/12

-  Increased exercise tolerance

-  Less withdrawal s/s

-  Decreased cough & cilia regrow, less risk of URTI

-  Less risk of Sx complications (by 6/12)

-  1yr

-  Pregnancy complications & fetal death rate to normal

-  Decreased CVD to 50% of smoker

-  5yrs

-  Ca risk (Mouth, throat, oesophagus) 50% of smoker

-  10yrs

-  Ca risk (Lung) 30-50% of smoker

-  Ca risk (Bladder, kidney & prostate) decreased

- Bone strength improves

-  15yrs

-  Normal CVD risk

 

 

 

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Smoking Cessation

 

Barriers to Quiting

-  Withdrawal S/S: 80% pts: cravings, irritability

-  Stress

-  Fear of failure

-  Peer/social pressure

-  Weight gain

 

Methods

-  QUITLine 137848

5 As: Brief Intervention

-  Ask about tobacco use at every opportunity

-  Assess motivation & confidence to quit

-  Advise smoker to stop (3-5 min)

-   7.5% quit rate in 12/12

-  Assist smoker to stop

-   20-24% quit rate in 12/12 (+ advice)

-  Arrange F/U to maintain non-smoking

-   1/52 post quit date

-   Relapse most common in 1st 2/52

4Ds: Behavioural Strategies

-  Delay a cigarette by 5min

-  Deep breathe x3

-  Drink some water slowly

-  Do something else ie: exercise

-  Pharmacological Mx

-  NRT (Nicotine Replacement Therapy)

-  Varenicline (Champix)

-  Bupropion

 

 

 

Reference

 

eTG – Smoking Cessation Therapy