Slide 1:Smoking cessation
Jon Malone and Liz Bartlett 2009
13 million adults in the UK smoke cigarettes. 70% want to stop. 1 NICE guidelines (August 2008) provide recommendations about service provision, pharmacotherapies, targeting specific groups and education/public campaigns. 2 If NHS support and a stop smoking medicine is used people are up to 4x more likely to be successful.3
Slide 3:Why stop smoking?
Health Reduce the risk of developing illness, disability, death caused by cancer, heart or lung disease. Reduce the risk of gangrene/amputation caused by circulation problems. Protect those around you from second hand smoke. Decrease risk of children having asthma. Improve fertility levels and chance of having healthy pregnancy and baby. Improved fitness.
Slide 4:Why stop smoking?
Lifestyle Save money. Improve appearance of teeth and skin. Stop smelling of tobacco. Reduce the risk of fire at home.
Slide 5:Smoking and pregnancy
4000 chemicals in cigarette smoke. CO gets into bloodstream, decreases O2 binding capacity. Fetal heart receives less O2 for growth and development. Fetal heart rate is also increased. Increased risk of miscarriage, stillbirth, premature birth and low birth weight babies.
Slide 7:Second hand smoke
Increases the risk of lung Ca by 24% and heart disease by 25% for a non smoker. Cot death is twice as likely if mum smokes. Risk of asthma increased. Increased risk of developing bronchitis and pneumonia in children.
Slide 8:Cost of smoking
Pack of 20 cigarettes £5.90 Smoking 10/day = £2.95/day £20.65/week £82.60/month £991.20/year £4,956.00/5 years £9,912.00/10 years
Slide 9:What happens when smoking is stopped?
20 mins – BP and pulse return to normal. 8 hrs – Nicotine and CO levels reduce by half. O2 levels return to normal. 24 hrs – Lungs start to clear out mucus. 48 hrs – No nicotine in body. Ability to taste and smell is improved.
Slide 10:What happens when smoking is stopped?
72 hrs – Breathing becomes easier. 2-12 wks – Circulation improves. 3-9 mths – Cough/wheeze and breathing problems improve as lung function is increased by 10%. 5yrs – Risk of heart attack falls to half that of a smoker. 10yrs – Risk of lung Ca falls to half that of a smoker. Risk of heart attack falls to same as a lifelong non smoker.
Slide 11:Treatments on offer
Nicotine replacement therapy (NRT)? Does not contain toxic chemicals like tar or carbon monoxide and doubles the chance of becoming smokefree successfully. Gum – nicotine absorbed through lining of mouth on chewing, over 30 minute period. Maximum dose 15 x 4mg gum/day. Patches – different durations of action, 16/24 hr Microtabs – small tablets containing nicotine dissolve quickly under tongue. 1-2 tabs/hour. Max dose 40/day.
Slide 12:Nicotine Replacement Therapy (2)?
Lozenges – sucked slowly to release nicotine. Inhalators – releases nicotine vapour. Good if hand to mouth aspect of smoking missed. Has mouthpiece and replaceable cartridge. Nasal spray – swift and effective dose of nicotine. Each spray=0.5mg nicotine. Used x2/hr for 16 hrs/day.
Slide 13:Treatments on offer (2)?
Zyban (Bupropion Hcl)? Does not contain nicotine. Changes way body responds to nicotine. Taken 1-2/52 before stopping and Rx lasts for several mths to help withdrawal cravings. Only available on prescription but NOT if pregnant. Champix (Varenicline)? Reduces both craving for cigarette and the effect if cigarette is smoked. Date is set for stopping and tablets taken 1-2/52 before. Rx lasts for 12/52. Only on prescription and NOT if pregnant.
Slide 14:Treatments on offer (3)?
Support groups When smoking stopped low mood, depression and rarely suicidal ideation have been reported. Group sessions can start 2/52 before stopping. Trained adviser helps establish a plan to be put into action. Group meets weekly for advice and motivation. Other option – 'together programme'. Can be done from home. 'Stress free day' identified as stopping point. Postal packs, texts, emails and phone calls for support.
These treatments are all free of charge. www.smokefree.nhs.uk Addiction test Cost calculator Support materials available to order. Section for young people and advice regarding pregnancy. Advice on relapsing and support available.
Slide 16:NICE guidelines
Ask all patients about smoking. Advise all smokers to stop. Assist all smokers to stop. Arrange follow-up. Set a date to stop. Review previous attempts – what helped/hindered. Plan ahead, strategies to cope etc. Plan how to handle social situations with alcohol. Try smoking cessation treatments.
1. “Action on smoking and health” 2. NICE guidelines – Smoking cessation services 3. www.smokefree.nhs.uk 4. www.gpnotebook.co.uk 5. www.bnf.org 6. www.helpwithsmoking.com