Smoking cessation and rehabilitation
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SMOKING CESSATION AND REHABILITATION. Dr. Oğuz Kılınç Dokuz Eylul University School of Medicine Chest Department oguz . kilinc @ deu .edu.tr. LECTURE PLAN. Fundamentals of smoking cessation (SC) programs What is the role of rehab in SC? Is rehab effective in SC ?. What is smoking?.

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Smoking cessation and rehabilitation

SMOKING CESSATION AND REHABILITATION

Dr. Oğuz Kılınç

Dokuz EylulUniversitySchool of Medicine

ChestDepartment

[email protected]


Lecture plan

LECTURE PLAN

  • Fundamentals of smoking cessation (SC) programs

  • What is the role of rehab in SC?

  • Is rehab effective in SC ?


Smoking cessation and rehabilitation

What is smoking?

  • Disease: Nicotin addiction

  • Treatment: Yes

  • Cause: Tobacco

  • Vector: Tobacco industry

  • Host: Human


Smoking cessation and rehabilitation

Behaviour

Psychologic

Neurochemical

Addiction triangle


Smoking cessation and rehabilitation

Morethan 4000 chemicals in smoke

Nicotine

CO

Cancerogens

Irritansandpoisons


Smoking cessation and rehabilitation

CNS- Nicotine

N. Accumbens

Nicotinic receptor

( α4β2)

Neuromediator: Dopamin

Locus coeruleus

(Craving)

Neuromediator:Noradrenalin


Smoking cessation and rehabilitation

Symptom

Duration

Percentage(%)

Dizziness

10

<48 h

Sleep disturbance

<1 wk

25

Lose of concentration

<2 wks

60

Craving

<2 wks

70

agressivity

<4 wks

50

Depression

<4 wks

60

İrritability

<4 wks

60

Appetite increase

<10 wks

70

Withdrawalsymptoms

1. Jarvis MJ. BMJ 2004; 328:277-279.


Smoking cessation and rehabilitation

Control of neurochemicaldimension

  • Pharmacologic treatment

    • NRT

    • Bupropion

    • Varenicline


Smoking cessation and rehabilitation

Behaviouraltreatment


Smoking cessation and rehabilitation

Why is important to understand the Behavioural and psychologic dimension ?

  • Understand this dimensions increase the success rate


Smoking cessation and rehabilitation

Questions for behaviour and psychologic dimensions

  • What are the provocative factors for smoking?

  • Which conditions are important for smoking?

  • What are the results?

  • Which factors are important continuing the smoking?


Smoking cessation and rehabilitation

Problematical behaviour: smokingProvocative factors

  • Conditional factors

    • Workplace, home, car

  • Behavioural factors

    • Tea, coffee, alcohol

  • Cognitive factors

    • Triggering thoughts

      • “If I smoke I would relax”.

      • “Smoking is very delicious after meal”


  • Smoking cessation and rehabilitation

    Problematical behaviour: smokingProvocative factors

    • Emotional factors

      • irritation, annoyance, joy

  • Group effect

    • Smoking in group

  • Physiologic factors

    • Withdrawal symptoms


  • Smoking cessation and rehabilitation

    Continuing factors

    • Relaxing after smoking

    • Reactional smoking


    Smoking cessation and rehabilitation

    Problematic behaviour: smoking

    • Provocative and continuing factors differ patient to patient

    • Smoking cessation treatment should be tailor made

    • Consultant should help patient for changing behaviour


    Smoking cessation and rehabilitation

    Pyschologicdimension of smoking


    Smoking cessation and rehabilitation

    Recover “vision defection”

    Smoking causes not only cancer, COPD, Buerger disease, Coronary artery disease but also “vision defect”


    Smoking cessation and rehabilitation

    ‘Smokers don’t see the real face of smoking because of “vision defect”


    Smoking cessation and rehabilitation

    This condition is similar with love, The treatment of love is wedding.


    Smoking cessation and rehabilitation

    How is emerge “love” withcigarette?

    Persons

    Objects

    Events

    Don’tcauseemotion


    Smoking cessation and rehabilitation

    Behaviour

    D

    negotiation

    Emotion

    C

    I like her

    Opinion

    B

    Warm

    Good people

    Person

    A

    Ayşe


    Smoking cessation and rehabilitation

    Behaviour

    D

    Buy cigarette

    Smoking

    Emotion

    C

    Like smoking

    Opinion

    B

    Pleasure,

    It’s my friend,

    Object

    A

    Cigarette


    Smoking cessation and rehabilitation

    Emotion

    C

    Fear

    Detastation

    Feel lock of willpower

    Opinion

    B

    Cause disease

    I have dispnea

    It cause cancer

    Object

    A

    Cigarette

    Behaviour

    D

    Effort of smoking cessation


    Smoking cessation and rehabilitation

    Realize and chance this condition is skill and can learn


    Smoking cessation and rehabilitation

    If patients don’t chance opinion about smoking

    • They feel weak theirself

    • Miss smoking

    • To desire smokers

      Relaps


    Smoking cessation and rehabilitation

    If patients change their opinion about smoking

    • Feel of success

    • Self confidence

    • Optimism

    • Feel energic

    • Upset for smokers


    Smoking cessation and rehabilitation

    Suggestionforsmokingcessationprocess

    • Changeopinionaboutsmoking

    • Findoutprovocativefactorsandcorrect

      • Tea, coffee

      • After meal

      • Alcohol

      • Stress

    • Pharmacotherapy


    How can rehab work in sc

    How can rehabwork in SC?

    • Rehab can play role for behavioural and physchologic dimension


    Smoking cessation and rehabilitation

    Behaviour

    Psychologic

    Neurochemical

    Addiction triangle


    Effect of rehab in sc

    Effect of rehab in SC


    Objective and study design

    Objectiveandstudydesign

    • Parallel group study

    • to investigate the effectiveness of a smoking cessation programme performed during routine rehabilitation practice for outpatients


    Groups

    groups

    • Group 1: Rehab + SC 102 pts

    • Group 2: SC101 pts

    • All participants underwent physical examination, pulmonary function tests and received identical behaviouraland/or pharmacological treatment.

    • In addition, the interventiongroup underwent rehabilitation practice 3 times a week for 3 months.


    Smoking cessation rate at the end of one year

    SmokingCessation rate at theend of oneyear

    • Group 1

      • Abstinence rate%68

      • Maintained their smoking habits %14

      • Lost after enrolment %12

    • Group 2

      • Abstinence rate%32

      • Maintained their smoking habits %52

      • Lost after enrolment %16

    • CO ölçümü ve evden birine sorma yöntemiyle bırakma değerlendirilmiş


    Discussion

    Discussion

    • Therefore a possible explanation for the difference observed could be that the interventiongroup individuals were highly health motivated (this subsetof subjects was recruited among individuals who underwentrehabilitation 3 times per week for 3 months).


    Limitations

    limitations

    • due to ethical reasons we did not randomize participants and it was not possible toinclude in the control group patients with serious medicaldisorders

    • Since our study was performed in only 2 centres, we believe that the dataobtained may suggest the opportunity of further prospectivemulti-centre studies to confirm our data

    • Missing cases might cause selection bias


    Summary

    Summary

    • All patients attending rehab ask about smoking and advice quit smoking.

    • Support the hypothesis that considering smoking cessationprogrammes as a mandatory component of rehabilitation may behighly effective in increasing smoking cessation rate and couldbe an additional strategy to reduce smoking habits


    Thank you for your attention

    Thankyouforyourattention


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