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6. Smoking cessation

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  1. 6. Smoking cessation Royal College of Physicians of London Tobacco Advisory Group

  2. Smokers’ attitudes • Reluctant and disillusioned • 83% say they would not smoke if they had their time again • 71% want to quit • Reasons • 61% Health • 43% Expense • 20% Addiction • 17% Disgust • 5% Social stigma

  3. Do you want to quit smoking?

  4. Do you want to quit smoking?

  5. The delusion gap Jarvis et al, BMJ 2002;324:608

  6. Relapse after quitting: Percent staying abstinent from cigarettes over time Stapleton, Statistical Methods in Medical Research 1998;7:187-203

  7. The case for smoking cessation • Excellent ‘holistic’ health intervention • Treat up to 50 diseases before they can arise… • Low unaided success rate (1-3%) among smokers • Small increases in success rate accumulate over time • Extremely cost effective • £800 per life year saved • Compares to up to £30,000 per life year for new health technologies approved by NICE • Saves burdens on NHS over time • Can reduce prescribing costs for patients at risk of heart disease episodes • Protection of children from passive smoking

  8. Health benefits of smoking cessation • Increased life expectancy • Halving of risk of lung cancer risk after ten years • Heart disease risk declines towards non-smoker level over 10 years • Accelerated decline in lung function reduced • Improved reproductive health • Improved recovery from surgery

  9. After 20mins: After 8 hrs: After 24 hrs: After 48 hrs: After 72 hrs: blood pressure and pulse rate return to normal blood nicotine & CO halved, oxygen back to normal CO eliminated; lungs start to clear mucus etc. nicotine eliminated; senses of taste & smell much improved. breathing easier; bronchial tubes begin to relax; energy levels increase Effects of quitting

  10. 2 to 12 weeks: 3 to 9 months: 1 year: 10 years: 15 years circulation improves coughs, wheezing and breathing problems improve risk of heart attack halved risk of lung cancer halved risk of heart attack equal to never-smoker’s Effects of quitting

  11. Smoking, quitting smoking, and life expectancy Taylor et al 2002

  12. 20.0 17.9 16.0 45-54 13.2 12.0 55-64 Rate per 1000 person years 9.2 65-74 8.0 7.1 7.0 75-84 4.5 3.9 4.0 2.7 1.7 1.1 0.6 0.6 0.6 0.3 0.1 0.0 0.0 Nonsmokers 1-14 cigs 15-24 25 + Halpern,MT et al JNCI 1993 85:457-64 Smoking habit Lung cancer risk by age and smoking habit

  13. Current smokers quit 30-39 Never 1500 smokers 1000 quit 40-49 Lung cancer deaths per 100,000 quit 50-54 500 quit 55-59 0 quit 60-64 40 50 60 70 80 Age Halpern,MT et al JNCI 1993 85: 457-64 Lung cancer risk by age of quitting

  14. Smoking policies – smoking cessation Doll et al, BMJ 1994;309:901-11

  15. “Healthy” smokers Mortality risk after cessation reaches that of non-smoker in 10 years; Acute myocardial infarction (heart attack) risk declines by 50% after 1 year Smokers with CHD Cessation halves risk during 1-13 years of follow-up (Eur Heart J 1999;20:1773) One of every five smokers that quits avoids CHD event during 10 years Smoking cessation and CHD

  16. Blood pressure, stroke, renal function • 24-hour BP monitoring showed daytime lowering of BP after 1 week of cessation (Hypertension 1999;33:586) • Former smokers have decreased carotid artery stenosis compared to current smokers • Cessation reduces risk of stroke to non-smoker level after 5 years • Drug treatment of hypertension is less effective in smokers • Former smokers have less renal function abnormalities than continuing smokers

  17. 2.9 2.8 Sustained quitters 2.7 Continuing smokers Postbronchodilator FEV1 2.6 2.5 2.4 5 Screen 1 2 3 4 Years of follow-up Anthonisen et al, JAMA 1994;272(19):1497-505 depqumch.tc Change in FEV1 by smoking status

  18. The case for smoking cessation

  19. The case for smoking cessation

  20. Cost effectiveness

  21. Cost-effectiveness of other common therapiesin medicine Intervention Discounted cost (£) per year of life saved Pravastatin in primary prevention of CVD 20,375 (Caro, BMJ 1997;315:1577) Simvastatin after myocardial infarction 5,502 (Jonsson, Eur Heart J 1996;17:1001) Aspirin in secondary prevention of CHD 7,750 (Gaspoz, NEJM 2002;346:1800)

  22. Modelling impact of smoking cessationon rates of hospitalisation for acute MI and stroke • Current policy would result in 347 AMI and 214 stroke hospitalisations avoided in the year 2000, and by 2010 this would be 6386 AMI and 4964 strokes avoided. Californian programme in the UK: • 739 AMI and 455 stroke avoided in 2000 • 14 554 AMI and 11 304 strokes avoided by 2010.

  23. Smoking cessation: infant health Value of cessation: Lightwood et al. • Measured excess direct medical costs of low birth weight due to smoking • Cost per birth - $511 • Equivalent to $263m in USA

  24. Success of cessation servicesEngland, April-December 2002 • 154,880 people set quit date • At 4 week follow up: 79,646 had quit: 51% of those setting a quit date (self report) • 53,770 confirmed as not smoking by CO validation Source: Department of Health, 2003.