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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 ?
slide3
What is smoking?
  • Disease: Nicotin addiction
  • Treatment: Yes
  • Cause: Tobacco
  • Vector: Tobacco industry
  • Host: Human
slide4
Behaviour

Psychologic

Neurochemical

Addiction triangle

slide5
Morethan 4000 chemicals in smoke

Nicotine

CO

Cancerogens

Irritansandpoisons

slide6
CNS- Nicotine

N. Accumbens

Nicotinic receptor

( α4β2)

Neuromediator: Dopamin

Locus coeruleus

(Craving)

Neuromediator:Noradrenalin

slide7
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.

slide8
Control of neurochemicaldimension
  • Pharmacologic treatment
    • NRT
    • Bupropion
    • Varenicline
slide10
Why is important to understand the Behavioural and psychologic dimension ?
  • Understand this dimensions increase the success rate
slide11
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?
slide12
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”
slide13
Problematical behaviour: smokingProvocative factors
  • Emotional factors
      • irritation, annoyance, joy
  • Group effect
      • Smoking in group
  • Physiologic factors
      • Withdrawal symptoms
slide14
Continuing factors
  • Relaxing after smoking
  • Reactional smoking
slide15
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
slide17
Recover “vision defection”

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

slide20
How is emerge “love” withcigarette?

Persons

Objects

Events

Don’tcauseemotion

slide21
Behaviour

D

negotiation

Emotion

C

I like her

Opinion

B

Warm

Good people

Person

A

Ayşe

slide22
Behaviour

D

Buy cigarette

Smoking

Emotion

C

Like smoking

Opinion

B

Pleasure,

It’s my friend,

Object

A

Cigarette

slide23
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

slide25
If patients don’t chance opinion about smoking
  • They feel weak theirself
  • Miss smoking
  • To desire smokers

Relaps

slide26
If patients change their opinion about smoking
  • Feel of success
  • Self confidence
  • Optimism
  • Feel energic
  • Upset for smokers
slide27
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
slide29
Behaviour

Psychologic

Neurochemical

Addiction triangle

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: SC 101 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
ad