Chronic Pulmonary Diseases And Smoking Cessationule Akçay, Associate Professor
World Tobaccco Conference 2009
World Tobaccco Conference 2009
World Tobaccco Conference 2009
Other region
GIS DISEASES
Smoking Cessation
In the treatment and prevention of pulmonary diseases, the most effective approach
Hard-core smokers are common among patients with respiratory disease, smoking cessation therapy is different in this group
Year 1990 Number of deaths (in millions)
Year 2020 Number of deaths (in millions)
Respiratory Diseases
0.95
2.3
COPD
2.2
4.7
Pneumonia
4.3
2.5
Tuberculosis
2.0
2.4
Leading causes of death from respiratory diseases worldwide in 1990 with the prediction for 2020
No COPD
Evidence is sufficient to infer a causal relationship
Injurious biologic processes (i.e., oxidant stress, inflammation, and a proteaseantiprotease imbalance) that result in airway and alveolar injury. This injury, if sustained, ultimately leads to the development of COPD Morbidity and mortality from COPD
Evidence is suggestive but not sufficient to infer a causal relationship
Acute respiratory infections, among persons with preexisting chronic obstructive pulmonary disease
Evidence is inadequate to infer the presence or absence of a causal relationship
Evidence is suggestive of no causal relationship
http://www.cdc.gov/tobacco/sgr/sgr
Disability
Death
Author, study
Positive
Positive
Positive
35-60
11
-66 (M, smokers), -30 (M, ex-smokers), -54 (F, smokers), -22 (F, ex-smokers)
Positive
Author, study
0/+
0/+
Positive
Author, study
Asthma-related symptoms (i.e., wheezing) in childhood and adolescence Poor asthma control
Evidence is suggestive but not sufficient to infer a causal relationship
Poorer prognosis for children and adolescents with asthma Increased nonspecific bronchial hyperresponsiveness
Evidence is inadequate to infer the presence or absence of a causal relationship
Physician-diagnosed asthma in childhood and adolescence Asthma in adults Acute asthma exacerbation, in persons with asthma
Evidence is suggestive of no causal relationship
http://www.cdc.gov/tobacco/sgr/sgr
Males
Females
Lung Cancer Map in Turkey: Turkish Thoracic Society,
Malignancy Study Group
Smoking Cessation Guidelines
1996 APA guideline
1996 US Agency for Health Care Policy and Research’s Clinical Practice Guidelines for Treating Tobacco Use and Dependence
2000 Updated guideline
Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons,
and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A
U.S. Public Health Service report. Am J Prev Med 2008; 35: 158–176.
COPD patients
29.4% precontemplation
60.7% contemplation
8.9% preparation
Barbano G, Diamandi A, Nardini S. In Respiratory Patients Short Term Complete Abstinence from Smoking does not Depend on the Stage of Change.
www.ers-education.org/pages/default.
QUESTIONS
According the guideline, smoking cessation therapy is not necessary in 90% of COPD patients. To wait for therapy is true?
If transtheoretical model is not adequate, which method can be apply?
“Catastrophe” theory
Immediate cessation, because five cycle is not true in COPD
West R BMJ 2006; 332:458
“Self-efficacy” theory
Asthma
Hypertension
Contraception
Every diseases must be treated. Smoking cessation is the most effective therapy in pulmonary patients.
Lee, Int J Nurs Stud 2008;45:1690
SMOKING AND PULMONARY DISEASES
URGENTLY NEED CESSATION!
regularly assessing smoking status
training and continuing medical education
Use a regular checking of lung function as a motivational tool
a budget must be established
Advise patients not interested in quitting or reducing that the issue will be adressed at at every visit
Key points (1)
Patients with respiratory disease have a greater and more urgent need to stop smoking than the average
Respiratory physicians must take a proactive and continuing role and provide treatment
regularly assessing smoking status using methods that can objectively detect smoking
pharmacological treatment for nicotine dependence:
bupropion
Varenicline is first-line agent (B).
behavioural support, which should be intensive and multi-sessional, and provided by someone who has been appropriately trained (B).
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Key points (2)
To carry out this role effectively, respiratory physicians must have adequate knowledge and appropriate attitudes and skills; this requires training and continuing medical education (C)
The cost of this strategy will partly be offset by a reduction in attendance for exacerbations etc., but a budget must be established (A)
It is important to check lung function regularly in order to chart disease evolution and use this as a motivational tool (C).
Smokers not motivated to stop should be offered NRT to reduce smoking as a gateway to cessation (B).
Smokers who are not interested in stopping or reducing should be advised that the physician will return to the question at a later visit (C).
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2009: Tobacco and Health Warning
2008: Tobacco Free Young
2007: Tobacco Free Environment
2005: Health Professionals and Smoking
2004: Smoking and Poverty
2002: Smokeless Sports
Theme: Tobacco Health Warnings
The World Health Organization selects "Tobacco Health Warnings" as the theme for the 20th World No Tobacco Day, which will take place on 31 May 2009. Tobacco health warnings appear on packs of cigarettes and are among the strongest defences against the global epidemic of tobacco. WHO particularly approves of warnings that contain both pictures and words because they are the most effective at convincing people to quit.
SMOKING CAUSES DEATH
SMOKING CAUSES SERIOUS HARM FOR YOU AND YOUR ENVIRONMENT
GIVE YOUR VOTE, TRUELY