TOBACCO CESSATION ppt

TOBACCO CESSATION: 

TOBACCO CESSATION Presented By Mrs. Sivalakshmi .M.sc (Nsg) Lecturer

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STATE TOBACCO CONTROL CELL DIRECTORATE OF PUBLIC HEALTH & PREVENTIVE MEDICINE GOVERNMENT OF TAMILNADU

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THEME “FRAMEWORK CONVENTION ON TOBACCO CONTROL”

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INCIDENCE Globally . tobacco kills -5.4 million people every year

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>80% of the death occur due to tobacco usage India – 8-9 lakhs death 40% cancers due to tobacco

TOBACCO TYPES : 

TOBACCO TYPES

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CONSTITTUES OF TOBACCO SMOKE

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EFFECTS OF TOBACCO Tobacco kills in three main ways………..

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Cancer of lung , liver , oral cavity , throat, larynx, pancreas and stomach, oesophagus.

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Cardio-vascular diseases (IHD, stroke).

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Respiratory disease (COLD ,bronchitis, pneumonia)

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……………….and is linked over 50 conditions…. Such us Impotency Lower fertility Birth defects in children Blindness Brain shrinkage Immune system impairment

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Decreased lung function Osteoporosis Reduced sperm count Tuberculosis Increased sperm abnormalities Depression Hearing loss and so on……..

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STAGES OF DEVELOPMENT OF ADDICTION Forming attitudes and beliefs about tobacco Trying tobacco Experimenting with tobacco Regularly using tobacco Becoming addicted to tobacco This process generally takes about 3 years.

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The addiction triangle to assess treatment needs behavioral Physical psychological

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BEHAVIORAL: (habit training) 1.change routine 2. break use patterns 3. find substitutes

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Physical stimulation tension reduction Craving 1. NRT 2. exercise 3. relaxation therapy

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Psychological pleasurable relaxation tension reduction craving 1. relaxation 2.Excecise 3. thought stopping 4. stress management

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BENEFITS OF QUIT SMOKING AFTER 20 MINS- -- Heart rate & blood pressure comes to normal AFTER 8 HOURS- --CO level comes to normal WITHIN 2 to 3 WEEKS – circulation will improve lung function increases upto 30% . WITHIN 6 to 9 MONTHS- -- experiences less coughing, sinus congestion, less tiredness and shortness of breath.

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AFTER ONE YEAR- ---risk of coronary heart disease is reduced to 50%. AFTER 5 YEARS- --- stroke risk is reduced AFTER 10 YEARS- -- cancer risk is reduced WITHIN 15 YEARS ----- your risk of dying from a heart attack is equal to a person who never smoked

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COMPREHENSIVE MULTI COMPONENT STRATEGY 1.Education 2.Legislation demand 3.Regulation reduction 4.Enforcement tobacco 5.Taxation control 6.Other fiscal measures supply 7.Economic alternatives reduction 8.Support for cessation 9.Community mobilization

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SOLUTIONS TO THE PROBLEM: ASK – about tobacco use ADVICE – to quit ASSESS – commitment and barriers to change ASSIST – users to committed to change ARRANGE - follow –up to monitor progress

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COMMON SMOKING SIGNALS: Wake – up

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Toilet rituals

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Coffee or tea

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After meals

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Drinking alcohol

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Driving

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Seeing others smoke

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Tension/ anxiety

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Finishing task

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Before starting task

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To relax / take a break

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To concentrate

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Studying

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Watching TV

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PHARMACOTHERAPY: For every patients , Nicotine replacement therapy non-nicotine medications (anti – craving effects)

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SPECIAL CONSIDERATIONS: Pregnant / BF women – cigarette is less harmful than tobacco use Smokers with CV or pulmonary disease – cautioned not to use tobacco while using NRT. It develops severe angina and serious arrhythmias .

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NRT: To reduce withdrawal symptoms. NRT alone is not the answer. Behaviour modification is an important aspect of any behaviour change. NRT is gradually decreased so that little withdrawal should occur.

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NICOTINE GUM: Acts via buccal absorption 4mg of nicotine released from a resin by chewing

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Scheduled dosing ( ½ piece of 4mg/gum/hour) Duration of treatment 4-6 weeks. Start weaning after 2 -3 months . PRECAUTIONS: Pregnancy Lactation CVD Peripheral vascular disease

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Endocrine disorders Oral or pharyngeal inflammation or oesophagus Gastric ulcers. NICOTINE PATCH: (6 -12WEEKS) Trans-dermal formulations. Dosage – 21-22 mg/24hr patch. 15 mg/16 hr patch. Patches are applied in the morning .

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After 4 to 6 weeks – 14 mg/24hr or 10mg /16 hrs. Next 2 to 4 weeks – 7mg/24hrs or 5 mg / 16 hrs.

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NON- NICOTINC AGENTS Bupropion Hydrochroride sustained release tablets. used along with NRT as first line therapy .(affects nor-adrenaline and dopamine levels in the brain) dosage 150mg, twice daily interval at least 8 hours. Initially it should be started with 150mg of single dose daily. If client is adequately tolerated , an increase to the 300 mg/day.

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Recommended as early as day 4 of dosing Set quit date for 1-2 weeks after beginning bupropion treatment. continue 150mg BID for 7 to 12 weeks after quit date. For maintenance therapy , consider 150mg BID for upto – 6months CONTRAINDICATIONS: Seizure disorders. Eating disorders.

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SELEGELINE HYDROCHLORIDE- Changes dopamine level. Dosage – 5 mg twice daily. CLONIDINE : ( second – line drug) suppresses sympathetic activity. Available in the forms of pills & patch . Dose: 0.2 to 0.4 mg/day. Side effects: sedation and postural hypotension.

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COPING WITH WITHDRAWAL EFFECTS PHYSICAL ADDICTION : 1. Craving - 4Ds to remember – Delay the thought , Drinking water Distract yourself Deep breathing excercies 2. Insomnia - avoid caffeinated drinks after 6 p.m

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3. constipation – Eat plenty of fibre (carrots)

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4. Weight gain – Exercise regularly and avoid fatty foods.

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PSYCHOLOGICAL ADDICTION: cues and triggers – avoid smokers, smoking areas and passive smoking. anxiety - practice relaxation techniques depression – think of your positive moments and the benefits of quitting. lack of concentration – take frequent breaks conditioned routine- break the routine

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SOCIAL ADDICTION: 1.lack of assertiveness – practice assertive behaviour

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2. peer pressure – learn to say NO assertively.

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TREATMENT ALGORITHM : 1ST VISIT: ASK , ADVICE & ASSESS Current stage of change. Help him to set a quit date approximately 1-2 weeks from the day. Advice use of bupropion or selegaline . Advice about changes in life style. Advice regarding changes in tobacco use patterns.

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2ND VISIT: Just before or immediately after the quit date. Review progress and problems Monitor medication – effects /side effects Inform about management of withdrawal symptoms

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3RD VISIT: Preferably after a week Review progress and problems Monitor medication – effects / side effects Review of dealing with high risk situation

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SO WE NEED A POSITIVE ATTITUDE