An effective approach to smoking cessation

Smoking Cessation Developed By: Carolyn Whiskin, RPh, BScPhm, NCMP Educational Grant Provided By: UCB Canada Inc. March 2013

 The information contained in this presentation is for educational purposes only and is not intended to replace the advice of your health care provider.  Always consult your physician before starting any new program

At the end of this session, you will:  Gain a greater knowledge of the impact of nicotine and cigarette smoke on your overall health, specifically as it relates to Rheumatoid Arthritis (RA)  Understand how nicotine causes addiction  Assess your personal motivation to quit and level of dependency  Develop a personal plan towards quitting  Register for the Smoker's Helpline  Build a community of support for each other

Smoking Cessation The most important thing you can do to protect your health now and in the future. Smoking Cessation Cigarettes are the product that kills 1 in 2 people when used as intended. Rivara FP et al. Am J Prev Med 2004; 27(2):118-25. Smoking In Canada  In 2010, 16.7% of Canadians (approximately 4.7 million) were current smokers.  Daily smokers in Canada smoked an average of 15.1 cigarettes per day  Over 60% of Canadians who have ever been smokers have now quit. How Canadians Quit  69% of smokers used the "reduce to quit" method.  6 in 10 smokers who attempted to quit used some form of cessation assistance  Stop‐smoking medications, including nicotine replacement therapy, were used by nearly half (48%)  More than a quarter of smokers "made a deal" with a friend or family member to quit together.  Leading preventable cause of disease, disability and death in Canada  Half of regular smokers will die prematurely of a tobacco-related disease  Smokers who report they wish to quit: Effects of Smoking Smokers are 6 ½ times more likely to die from lung cancer Double the risk for a stroke Three times the risk to die from heart attack Breast Cancer and Large Swedish Study Presented Results in 2011  Women smoking for 15 - 35 years had a 34% higher risk for breast cancer than
women who never smoked.
 Women who smoked for at least 35 years had a 59% higher risk.
 Women who smoked for less than 15 years had no increased risk for breast cancer. Effects of Smoking On  Onset of RA is up to 2.4 times more likely in people who smoke  There is a decreased response to methotrexate and biologic medication in people who smoke  In people who smoke and have a positive Rheumatoid Factor, it can be predicted that they will develop severe extra-articular RA  Smoking adds significantly to the already increased risk of cardiovascular disease in people Smoking May Increase the Need For Other Medications  Insulin absorption can be decreased by 30%  Insulin resistance is increased  Stomach acid production is increased  Fluid retention is increased  Blood pressure is increased  Cardiovascular disease increased  Increased platelet activity- increased clotting  Macular Degeneration is increased by 4 fold  Erectile dysfunction is increased  When smokers develop chronic pain their level of pain is worse than a non-smoker Nicotine Effects The Brain  Nicotine enters the brain within seconds  It attaches to nicotinic  This results in the release of dopamine  Within days of smoking, the nicotinic receptors increase- the brain changes!! 13 It Is More Than Nicotine  4,000 chemicals  70 cancer causing  The smoke contains:  carbon monoxide Nicotine Withdrawal Increased appetite Irritability/aggression Craving for nicotine Poor concentration Sleep disturbance Duration In Weeks Potential Health Benefits of Quitting Smoking CAD risk is similar to never smokers
Lung cancer risk is 30%-50% that of continuing smokers
Stroke risk returns to the level of people who have never smoked at
5-15 years post-cessation
CAD: excess risk is reduced by 50% among ex-smokers
Lung function may start to improve with
decreased cough, sinus congestion, fatigue,
and shortness of breath
Blood CO level may
return to normal
BP = blood pressure; CO = carbon monoxide; CAD = coronary artery disease American Cancer Society. Guide to Quitting Smoking. Available at: Accessed: July 29, 2010.; US Department of Health and Human Services. News Release, June 27, 2006. Available at: Accessed: July 29, 2010. Adapted from Prochaska Stages of Behaviour Change What do you think about quitting smoking? What motivates us to change behaviour? Recognition of the benefits of a behavioural change Sense of ability to modify a behaviour What are the benefits to quitting in your personal life?  Health (be specific)  Impact on family/friends  Social situations  Taste, smell  Financial- What would you do about these benefits often! What challenges do you List your triggers  Environment –where you  Keeping your hands busy  Friends/family who smoke What will I do with my Start a new project before quitting to occupy  New music book  Parts for "car" project  Home decorating, reorganization  Knitting, crocheting, bead-work etc  New Crossword/Sudoku book Carry something to squeeze!! How do I handle a  Deep Breathe Cutting Back Leading Up To  Record every cigarette smoked leading up to the quit date- use your cell phone or the back of cigarette package  Up to half of cigarettes smoked are out of routine, by recording the cigarette before smoking it- you may realize you didn't really need it. Enlisting Support Inform friends/family of your quit date and ask for their  Not smoking around you or offering cigarettes  Not teasing you  Helping you make your home smoke free  Reminding you of "why" you quit – your personal  Emotional Support  Quitting with you!!! Probability Someone Will Quit Smoking According to
Type of Relationship with Contact Who Quits Smoking
Subject-perceived friend Contact-perceived friend Friend with higher level Friend with lower level Immediate neighbour Coworker in a small firm Increase in probability of quitting (%)
Christakis NA, Fowler JH. N Engl J Med 2008; 358(21):2249-58. Picking A Quit Date There is never an ideal time to quit!!!  Choose a day with a regular  Avoid special events or milestones  Avoid a date when changes are being made to your medications Cut Back On Caffeine  Smoking increases the rate of caffeine being cleared from the body  To avoid caffeine toxicity, reduce caffeine intake by half upon quitting smoking Replacing a portion of intake with decaffeinated coffee is one strategy Preparing For The Quit  In consultation with your health care practitioner, decide if a medication is needed. Varenicline (Champix ) and Bupropion (Zyban ) to be started at least 1 week before the quit date. Nicotine replacement products can be started on the actual quit date.  Inform friends/family  Make your home and car smoke free  Start to cut back- use a smoking log  Have healthy snacks on hand- appetite will increase  Focus on your personal benefits of quitting Do I need treatment beyond Fragerstrom Nicotine Dependence  Complete the questionnaire to determine your level of dependency. Nicotine Withdrawal Increased appetite Irritability/aggression Craving for nicotine Poor concentration Sleep disturbance Duration In Weeks Time in Weeks Pharmacologic Treatment  Nicotine Replacement Therapy  All treatments must enough for a new non-smoking  This can often take  Bupropion (Zyban )  Varenicline (Champix ) Newest Treatment-  Use 1-2 sprays at the time of a  Maximum dose is 2 sprays at a time, 4 sprays per hour and 64 sprays per day.  May cause tingling/ burning of lips- aim directly in the mouth  May cause hiccups  Strong taste  Works in 60 seconds!!!
Tips For Other Nicotine  Gum- Chew slowly to release
flavour/nicotine, then "park" gum between teeth and cheek until flavour gone – repeat  Inhaler- releases nicotine when you
inhale – breathe in slowly, cartridge lasts for 20 minutes of inhaling  Lozenge- Dissolve slowly in the mouth
moving from side to side (20-30 minutes). The lozenge should not be chewed or swallowed whole. Don't eat or drink while the lozenge is in your mouth Nicotine Patches  Apply patch daily to a clean, non- hairy area of skin  You can shower with the patch  Gum, lozenges, spray or inhaler can be used in combination with the patch.  Starting doses is based on 1 mg of patch per cigarette smoked.  A 10 week step down therapy is Bupropion (Zyban )  Start treatment 1-2 weeks before quit date  150 mg tablets  For the first 3 days, 1 tablet at breakfast  Then 1 tablet twice daily  8-12 weeks of treatment minimum  Can be taken along with nicotine replacement products  Also used as an antidepressant Varenicline (Champix )  Start treatment at least 1 week after quit date  Two week starter pack includes: 0.5 mg daily for 3 days Then 0.5 mg twice daily for 4 days Then 1 mg twice daily for 7 days  Maintenance therapy: 0.5mg or 1 mg tablets twice  Take with food and a full glass of water to avoid  Stimulates the nicotinic receptor while blocking the effects of actual nicotine, therefore nicotine replacement products have no benefit while on Varenicline. Cost of Prescription  28 day supply of Zyban =$82.41  28 day supply of Champix =$133.38  28 day supply of Cigarettes =$280.00 based on 1 pack/day  Many private insurance plans cover the cost of prescribed smoking cessation treatments  Government plans in some provinces cover smoking cessation products for senior citizens and residents receiving social assistance or those with a disability Cost Of Nicotine  Public Health Units may offer campaigns throughout the year for free nicotine replacement products. (ie. STOP program) Gum- $35.99/ 108 pieces (1 piece of gum/craving) Spray- $45.99 /150 sprays (1-2 sprays per craving) Lozenge- $14.99/22 lozenges (1 lozenge per craving) Inhaler- $54.99/42 cartridges (may use 6/day) Patch- $29.99-$37.99/7 patches (use 1/day) Cigarettes contain more than one
chemical which acts like an
When quitting smoking, the loss of these
chemicals may uncover a pre-existing
Mood changes must be watched for
regardless of the treatment chosen.
Smokers' Helpline Tobacco products are responsible for an estimated 47,000 deaths every year in (22% of all deaths in Canada) The time to act is now!!!  What is the most important piece of information you have learned from this session?  What changes will you make in the week ahead?  What additional information do you need to move forward in quitting? Your Partner In RA Care


Pituitary 7: 83–87, 2004  2005 Springer Science + Business Media, Inc. Manufactured in The Netherlands. Pituitary Apoplexy During Therapy with Cabergoline in anAdolescent Male with Prolactin-Secreting Macroadenoma Mirta Knoepfelmacher, Miriam C. Gomes, Maria E.Melo, and Berenice B. MendoncaDepartment of Endocrinology, Hospital das Cl´ınicas, Universityof S ˜ao Paulo Medical School, S ˜ao Paulo, Brasil

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