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Chronic Pulmonary Diseases And Smoking Cessation

Chronic Pulmonary Diseases And Smoking Cessation. Şule Akçay, Associate Professor Baskent University , Faculty of Medicine , Pulmonary Diseases Department. World Tobaccco Conference 2009. World Tobaccco Conference 2009. World Tobaccco Conference 2009. SMOKING-RELATED CHRONIC DISEASES.

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Chronic Pulmonary Diseases And Smoking Cessation

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  1. ChronicPulmonaryDiseasesAndSmokingCessation Şule Akçay, AssociateProfessor BaskentUniversity, Faculty of Medicine, PulmonaryDiseasesDepartment

  2. WorldTobacccoConference 2009

  3. WorldTobacccoConference 2009

  4. WorldTobacccoConference 2009

  5. SMOKING-RELATED CHRONIC DISEASES • MALIGNANCY • Respiratorytract • Lung, larynx, pharynx, oral cavity • Otherregion • Esophagus, Pancreas, urinebladder, uterinecervix, endometrium, breast, renal, anus, stomach, colorectal, liver, leukemia • GIS DISEASES • REPRODUCTIVE SYSTEM DISEASES • PREGNANT AND INFANT DISEASES • POSTMENAUPOSAL DISEASES • ENDOCRİNE SYSTEM DISEASES • RENAL DISEASES • EYE DISEASES • HEMATOLOGİC DISEASES • SKIN DISEASES • CARDIOVASCULAR • Atherosclerosis • Coronaryarterialdisease • Carotisvesseldisease • Abdominalaorticaneurism • Mesenteric, renal, iliac • Peripheralvasculardisease • Thromboangiitisobliterans • Deepvenousthrombosis • Cardiacdiseases • Angina • Aritmia • PULMONARY • COPD, Asthma, IPF, LHH, RB-ILD, DIP, Pneumothorax, Goodpasture, OSA, Tuberculosis, Drugresistance

  6. SmokingCessation • Inthetreatmentandprevention of pulmonarydiseases, themosteffectiveapproach • Hard-coresmokersarecommonamongpatientswithrespiratorydisease, smokingcessationtherapy is different in thisgroup

  7. No COPD %20 COPD Smokers %80 Smokers Nonsmokers Patients with COPD GOLD Report 2008

  8. Smoking & COPD http://www.cdc.gov/tobacco/sgr/sgr

  9. Relationshipbetweensmoking, pulmonaryfunctionandage Nonsmokers Ex-smokers in 45 years Sensitivesmokers COPD Disability Ex-smokers in 65 years Death

  10. COPD-RELATED MORBIDITY AFTER SMOKING CESSATIONClinicalStudies

  11. COPD-RELATED MORBIDITY AFTER SMOKING CESSATIONPopulationStudies

  12. COPD-RELATED MORTALITY AFTER SMOKING CESSATION

  13. Smoking & Asthma http://www.cdc.gov/tobacco/sgr/sgr

  14. Males Lung cancer Females Chapman KR, et al. Eur Respir J 2006;27(1):188-207.

  15. LungCancerMap in Turkey: TurkishThoracicSociety, MalignancyStudyGroup Türkiye akciğer kanser haritası Bulletin of Thorax, December 2006

  16. Ryu JH, Eur Respir J 2001; 17:122-132

  17. Ryu JH, Eur Respir J 2001; 17:122-132

  18. SmokingCessationGuidelines • 1995 ERS positionpaper • 1996 APA guideline • 1996 US AgencyforHealthCarePolicyandResearch’sClinicalPracticeGuidelinesforTreatingTobaccoUseandDependence • 2000 Updatedguideline • 2002 ACCP positionpaper • 2008 Updatedguideline

  19. “Transtheoretical model” cycle • Precontemplation • Contemplation • Preparation • Action • Maintenance Prochaska, DiClemente • Treatment is necessary in “preparationphase” according 2008 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.

  20. COPD patients • 29.4% precontemplation • 60.7% contemplation • 8.9% preparation Barbano G, Diamandi A, Nardini S. InRespiratoryPatientsShortTermCompleteAbstinencefrom Smoking does not Depend on the Stage of Change. www.ers-education.org/pages/default.

  21. QUESTIONS • Accordingtheguideline, smokingcessationtherapy is not necessary in 90% of COPD patients. Towaitfortherapy is true? • Iftranstheoretical model is not adequate, whichmethod can be apply?

  22. “Catastrophe” theory • Immediatecessation, becausefivecycle is not true in COPD West R BMJ 2006; 332:458

  23. “Self-efficacy” theory • Smokingcessation in comorbidity • Asthma • Hypertension • Contraception Everydiseasesmust be treated. Smokingcessation is themosteffectivetherapy in pulmonarypatients. Lee, Int J NursStud 2008;45:1690

  24. SMOKING AND PULMONARY DISEASES • Smoker patients with respiratory disease URGENTLY NEED CESSATION! • Respiratory physicians shouldtreatthem • regularly assessing smoking status • using pharmacological treatment • making behavioural support available

  25. To carry out this role effectively, respiratory physicians need • 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

  26. 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 • using high-dose and/or prolonged nicotine replacement therapy (NRT) • Varenicline is first-lineagent (B). • behavioural support, which should be intensive and multi-sessional, and provided by someone who has been appropriately trained (B).

  27. 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).

  28. InterventionForSmokingCessation Gratziou, CurrentMedResOpin 2009; 25:535-545

  29. 31 May “No TobaccoDay” WHO Themes • 2009: TobaccoandHealthWarning • 2008: TobaccoFreeYoung • 2007: TobaccoFreeEnvironment • 2006: TobaccoCausesDeath in Every Form • 2005: HealthProfessionalsandSmoking • 2004: SmokingandPoverty • 2003: Smokeless Film andFashion • 2002: SmokelessSports • 2001: PassiveSmokingKills • 2000: SmokingKills

  30. SONUÇ • Theme: TobaccoHealthWarnings • TheWorldHealthOrganizationselects "TobaccoHealthWarnings" as thethemeforthe 20th World No TobaccoDay, whichwilltakeplace on 31 May 2009. Tobaccohealthwarningsappear on packs of cigarettesandareamongthestrongestdefencesagainstthe global epidemic of tobacco. WHO particularlyapproves of warningsthatcontainbothpicturesandwordsbecausetheyarethemosteffective at convincingpeopletoquit.

  31. SMOKING CAUSES SERIOUS HARM FOR YOU AND YOUR ENVIRONMENT SMOKING CAUSES DEATH SMOKING IS AN ADDICTION, DO NOT START

  32. GIVE YOUR VOTE, TRUELY

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