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European smoke-free hospital Network

European smoke-free hospital Network. Bertrand Dautzenberg Ariadni Ouranou Loïc Josseran for the European Network of smoke-free hospital. NRT in European hospital. Tobacco is a major cause of disease in hospital. Cumulative mortality (millions deaths). >. 500. 500. 400. ~300. 300.

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European smoke-free hospital Network

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  1. European smoke-free hospital Network Bertrand Dautzenberg Ariadni Ouranou Loïc Josseran for the European Network of smoke-free hospital NRT in European hospital

  2. Tobacco is a major cause of disease in hospital Cumulative mortality (millions deaths) > 500 500 400 ~300 300 200 ~150 100 0 2000-2025 2025-2050 2050-2100

  3. Smoking cessation is a major treatment for patients with coronary disease • On year after myocardial infarction, the risk of death decrease by 50% in case of smoking cessation • The efficacy of quit smoking is higher than : • beta-adrenergic receptor blocking agent • salicylic acid, • anticoagulation, • angiotensin II receptor antagonists Source: UDSHHS 1990 http://sgreports.nlm.nih.gov/NN/B/B/C/T/_/nnbbct.pdf

  4. Smoking cessation is the main curative treatment of lung carcinoma • In non-small-cell-carcinoma, survival increase : • + 50 % with smoking cessation • + 7% with chemotherapy • + 0% with radiotherapy • In small-cell-carcinoma, with smoking cessation : • Survival X 2 at 2 years • Survival X 4 at 5 years

  5. Smoking substitution increase the well-being of smoker with acute disease A smoker hospitalised after a traffic accident decrease acute withdrawal syndrome with NRT.

  6. If an hospital offered Antibiotic, Chemotherapy Morphine, it had to offer NRT.

  7. NRTavailability in European hospital

  8. Nicotine replacement therapy may have 4 goals for in-patient use : • Initiate smoking cessation in a nicotine dependant patient, • Maintain in-patient treatment, when smoking cessation started before hospitalisation, • Preventing withdrawal symptoms for hospitalised nicotine dependant patients, • Reduce risks for patients with tobacco related disease.

  9. Indications for nicotine replacement in dependant in-patient smokers NRT had to be proposed to all dependant smokers hospitalised, because short term substitution is associated with a dramatic decrease of withdrawal symptoms when a smoker is hospitalised.

  10. NRT for in-patients smokers.. • .. prevents the risk of smoking in hospital (fire…) and passive smoking. • .. can help patients to review their smoking behaviour and nicotine dependence and seriously consider smoking cessation.

  11. Risk reduction for in-patient smokers with tobacco related diseases Nicotine replacement therapy is indicated for hospitalised patients with tobacco related diseases who cannot refrain from smoking. In patients with COPD and cardiovascular diseases, nicotine replacement therapy decrease risks as compared with that of continued smoking.

  12. Reduction of risk before surgery Dr. Ann Møller

  13. Bupropion (Zyban) • Is indicated for smoking cessation • but not for : • Short term substitution • Risk reduction • Temporary abstinence • Interactions with other drugs • Some side effects • Less useful in hospital than NRT

  14. Bupropion availability in European hospitals

  15. Substitution for medical staff • NRT could be used for HCW substitution in smoke-free workplace.

  16. NRT for HCW • Some hospital offer NRT free of charge for HCW • Some hospital offer reduced charge for substitution of HCW

  17. NRT for HCW in some European countries

  18. Recommendation 1 • NRT available in all hospital as an essential medication. Medium and large patch One or more oral form

  19. Recommendation 2 • Educate HCW to use NRT in hospital… • with medical prescription • without medical prescription with standard nurse procedure

  20. Recommendation 3 • Facilitate NRT availability for hospital staff.

  21. What happen in the real world ? It take time to educate and change the attitude of HCW.

  22. NRT in Paris Hospital (AP-HP) 1 day NRT/smoker • AP HP = • 42 hospitals • 25 000 beds, • 90 000 HCW • 750 000 admittances

  23. Conclusions • NRT is an essential medication for hospital • Greece, Spain, Romania and many others countries through the World had to move NRT as a hospital medication available • An international recommendation (European ?) on good-use of NRT in hospital is need for medical staff.

  24. Thank you

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