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SMOKING CESSATION AND REHABILITATION

SMOKING CESSATION AND REHABILITATION. Dr. Oğuz Kılınç Dokuz Eylul University School of Medicine Chest Department oguz . kilinc @ deu .edu.tr. LECTURE PLAN. Fundamentals of smoking cessation (SC) programs What is the role of rehab in SC? Is rehab effective in SC ?. What is smoking?.

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SMOKING CESSATION AND REHABILITATION

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  1. SMOKING CESSATION AND REHABILITATION Dr. Oğuz Kılınç Dokuz EylulUniversitySchool of Medicine ChestDepartment oguz.kilinc@deu.edu.tr

  2. LECTURE PLAN • Fundamentals of smoking cessation (SC) programs • What is the role of rehab in SC? • Is rehab effective in SC ?

  3. What is smoking? • Disease: Nicotin addiction • Treatment: Yes • Cause: Tobacco • Vector: Tobacco industry • Host: Human

  4. Behaviour Psychologic Neurochemical Addiction triangle

  5. Morethan 4000 chemicals in smoke Nicotine CO Cancerogens Irritansandpoisons

  6. CNS- Nicotine N. Accumbens Nicotinic receptor ( α4β2) Neuromediator: Dopamin Locus coeruleus (Craving) Neuromediator:Noradrenalin

  7. Symptom Duration Percentage(%) Dizziness 10 <48 h Sleep disturbance <1 wk 25 Lose of concentration <2 wks 60 Craving <2 wks 70 agressivity <4 wks 50 Depression <4 wks 60 İrritability <4 wks 60 Appetite increase <10 wks 70 Withdrawalsymptoms 1. Jarvis MJ. BMJ 2004; 328:277-279.

  8. Control of neurochemicaldimension • Pharmacologic treatment • NRT • Bupropion • Varenicline

  9. Behaviouraltreatment

  10. Why is important to understand the Behavioural and psychologic dimension ? • Understand this dimensions increase the success rate

  11. Questions for behaviour and psychologic dimensions • What are the provocative factors for smoking? • Which conditions are important for smoking? • What are the results? • Which factors are important continuing the smoking?

  12. Problematical behaviour: smokingProvocative factors • Conditional factors • Workplace, home, car • Behavioural factors • Tea, coffee, alcohol • Cognitive factors • Triggering thoughts • “If I smoke I would relax”. • “Smoking is very delicious after meal”

  13. Problematical behaviour: smokingProvocative factors • Emotional factors • irritation, annoyance, joy • Group effect • Smoking in group • Physiologic factors • Withdrawal symptoms

  14. Continuing factors • Relaxing after smoking • Reactional smoking

  15. Problematic behaviour: smoking • Provocative and continuing factors differ patient to patient • Smoking cessation treatment should be tailor made • Consultant should help patient for changing behaviour

  16. Pyschologicdimension of smoking

  17. Recover “vision defection” Smoking causes not only cancer, COPD, Buerger disease, Coronary artery disease but also “vision defect”

  18. ‘Smokers don’t see the real face of smoking because of “vision defect”

  19. This condition is similar with love, The treatment of love is wedding.

  20. How is emerge “love” withcigarette? Persons Objects Events Don’tcauseemotion

  21. Behaviour ● D negotiation Emotion ● C I like her Opinion ● B Warm Good people Person ● A Ayşe

  22. Behaviour ● D Buy cigarette Smoking Emotion ● C Like smoking Opinion ● B Pleasure, It’s my friend, Object ● A Cigarette

  23. Emotion ● C Fear Detastation Feel lock of willpower Opinion ● B Cause disease I have dispnea It cause cancer Object ● A Cigarette Behaviour ● D Effort of smoking cessation

  24. Realize and chance this condition is skill and can learn

  25. If patients don’t chance opinion about smoking • They feel weak theirself • Miss smoking • To desire smokers Relaps

  26. If patients change their opinion about smoking • Feel of success • Self confidence • Optimism • Feel energic • Upset for smokers

  27. Suggestionforsmokingcessationprocess • Changeopinionaboutsmoking • Findoutprovocativefactorsandcorrect • Tea, coffee • After meal • Alcohol • Stress • Pharmacotherapy

  28. How can rehabwork in SC? • Rehab can play role for behavioural and physchologic dimension

  29. Behaviour Psychologic Neurochemical Addiction triangle

  30. Effect of rehab in SC

  31. Objectiveandstudydesign • Parallel group study • to investigate the effectiveness of a smoking cessation programme performed during routine rehabilitation practice for outpatients

  32. groups • Group 1: Rehab + SC 102 pts • Group 2: SC 101 pts • All participants underwent physical examination, pulmonary function tests and received identical behaviouraland/or pharmacological treatment. • In addition, the interventiongroup underwent rehabilitation practice 3 times a week for 3 months.

  33. SmokingCessation rate at theend of oneyear • Group 1 • Abstinence rate %68 • Maintained their smoking habits %14 • Lost after enrolment %12 • Group 2 • Abstinence rate %32 • Maintained their smoking habits %52 • Lost after enrolment %16 • CO ölçümü ve evden birine sorma yöntemiyle bırakma değerlendirilmiş

  34. Discussion • Therefore a possible explanation for the difference observed could be that the interventiongroup individuals were highly health motivated (this subsetof subjects was recruited among individuals who underwentrehabilitation 3 times per week for 3 months).

  35. limitations • due to ethical reasons we did not randomize participants and it was not possible toinclude in the control group patients with serious medicaldisorders • Since our study was performed in only 2 centres, we believe that the dataobtained may suggest the opportunity of further prospectivemulti-centre studies to confirm our data • Missing cases might cause selection bias

  36. Summary • All patients attending rehab ask about smoking and advice quit smoking. • Support the hypothesis that considering smoking cessationprogrammes as a mandatory component of rehabilitation may behighly effective in increasing smoking cessation rate and couldbe an additional strategy to reduce smoking habits

  37. Thankyouforyourattention

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