Smoking Cessation. Hassan Sajjad Pulmonary & Critical Care
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1 Smoking Cessation Hassan Sajjad Pulmonary & Critical Care
2 Objectives Burden of Smoking Health Impacts of Smoking Smoking Cessation Motivational Interviewing Nicotine Replacement Therapy Bupropion Varenicline Electronic Cigarettes
3 Burden of Smoking
4 Burden of Smoking
5 The picture can't be displayed. Prevalence of Smoking per State
6 The picture can't be displayed. High Risk Groups
7 The picture can't be displayed. Health Impacts of Smoking
8 Health Impacts of Smoking
9 Effect of Smoking on Life expectancy Overall mortality among smokers is three times as high as that among otherwise similar persons who never smoked Smokers lose approximately a decade of life Adults who quit smoking at 25 to 34, 35 to 44, or 45 to 54 years of age gained about 10, 9, and 6 years of life, respectively, as compared with those who continued to smoke Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st century hazards of smoking and benefits of cessation in the United States. N Engl J Med Jan 24;368(4): doi: /NEJMsa PubMed PMID:
10 Age Specific Proportion of Participants according to baseline Smoking Status Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st century hazards of smoking and benefits of cessation in the United States. N Engl J Med Jan 24;368(4): doi: /NEJMsa PubMed PMID:
11 Adjusted Hazard Ratios for Various Causes of Death among Current Smokers and Never Smokers Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st century hazards of smoking and benefits of cessation in the United States. N Engl J Med Jan 24;368(4): doi: /NEJMsa PubMed PMID:
12 Survival Probabilities for Current Smokers and Never Smokers Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st century hazards of smoking and benefits of cessation in the United States. N Engl J Med Jan 24;368(4): doi: /NEJMsa PubMed PMID:
13 Smokers versus Those Who Quit Smoking Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st century hazards of smoking and benefits of cessation in the United States. N Engl J Med Jan 24;368(4): doi: /NEJMsa PubMed PMID:
14 Smoking Cessation: Motivational Interviewing Counselling style which helps people to explore and resolve their uncertainties about changing their smoking behavior Avoid an aggressive or confrontational approach Steer people towards choosing to change their behavior and encouraging their self belief
15 Smoking Cessation: Motivational Interviewing Smokers Ready to Quit empathy, encouragement, ask about quit date, urge total abstinence, supplemental books and resources, medications Smoker currently Not Ready to Quit empathy, accept patient s resistance to change related to quitting, ask for permission to help, build on past successes, give patient options on how to proceed, consider nicotine replacement
16 The picture can't be displayed. Smoking Cessation: Motivational Interviewing tobacco use in patients
17 Motivational Interviewing vs Brief Advice: Metanalysis
18 Smoking Cessation: Nicotine Replacement Therapy Reduce motivation to smoke and the physiological and psychomotor withdrawal symptoms often experienced during an attempt to quit An average cigarette delivers between 1 and 3 mg of nicotine and the typical pack per day smoker absorbs 20 to 40 mg of nicotine each day
19 The picture can't be displayed. Nicotine Replacement Therapy
20 The picture can't be displayed. Efficacy of Nicotine Replacement Therapy
21 Nicotine Patch: High versus Standard dose
22 Nicotine Replacement Therapy: Combination Therapy The picture can't be displayed.
23 Nicotine Replacement Therapy: Adverse Effects Nicotine Gum: hiccoughs, gastrointestinal disturbances, jaw pain, and orodental problems Nicotine Patch: skin sensitivity and irritation (may affect up to 54% of patch users, but it is usually mild and rarely leads to withdrawal of patch use)
24 Nicotine Replacement Therapy: CVS Adverse Effects Review of adverse effects based on 35 trials with over 9,000 participants did not find evidence of excess adverse cardiovascular events amongst those assigned to nicotine patch Greenland S, Satterfield MH, Lanes SF. A meta analysis to assess the incidence of adverse effects associated with the transdermal nicotine patch. Drug Saf Apr;18(4): PubMed PMID: Trial of nicotine patch that recruited smokers aged over 45 with at least one diagnosis of cardiovascular disease found no evidence that serious adverse events were more common in smokers in the nicotine patch group Joseph AM, Antonuccio DO. Lack of efficacy of transdermal nicotine in smoking cessation. N Engl J Med Oct 7;341(15): Erratum in: N Engl J Med Jun 14;356(24):2554. Antonnucio, DO [corrected to Antonuccio, DO]. PubMed PMID:
25 Nicotine Replacement Therapy: CVS Adverse Effects A meta analysis of adverse events associated with NRT across 92 RCTs and 28 observational studies addressed a possible excess of chest pains and heart palpitations among users of NRT compared with placebo groups. The authors report an OR of 2.06 (95% CI 1.51 to 2.82) across 12 studies. Mills EJ, Wu P, Lockhart I, Wilson K, Ebbert JO. Adverse events associated with nicotine replacement therapy (NRT) for smoking cessation. A systematic review and meta analysis of one hundred and twenty studies involving 177,390 individuals. Tob Induc Dis Jul 13;8:8. doi: / PubMed PMID: ; PubMed Central PMCID: PMC
26 The picture can't be displayed. Smoking Cessation: Bupropion Bupropion exerts its main mechanism of action through dopamine and noradrenalin reuptake inhibition with little serotonergic effect. It also attenuates the stimulant effects of nicotine on the nicotinic acetylcholine receptors Wilkes S. The use of bupropion SR in cigarette smoking cessation. Int J Chron Obstruct Pulmon Dis. 2008;3(1):45 53.
27 The picture can't be displayed. Smoking Cessation: Bupropion Wilkes S. The use of bupropion SR in cigarette smoking cessation. Int J Chron Obstruct Pulmon Dis. 2008;3(1):45 53.
28 Bupropion Adverse Effects Wilkes S. The use of bupropion SR in cigarette smoking cessation. Int J Chron Obstruct Pulmon Dis. 2008;3(1):45 53.
29 The picture can't be displayed. Bupropion and Nicotine patch Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR, Smith SS, Muramoto ML, Daughton DM, Doan K, Fiore MC, Baker TB. A controlled trial of sustained release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med Mar 4;340(9): PubMed PMID:
30 Smoking Cessation: Varenicline Varenicline is a partial agonist of the α4β2 nicotinic acetylcholine receptor that causes partial stimulation while it competitively inhibits nicotine binding. Hays JT, Ebbert JO. Varenicline for tobacco dependence. N Engl J Med Nov 6;359(19): doi: /NEJMct Review. PubMed PMID: ; PubMed Central PMCID: PMC
31 Efficacy of Varenicline Varenicline was significantly more efficacious than placebo for smoking cessation at all time points and significantly more efficacious than bupropion SR at the end of 12 weeks of drug treatment and at 24 weeks. Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, Watsky EJ, Gong J, Williams KE, Reeves KR; Varenicline Phase 3 Study Group. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA Jul 5;296(1): PubMed PMID:
32 The picture can't be displayed. Smoking Cessation: Varenicline Aubin HJ, Bobak A, Britton JR, Oncken C, Billing CB Jr, Gong J, Williams KE, Reeves KR. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open label trial. Thorax Aug;63(8): doi: /thx Epub 2008 Feb 8. PubMed PMID: ; PubMed Central PMCID: PMC
33 Smoking Cessation: Varenicline Aubin HJ, Bobak A, Britton JR, Oncken C, Billing CB Jr, Gong J, Williams KE, Reeves KR. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open label trial. Thorax Aug;63(8): doi: /thx Epub 2008 Feb 8. PubMed PMID: ; PubMed Central PMCID: PMC
34 Varenicline Adverse Effects Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, Watsky EJ, Gong J, Williams KE, Reeves KR; Varenicline Phase 3 Study Group. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA Jul 5;296(1): PubMed PMID:
35 Electronic Cigarettes Polosa R, Caponnetto P. The Health Effects of Electronic Cigarettes. N Engl J Med Dec 29;375(26):2608. PubMed PMID:
36 Evolution of Electronic Cigarettes cigarettes facts stats and regulations
37 Constituents of Electronic Cigarettes Polosa R, Caponnetto P. The Health Effects of Electronic Cigarettes. N Engl J Med Dec 29;375(26):2608. PubMed PMID:
38 Electronic Cigarettes: Prevalence and Patterns Current use of E cigarettes increased from 0.3% to 6.8% between 2010 and 2013 A third of E cigarettes users had never smoked tobacco or were former smokers McMillen RC, Gottlieb MA, Shaefer RM, Winickoff JP, Klein JD. Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers. Nicotine Tob Res Oct;17(10): doi: /ntr/ntu213. Epub 2014 Nov 6. PubMed PMID: In 2011, less than 2% of US High School students reported using E cigarettes in the past month. By 2015, usage increased to 15%. By 2016, use decreased to 11% National academies of sciences, engineering and medicine. public health consequences of e cigarettes. Washington DC: National Academics Press 2018
39 Electronic Cigarettes: Smoking Aid? Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet Nov 16;382(9905): doi: /S (13) Epub 2013 Sep 9. PubMed PMID:
40 Polosa R, Caponnetto P. The Health Effects of Electronic Cigarettes. N Engl J Med Dec 29;375(26):2608. PubMed PMID:
41 Conclusions Smoking is the leading cause of preventable death No level of tobacco smoke is risk free Benefits of Smoking Cessation can be seen at any age Effective therapies for Smoking Cessation exist Electronic Cigarettes have the potential to benefit some and harm some (especially young people and previous non smokers)
42 Thank You
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47 Bupropion and Nicotine patch Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR, Smith SS, Muramoto ML, Daughton DM, Doan K, Fiore MC, Baker TB. A controlled trial of sustained release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med Mar 4;340(9): PubMed PMID:
Title: Varenicline for Smoking Cessation. Date: June 4, Context and policy issues:
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