Tuberculosis and Tobacco

Transcription

1 ᐋᓐᓂᐊᖃᕐᓇᙱᑦᑐᓕᕆᔨᒃᑯᑦ Department of Health Munaqhiliqiyitkut Ministère de la Santé Tuberculosis and Tobacco Overlapping Epidemics in Nunavut

2 Brought to you by Tuberculosis (TB) Program Educates and supports health care providers. Promotes TB awareness in Nunavut. Supports research for more effective TB treatments. Tobacco Reduction Program Educates and supports community health and wellness workers. Produces and distributes tobacco reduction resources. Manages quit supports, like the QuitLine and Tobacco Has No Place Here Facebook page. Oversees enforcement of the Tobacco Control Act.

3 Presenters Sandy Finn, RN Territorial Tuberculosis Educator James Smith-Sparling, RRT, CTE Clinical Cessation Educator

4 Learning Objectives To understand the history of TB and tobacco use in Nunavut. To review TB and treatments. To understand the importance of reducing and quitting smoking in patients with TB. To review the resources available to help patients with TB to reduce or quit smoking.

5 Thousands of years, Inuit and their ancestors lived nomadic lives in the Canadian Arctic Pre-European contact 1576 Post-European contact Martin Frobisher arrives Whaling industry began. Fur Trade likely first opportunity for exposure to TB 1920 s RCMP arrived in the Arctic 1950 s Forced settlement into communities, residential schools, forced evacuation to TB sanatoria and dog slaughter CD Howe, Pangnirtung (July 1951)

6 The TB Epidemic Age Standardized rates of active TB, Nunavut and the rest of Canada

7 History of Tobacco In Nunavut Inuit have a history with tobacco that is different than that of other Indigenous people of Canada. Tobacco was never part of Inuit culture. Tobacco was first introduced by European whalers and fur traders. Nicotine in tobacco is very addictive and caused the widespread tobacco use we see today data indicates nearly 75% of Nunavummiut aged 16 and older use tobacco.

8 What is Tuberculosis? Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Most often present in the lungs, but can be extrapulmonary. TB is a serious condition that is highly contagious (active TB) or may be dormant and not presently contagious (latent TB). TB is curable with medications. Worldwide, 10.4 million people became ill with TB in 2015; 1.8 million died from TB.

9 Why is there so much TB in Nunavut? Social determinants of health (and TB) Examples include: Overcrowded housing Food insecurity Addictions, including tobacco use Health System Challenges Large pool of people with untreated Latent TB Infection (LTBI) in Nunavut. Population Demographics Over 30% of Nunavummiut are under 15. Fear and Stigma

10 Why Does Smoking Matter? Smokers have a greater chance of being infected and developing TB. Smoking increases the risk of getting TB by 2.5 times! Smoking increases the chance of recurrence and mortality from TB. Continuing to smoke while on TB treatment makes treatment less effective. Children exposed to second-hand smoke have greater risk of developing active TB.

11 Opportunity! In Nunavut, all TB medications are administered at Community Health Centers through local TB programs. All medications including ACTIVE and LATENT treatment is provided by DOT: Directly Observed Therapy DOT is good time to support your patient to quit smoking.

12 Suggested Approach to Tobacco and DOT Rapport and relationships are integral to successful TB treatment. Smoking cessation can be introduced at any point during DOT, if patient is ready. Avoid pressure to DOT relationship by establishing low barrier approach to smoking cessation supports.

13 Use a Trauma Informed Approach Trauma awareness is important. Emphasis on safety and trustworthiness. Opportunity for choice, collaboration and connection. Identifying strengths and skill-building.

14 5As: Evidence based approach to tobacco cessation ASK patient with TB about tobacco use ADVISE them of the benefits of quitting ASSESS their willingness to attempt a quit ASSIST with their quit attempt ARRANGE follow up with the patient

15 ASSIST with Advice Suggest trying to quit for just one day. Then increase to two days next time and so on. Talk to someone close to you who has quit smoking. Develop a quit plan: Set a quit day. Tell family and friends. Ask for their support and to not use tobacco around you. Anticipate triggers and challenging situations.

16 ASSIST with Advice Use the 4 Ds to overcome cravings: Drink water Distract yourself Do something else Deep breathe Cut caffeine intake in half

17 ASSIST with Medications Nicotine Replacement Therapy (NRT) Help lessen withdrawal symptoms and cravings. Combination of patch and short acting gum/lozenge/inhaler works best. Taper every 2 to 3 weeks, as symptoms allow. Patch, gum and inhaler are Health Centre stock as per Nunavut Drug Formulary:

18 NRT Specifics Patch: Applied every 24 hours Can be removed at bedtime if sleep disturbances occur (insomnia/bad dreams). Change application area each day to avoid skin irritation (any hairless area on torso ok). Inhaler: Used as needed; 1 cartridge equivalent to 1 cigarette. Short frequent puffs allows buccal absorption. Throat irritation possible.

19 NRT Specifics Gum: Comes in 2 and 4 mg strengths; mint or fruit flavour. Used as needed or regularly (eg. every 2 hours) to treat/prevent cravings. BITE BITE PARK chewing method to avoid nausea. Lozenge: Comes in 1 and 2 mg strengths; mint or fruit flavour. Used as needed or regularly (eg. Every 2 hours) to prevent/treat cravings. Good option for patients with poor oral health.

20 Documentation for Chart Paper based order set Meditech version

21 TB Medications and Cessation Medications Can be safely combined. Try NRT first. Other options: Zyban (Bupropion SR): Metabolized by liver. Champix (Varenicline): Renally eliminated.

22 TB Medications (first line) Drug Name Isoniazid Rifampin Ethambutol Pyrazinamide Common Adverse Effects Peripheral neuropathy; pyridoxine given as preventative Orange/red urine Visual impairment Joint pain CAUTION: All have hepatotoxic potential. Monitor for nausea/vomiting, abdominal pain, loss of appetite, jaundice. Additional monitoring: monthly weight, TB symptom resolution, rash. Do not combine with Acetaminophen; use Ibuprofen instead. Give with a small meal if stomach upset occurs. Rifampin causes majority of drug interactions: Before giving any new drug, check with the TB physician or pharmacist.

23 Cessation Resources for Patients NRT Guide Reviews nicotine gum, lozenge, inhaler and patch and how to use them. Tobacco Quit Guide The Quit Guide provides helpful tips and ideas on how to quit for life.

24 Cessation Resources for Patients Tobacco Has No Place Here Facebook page Get answers to your questions on quitting tobacco from trained counsellors.

25 Cessation Resources for Health Care Providers Intermediate Tobacco Cessation Module for Health Care Providers in Nunavut Visit Also on USB sticks sent to each Health Centre labelled TOBACCO CESSATION

26 Cessation Resources for Health Care Providers NRT Fact Sheet 5As / Stages of Change Guide Laminated and on metal ring in all Health Centres. Available for download on nuquits.ca.

27 Sources Oakes, Dana. Oakes Respiratory Home Care: An On-Site Reference Guide. Health Educator Publishing, Inc Orono, Maine, USA. Centers for Disease Control and Prevention. Tuberculosis: Data and Statistics. World Health Organization Tuberculosis and Tobacco. Centre for Addictions and Mental Health. Tuberculosis and Smoking: Key messages for health care providers and policy makers. World Health Organization A guide for tuberculosis patients to quit smoking.

28 Questions?

29 Thank You!!