Smoking Cessation: A readily modifiable risk factor

Transcription

1 Robert L. Keith MD FCCP Associate Professor of Medicine Medical Director of Respiratory Therapy Eastern Colorado Health Care System University of Colorado Denver Smoking Cessation: A readily modifiable risk factor Background/Epidemiology Nicotine Addiction Pharmacotherapies for Smoking Cessation Nicotine Replacement Bupropion Maintenance Therapy Behavioral Counseling % Nationwide: 21% Men = 23.4% Women = 18.5% No Drop in Smoking Rates from

2 More than 1140 kids start smoking every day (the so-called replacement generation ) Healthcare providers tend to underestimate their patients willingness to quit smoking

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4 10 Smoking Cessation: A readily modifiable risk factor Background/Epidemiology Nicotine Addiction Pharmacotherapies for Smoking Cessation Nicotine Replacement Bupropion Maintenance Therapy Behavioral Counseling 11 12

5 13 Smoking Cessation: A readily modifiable risk factor Background/Epidemiology Nicotine Addiction Pharmacotherapies for Smoking Cessation Nicotine Replacement Bupropion Maintenance Therapy Behavioral Counseling 14 15

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9 25 Smoking Cessation: A readily modifiable risk factor Background/Epidemiology Nicotine Addiction Pharmacotherapies for Smoking Cessation Nicotine Replacement Bupropion Maintenance Therapy Behavioral Counseling 26 27

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11 Smoking Cessation: A readily modifiable risk factor Background/Epidemiology Nicotine Addiction Pharmacotherapies for Smoking Cessation Nicotine Replacement Bupropion Maintenance Therapy Behavioral Counseling FDA Regulation of Tobacco (HR approved ) Main provisions of legislation giving the Food and Drug Administration authority to regulate the production and marketing of tobacco products: Creates a tobacco control center within the FDA and gives the FDA authority to regulate the content, marketing and sale of tobacco products to protect public health. Requires tobacco companies and importers to reveal all product ingredients and seek FDA approval for any new tobacco products. Allows the FDA to change tobacco product content to protect the public health. Bans the use of flavors, including candies and fruit flavors, in tobacco products. Calls for new rules that would prevent sales to minors except through direct, face-toface exchanges between a retailer and a consumer. Limits advertising that could attract young smokers. Strengthens warning labels. Bars the use of expressions such as "light, "mild" or "low" that give the impression that a tobacco product poses less of a health risk. 33

12 New Study Finds Positive Return on Investment for States that Invest in Quit Smoking Treatments For every $1 spent on helping smokers quit, states would see $1.26 return Washington, DC, (September 14, 2010) A new study released today by the American Lung Association, and conducted by researchers at Penn State University, finds that helping smokers quit not only saves lives but also offers favorable economic benefits to states. The study, titled Smoking Cessation: the Economic Benefits, provides a nationwide cost-benefit analysis that compares the costs to society of smoking with the economic benefits of states providing cessation (quit-smoking) coverage. The study comes at an important time, as important cessation benefit provisions are being implemented at the federal and state levels as a result of healthcare reform legislation

13 37 38 Future Directions Nicotine Vaccine (NicVAX ) immunize subjects (5 injections over 6 months) against the nicotine reward that contributes to addiction. Immune system can prevent the nicotine from reaching the central nervous system. Phase II trials recently reported in abstract form (15% vs. 6% quit rates). Drugs targeting the receptors involved in cravings (cannabinoid receptor, CB1) may also help quitters avoid weight gain. Average smoker gains less than 10 pounds after quitting. Genetics of addiction: It may be possible to test children and determine those with a genetic risk of becoming addicted to cigarettes or other drugs. Nicotine Metabolism: sex hormones increase nicotine metabolism (women on oral contraceptives > women > men). This may explain why NRT is less successful in women & ongoing studies are looking at higher doses. Financial incentives 39

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