Smoking Cessation Hassan Sajjad Pulmonary & Critical Care
Objectives Burden of Smoking Health Impacts of Smoking Smoking Cessation Motivational Interviewing Nicotine Replacement Therapy Bupropion Varenicline Electronic Cigarettes
Burden of Smoking http://gamapserver.who.int/gho/interactive_charts/tobacco/use/atlas.html
Burden of Smoking http://gamapserver.who.int/gho/interactive_charts/tobacco/use/atlas.html
The picture can't be displayed. Prevalence of Smoking per State https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm
The picture can't be displayed. High Risk Groups https://www.cdc.gov/tobacco/infographics/adult/index.htm#down
The picture can't be displayed. Health Impacts of Smoking
Health Impacts of Smoking
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. 2013 Jan 24;368(4):341 50. doi: 10.1056/NEJMsa1211128. PubMed PMID: 23343063.
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. 2013 Jan 24;368(4):341 50. doi: 10.1056/NEJMsa1211128. PubMed PMID: 23343063.
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. 2013 Jan 24;368(4):341 50. doi: 10.1056/NEJMsa1211128. PubMed PMID: 23343063.
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. 2013 Jan 24;368(4):341 50. doi: 10.1056/NEJMsa1211128. PubMed PMID: 23343063.
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. 2013 Jan 24;368(4):341 50. doi: 10.1056/NEJMsa1211128. PubMed PMID: 23343063.
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 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.cd006936.pub3/full
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
The picture can't be displayed. Smoking Cessation: Motivational Interviewing https://us.humankinetics.com/blogs/excerpt/addressing tobacco use in patients
Motivational Interviewing vs Brief Advice: Metanalysis https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.cd006936.pub3/full
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 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.cd000146.pub4/full
The picture can't be displayed. Nicotine Replacement Therapy https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.cd000146.pub4/full
The picture can't be displayed. Efficacy of Nicotine Replacement Therapy https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.cd000146.pub4/full
Nicotine Patch: High versus Standard dose
Nicotine Replacement Therapy: Combination Therapy The picture can't be displayed.
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)
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. 1998 Apr;18(4):297 308. PubMed PMID: 9565740. 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. 1999 Oct 7;341(15):1157 8. Erratum in: N Engl J Med. 2007 Jun 14;356(24):2554. Antonnucio, DO [corrected to Antonuccio, DO]. PubMed PMID: 10515763
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. 2010 Jul 13;8:8. doi: 10.1186/1617 9625 8 8. PubMed PMID: 20626883; PubMed Central PMCID: PMC2917405
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.
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.
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.
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. 1999 Mar 4;340(9):685 91. PubMed PMID: 10053177
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. 2008 Nov 6;359(19):2018 24. doi: 10.1056/NEJMct0800146. Review. PubMed PMID: 18987369; PubMed Central PMCID: PMC2959114.
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. 2006 Jul 5;296(1):47 55. PubMed PMID: 16820546.
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. 2008 Aug;63(8):717 24. doi: 10.1136/thx.2007.090647. Epub 2008 Feb 8. PubMed PMID: 18263663; PubMed Central PMCID: PMC2569194
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. 2008 Aug;63(8):717 24. doi: 10.1136/thx.2007.090647. Epub 2008 Feb 8. PubMed PMID: 18263663; PubMed Central PMCID: PMC2569194
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. 2006 Jul 5;296(1):47 55. PubMed PMID: 16820546.
Electronic Cigarettes Polosa R, Caponnetto P. The Health Effects of Electronic Cigarettes. N Engl J Med. 2016 Dec 29;375(26):2608. PubMed PMID: 28032962.
Evolution of Electronic Cigarettes https://truthinitiative.org/news/e cigarettes facts stats and regulations
Constituents of Electronic Cigarettes Polosa R, Caponnetto P. The Health Effects of Electronic Cigarettes. N Engl J Med. 2016 Dec 29;375(26):2608. PubMed PMID: 28032962.
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. 2015 Oct;17(10):1195 202. doi: 10.1093/ntr/ntu213. Epub 2014 Nov 6. PubMed PMID: 25381306. 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
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. 2013 Nov 16;382(9905):1629 37. doi: 10.1016/S0140 6736(13)61842 5. Epub 2013 Sep 9. PubMed PMID: 24029165.
Polosa R, Caponnetto P. The Health Effects of Electronic Cigarettes. N Engl J Med. 2016 Dec 29;375(26):2608. PubMed PMID: 28032962.
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)
Thank You
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. 1999 Mar 4;340(9):685 91. PubMed PMID: 10053177