smoki cess update 04 nop 07

Nama : dr. Isnu Pradjoko, Sp.P(K)

TTL : Indonesia, Jumat legi 22 Agustus 1950

Pend. S1 : FK UNAIR 1978

Pend. Spesialis : FK UNAIR 1992

• Bronchoscopy and thoracoscopy course

Perth Royal & Charles Gardner Hospital W.Austrl

Jabatan : Staf Medik SMF Paru FK Unair

Riwayat Pekerjaan :

- Ka Puskesmas Omben & Sampang Kota (1978-1983)

- Direktur RSU Sampang Madura (1983-1986)

Curriculum Vitae

SMOKING CESSATION SMOKING CESSATION &&

NICOTINE NICOTINE REPLACEMENT REPLACEMENT

Isnu PradjokoIsnu PradjokoPULMONARY DEPARTMENTPULMONARY DEPARTMENT

MEDICAL FACULTY AIRLANGGA UNIVERSITY- MEDICAL FACULTY AIRLANGGA UNIVERSITY- DR.SOETOMO GENERAL HOSPITALDR.SOETOMO GENERAL HOSPITAL

SURABAYASURABAYA

SMOKING CIGARETTE ? SMOKING CIGARETTE ?

RokokRokokCerutuCerutuPipaPipaRokok rastaRokok rastaRokok Rokok

“klembak”“klembak”““Horsa”Horsa”““pipa pipa

perdamaian”perdamaian”

ALAT UNTUK MENIKMATI ALAT UNTUK MENIKMATI TEMBAKAUTEMBAKAU

WHY STARTING ??WHY STARTING ??

NikotinNikotinTarTarKarbon monoksidaKarbon monoksidaFenolFenolAsetonAsetonArsenArsenMerkuriMerkuriHidrogen sianidaHidrogen sianidaFormalinFormalin

Direct injuryDirect injury

CIGARETTESCIGARETTES

Indirect injuryIndirect injury

Oxidant damage: Lipids Proteins DNAAldehydes: Lipids Proteins DNAXenobiotics: DNA alterations

Oxidant damage: Lipids Proteins DNAAldehydes: Lipids Proteins DNAXenobiotics: DNA alterations

Inflammation:

Oxidants

Proteases

Toxic peptides

Altered lung structures

Altered cellular responses

Inflammation:

Oxidants

Proteases

Toxic peptides

Altered lung structures

Altered cellular responses

CIGARETTE INJURY

Mild Severe

Survival

Persistent

Necrosis

Inflammation

Apoptosis

DNA damage

CIGARETTESCIGARETTES

The 2007 National Symposia Update on Tuberculosis And Respiratory DisordersBandung, 23rd-25th Marc, 2007

BRONCHIBRONCHITIS TIS CHRONISCHRONIS

EMPHYSEEMPHYSEMA MA

KANKER KANKER >> >> PARU >PARU >

HAMIL -HAMIL - ANAK ANAK ASMA >ASMA >

DIABETEDIABETES M >S M >

AIR WAY AIR WAY DEFENCE DEFENCE MECHANISMMECHANISM!!!!

Soft mucous layerSoft mucous layer Blood vesselBlood vessel Sputum productionSputum production Muco-cilliairMuco-cilliair Muco-cilliair Muco-cilliair

transport to oral.transport to oral.

Cellular-humoral Cellular-humoral defencedefence

Acid-base balanceAcid-base balance

ACCUTE INFECTION ACCUTE INFECTION

CHRONICLE INFECTIONCHRONICLE INFECTION

MALIGNANCYMALIGNANCY

Gb hal 148

PPOK

Gb hal 149

BRONKITIS KRONIK

Miscoding

NicotineOther

carcinogenesDNA

Cigarrette smoker

Metabolicactivation

NormalDNA

Apoptosis

PUTATIVE PATHWAY FROM NICOTINE ADDICTION TOTHE DEVELOPMENT OF COPD

(Martyn R Partridge, Understanding Respir Medcine, 2006)

Genetic mutations

Lung cancer

Repair

Tobacco use

Nonsmokerdeath rate, 10

Ex-smokerdeath rate, 43

Continuing smoker – any tobacco- death rate, 104

Cigar/pipe smokerdeath rate, 52

Number of cigarettes smoked

1-14 per day,death rate 78

15-24 per day,death rate 127

> 24 per day,death rate, 251

(Death rates per 100,000 population)

CORRELATION BETWEEN NUMBER OF CIGARETTES CONSUME AND LUNG DISEASE

(Doll’s and Hill’s Doctors Study, 2006)

Who Scared ??Who Scared ??

Who Scared ?Who Scared ?

BUKAN LELAKI KALAU TIDAK BUKAN LELAKI KALAU TIDAK sundhut tembakausundhut tembakau

Merokok dapat Merokok dapat

menyebabkan ..menyebabkan ..

………………………………………………

Habits Habits

Or Life Style ?Or Life Style ?

DEMO MASSAL??DEMO MASSAL??BLOKIR JALANBLOKIR JALANUNJUK RASAUNJUK RASA DUDUKI AIRPORTDUDUKI AIRPORT

70 % of SMOKERSREPORT WANTING

TO QUIT

THE 5 A’S FOR PATIENTS WILLING TO QUIT

ASK : about tobacco useADVISE : to quitASSESS : willingness to make a quit attemptASSIST : in quit attemptARRANGE : for follow-up

THE 5 R’sFOR TREATING PATIENTS WHO ARE NOT READY

TO MAKE A QUIT ATTEMPT

RELEVANCE : tailor advice & discussion to each patientRISKS : outline risks of continued smokingREWARDS : outline the benefits of quittingROADBLOCKS : identify barriers to quittingREPETITION : reinforce the motivational message at every visit

CLINICAL USE OF PHARMACOTHERAPIES FOR SMOKING CESSATION (with/after COUNSELLING)

•BUPROPION SR•NICOTINE GUM•NICOTINE INHALER•NICOTINE NASAL SPRAY•NICOTINE PATCH•NICOTINE LOZENGES•VARENICLINE

SUGGESTIONPharmacotherapy Precaution/C.I Side

effectDosage

Bupropion SR

Varenicline

Nicotine gum

Nicotine Loz

Nicotine inhaler

Nicotine Nasal spray

Nicotine Patch

-Seizure- Eating disorder

-Insomnia-- dry mouth

- renal impairment - undergoing dialysis

-Insomnia-abnormal dreamNausea Dry mouth

-mouth soreness-dyspepsia

-Nausea--insomnia

-local irritation

- Nasal irritation

Local skin irritationinsomnia

150 mg every morning 3 days. 2 xdaily .(start 1-2 weeks before quit date)

Day 1-3 0,5mg tab morningDay 4-7 0,5mg tab 2x/dayDay 8-end 1mg tab 2x/day (1week before

1-24cig/day -2mg gum (>24 /day>25 cig/day 4mg gum (>24 /day)

2mg: >30 min wake– smoke4mg- < 30 min wake- smoke

6-16 cartrides/day

8-40 doses/day

-21 mg/24 hours--14 mg/24 hours-7 mg/24 hours--15 mg/16 hours

SUGGESTIONPharmacotherapy Duration Availability Avg. Cost/day

Bupropion SR

Varenicline

Nicotine gum

Nicotine Loz

Nicotine inhaler

Nicotine Nasal spray

Nicotine Patch

7-12 weeks Maintenance >6 mo

R/ only -Zyban SR-Wellbutrin SR

-1 box/60 tab. 150 mg.-- Zyban $185.99. Wellbutrin $167.99-- generic $101,99

3 – 6 month Chantix ???Varies $115/mo

> 12 weeks

> 12 weeks

> 6 month

3 - 6 month

-4 weeks -Then 2 weeks-Then 2 weeks-- 8 weeks

OTC only.nicoderm CQ.nicotrol.genericR/only-generic (Legend)

21mg.box 0f 7-Nicoderm : $29.00-- generic $21.9914 mg box of 7:-Nicoderm $29.00--generic $21.99

R/ only - Nicotrol NS

1 metered dose dispenser 40 ml $190.99

R/ only- Nicotrol inhaler

1 box of 168 cartridges : $166.99

-Commit loz--generic(Nicabate

2mg – 48 loz- Commit $29.994mg- 48 loz- Commit $29.99

-Nicorette-Nicorette mint

2mg-1box/50 pieces$29.99/22.994mg-1 box/50 pieces $ 32.99

AKIBAHARA CORNERAKIBAHARA CORNER

????

Gb hal 241

PNEUMOTORAKS