smoki cess update 04 nop 07

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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- Curriculum Vitae

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Smoke Seminar Paru

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Page 1: 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

Page 2: Smoki Cess Update 04 Nop 07

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

Page 3: Smoki Cess Update 04 Nop 07

SMOKING CIGARETTE ? SMOKING CIGARETTE ?

RokokRokokCerutuCerutuPipaPipaRokok rastaRokok rastaRokok Rokok

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

perdamaian”perdamaian”

Page 4: Smoki Cess Update 04 Nop 07

ALAT UNTUK MENIKMATI ALAT UNTUK MENIKMATI TEMBAKAUTEMBAKAU

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WHY STARTING ??WHY STARTING ??

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NikotinNikotinTarTarKarbon monoksidaKarbon monoksidaFenolFenolAsetonAsetonArsenArsenMerkuriMerkuriHidrogen sianidaHidrogen sianidaFormalinFormalin

Page 7: Smoki Cess Update 04 Nop 07

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

Page 8: Smoki Cess Update 04 Nop 07

Mild Severe

Survival

Persistent

Necrosis

Inflammation

Apoptosis

DNA damage

CIGARETTESCIGARETTES

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

Page 9: Smoki Cess Update 04 Nop 07

BRONCHIBRONCHITIS TIS CHRONISCHRONIS

EMPHYSEEMPHYSEMA MA

KANKER KANKER >> >> PARU >PARU >

HAMIL -HAMIL - ANAK ANAK ASMA >ASMA >

DIABETEDIABETES M >S M >

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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

Page 13: Smoki Cess Update 04 Nop 07

ACCUTE INFECTION ACCUTE INFECTION

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CHRONICLE INFECTIONCHRONICLE INFECTION

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MALIGNANCYMALIGNANCY

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Gb hal 148

PPOK

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Gb hal 149

BRONKITIS KRONIK

Page 18: Smoki Cess Update 04 Nop 07

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

Page 19: Smoki Cess Update 04 Nop 07

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)

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Who Scared ??Who Scared ??

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Who Scared ?Who Scared ?

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BUKAN LELAKI KALAU TIDAK BUKAN LELAKI KALAU TIDAK sundhut tembakausundhut tembakau

Page 27: Smoki Cess Update 04 Nop 07

Merokok dapat Merokok dapat

menyebabkan ..menyebabkan ..

………………………………………………

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Habits Habits

Or Life Style ?Or Life Style ?

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

Page 32: Smoki Cess Update 04 Nop 07
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70 % of SMOKERSREPORT WANTING

TO QUIT

Page 34: Smoki Cess Update 04 Nop 07

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

Page 35: Smoki Cess Update 04 Nop 07

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

Page 36: Smoki Cess Update 04 Nop 07

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

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

Page 37: Smoki Cess Update 04 Nop 07

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

Page 38: Smoki Cess Update 04 Nop 07

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

Page 39: Smoki Cess Update 04 Nop 07

AKIBAHARA CORNERAKIBAHARA CORNER

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????

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Gb hal 241

PNEUMOTORAKS