SMOKING CESSATION AND REHABILITATIONDr. Oğuz KılınçDokuz Eylul University School of MedicineChest Departmentoguz.kilinc@deu.edu.tr

LECTURE PLAN

Fundamentals of smoking cessation (SC) programs

What is the role of rehab in SC? Is rehab effective in SC ?

What is smoking?

Disease: Nicotin addiction Treatment: Yes

Cause: Tobacco Vector: Tobacco industry Host: Human

Addiction triangle

Neurochemical

BehaviourPsychologic

More than 4000 chemicals in smoke

Nicotine COCancerogens

Irritans and poisons

N. Accumbens

Nicotinic receptor( α4β2)Neuromediator: Dopamin

CNSCNS- Ni- Nicotine cotine

Locus coeruleus(Craving)Neuromediator:Noradrenalin

Withdrawal symptoms

1. Jarvis MJ. BMJ 2004; 328:277-279.

70<10 wksAppetite increase

60<4 wksİrritability

60<4 wksDepression

50<4 wksagressivity

70<2 wksCraving

60<2 wksLose of concentration

25<1 wkSleep disturbance

10<48 hDizziness

Percentage(%)DurationSymptom

CONTROL OF NEUROCHEMİCAL DİMENSİON

Pharmacologic treatment NRT Bupropion Varenicline

Behavioural treatment

Why is important to understand the Behavioural and psychologic dimension ?

Understand this dimensions increase the success rate

Questions for behaviour and psychologic dimensions

What are the provocative factors for smoking?

Which conditions are important for smoking?

What are the results? Which factors are important

continuing the smoking?

Problematical behaviour: smokingProvocative factors

Conditional factors Workplace, home, car

Behavioural factors Tea, coffee, alcohol

Cognitive factors Triggering thoughts

“If I smoke I would relax”. “Smoking is very delicious after meal”

Emotional factors irritation, annoyance, joy

Group effect Smoking in group

Physiologic factors Withdrawal symptoms

Problematical behaviour: smokingProvocative factors

Continuing factors

Relaxing after smoking Reactional smoking

Problematic behaviour: smoking

Provocative and continuing factors differ patient to patient

Smoking cessation treatment should be tailor made

Consultant should help patient for changing behaviour

Pyschologic dimension of smoking

Recover “vision defection”

Smoking causes not only cancer, COPD, Buerger disease, Coronary artery disease but also “vision defect”

‘Smokers don’t see the real face of smoking because of “vision defect”

This condition is similar with love, The treatment of love is wedding.

How is emerge “love” How is emerge “love” with cigarette?with cigarette?

PersonsPersons

ObjectsObjects

EventsEvents

Don’t cause emotionDon’t cause emotion

Person

●A

Ayşe

Opinion

●B

WarmGood people

Emotion

●C

I like her

Behaviour

●D

negotiation

Object

●

ACigarett

e

Opinion

●

BPleasure,

It’s my friend,

Emotion

●

CLike

smoking

Behaviour

●

DBuy

cigaretteSmoking

Object

●ACigarette

Opinion

●B

Cause diseaseI have dispneaIt cause cancer

Emotion●C

FearDetastation

Feel lock of willpower

Behaviour

●D

Effort of smoking cessation

Realize and chance this condition is skill and can learn

If patients don’t chance opinion about smoking

They feel weak theirself Miss smoking To desire smokers

Relaps

If patients change their opinion about smoking

Feel of success Self confidence Optimism Feel energic Upset for smokers

Suggestion for smoking cessation processChange opinion about smokingFind out provocative factors and correct

Tea, coffeeAfter mealAlcoholStress

Pharmacotherapy

HOW CAN REHAB WORK İN SC?

Rehab can play role for behavioural and physchologic dimension

Addiction triangle

Neurochemical

BehaviourPsychologic

EFFECT OF REHAB İN SC

OBJECTİVE AND STUDY DESİGN

Parallel group study to investigate the effectiveness of a smoking

cessation programme performed during routine rehabilitation practice for outpatients

GROUPS

Group 1: Rehab + SC 102 pts Group 2: SC 101 pts

All participants underwent physical examination, pulmonary function tests and received identical behavioural and/or pharmacological treatment.

In addition, the intervention group underwent rehabilitation practice 3 times a week for 3 months.

SMOKİNG CESSATİON RATE AT THE END OF ONE YEAR Group 1

Abstinence rate %68 Maintained their smoking habits %14 Lost after enrolment %12

Group 2 Abstinence rate %32 Maintained their smoking habits %52 Lost after enrolment %16

CO ölçümü ve evden birine sorma yöntemiyle bırakma değerlendirilmiş

DİSCUSSİON

Therefore a possible explanation for the difference observed could be that the intervention group individuals were highly health motivated (this subset of subjects was recruited among individuals who underwent rehabilitation 3 times per week for 3 months).

LİMİTATİONS

due to ethical reasons we did not randomize participants and it was not possible to include in the control group patients with serious medical disorders

Since our study was performed in only 2 centres, we believe that the data obtained may suggest the opportunity of further prospective multi-centre studies to confirm our data

Missing cases might cause selection bias

SUMMARY

All patients attending rehab ask about smoking and advice quit smoking.

Support the hypothesis that considering smoking cessation programmes as a mandatory component of rehabilitation may be highly effective in increasing smoking cessation rate and could be an additional strategy to reduce smoking habits

THANK YOU FOR YOUR ATTENTİON