Strategies to Help Patients Quit Smoking

Como podemos ajudar um paciente parar de fumar? Dados recolhidos do sistema de informa o DYNAMED junto com experi ncias pessoais na tentativa de ajudar pacientes a pararem de fumar

No ser chato mais falar os dados concretos Voc est em uma negocia o. N o adianta for ar a barra....... N o tentar fazer uma tentativa de iniciar um tratamento para parar de fumar no meio do corredor. Consulta s para isto. Revele os dados de maneira clara....

Dados do tabagismo prevalence of daily tobacco smoking 31% in men > 15 years old from 187 countries in 2012 based on analysis of data of individuals > 15 years old from 187 countries from 1980 to 2012 age-standardized prevalence of daily tobacco smoking in 2012 31.1% in men 6.2% in women Reference - JAMA 2014 Jan 8;311(2):183

Maior risco isolado para mortalidade smoking is the single largest population-attributable risk factor for cancer mortality worldwide comprehensive systematic review of population-attributable risk factors for cancer mortality total 7,018,402 annual cancer deaths worldwide 1,493,000 (21%) attributable to smoking Reference - Lancet 2005 Nov 19;366(9499):1784

cancer sites associated with the cancer sites associated with the highest proportion of smoking highest proportion of smoking- - attributable deaths attributable deaths include lung/bronchus/trachea, larynx, esophagus, oral cavity, and urinary bladder based on cohort study 345,962 deaths in adults 35 years old in 2011 from 12 cancer sites evaluated estimated 167,805 deaths (48.5%) attributed to smoking largest proportion of smoking-attributable deaths for cancers of lung, bronchus, and trachea (80.2%), larynx (76.6%), esophagus (50.7%), oral cavity (47%), urinary bladder (44.8%) Reference - JAMA Intern Med 2015 Sep 1;175(9):1574,

cardiovascular disease and other vascular disorders current and former smoking associated with increased risk of cardiovascular death, acute coronary events, and stroke based on pooled analysis of individual patient data from cohort studies 503,905 patients 60 years old from 12 cohort studies were assessed self-reported smoking status included 40.2% never smokers, 47.4% former smokers, and 12.4% current smokers cardiovascular death in 7.5% overall

Comparados aos que no fumam current smoking associated with increased risk of cardiovascular death overall (hazard ratio [HR] 2.07, 95% CI 1.82-2.36) acute coronary events (HR 1.98, 95% CI 1.75-2.25) stroke (HR 1.58, 95% CI 1.4-1.78) former smoking associated with increased risk of cardiovascular death (HR 1.37, 95% CI 1.25-1.49) acute coronary events (HR 1.18, 95% CI 1.06-1.32) stroke (HR 1.17, 95% CI 1.07-1.26) former smoking associated with decreased risk of cardiovascular death vs. current smoking, (HR 0.85 for every 10 years since smoking cessation, 95% CI 0.82-0.89) consistent results in subgroup analyses by age and gender Reference - BMJ 2015 Apr 20;350:h1551 full-text

cognitive decline and other neurologic disorders smoking associated with dementia and cognitive decline based on meta-analysis of 19 prospective cohort studies 26,374 participants followed for 2-30 years for dementia 17,023 participants followed for 2-7 years to assess cognitive decline mean age 74 years compared to never-smokers at baseline, current smokers at baseline had increased risk for incident Alzheimer disease (relative risk [RR] 1.79, 95% CI 1.43-2.23) increased risk for incident vascular dementia (RR 1.78, 95% CI 1.28-2.47) increased risk for any dementia (RR 1.27, 95% CI 1.02-1.6) greater annual declines in Mini-Mental State Exam scores Reference -Am J Epidemiol 2007 Aug 15;166(4):367 full-text

depresso mental health disorders depression(1,2) estimated 30%-60% of tobacco smokers have history of depression current daily smoking associated with subsequent occurrence of suicidal thoughts or attempts based on prospective cohort study study enrolled 990 patients aged 21-30 years and followed them for 10 years compared to never-smokers, current daily smoking associated with subsequent suicidal thoughts or attempts (adjusted odds ratio 1.82, 95% CI 1.22-2.69) history of smoking not associated with development of suicidal ideation or attempts Reference -Arch Gen Psychiatry 2005 Mar;62(3):328

5-A strategy for advising patients recommended by United States Preventive Services Task Force (USPSTF) Ask about tobacco use Advise to quit through clear personalized messages Assess willingness to quit Assist to quit Arrange follow-up and support

Estratgias sem chiclete com media o para abstin ncia. Diminuir a cada semana um cigarro usado. N o usar mais nem menos. Um cigarro de 10 a 20mg de nicotina, na corrente sangu nea 1 a 2mg. Chiclete 2 a 4 mg. Usar a programa o utilizando o pr prio cigarro pode ser uma estrat gia com menos nicotina.

Cigarro eletrnico nicotina dilu da em uma subst ncia, normalmente o composto propilenoglicol. Essa mistura comparada em refis, que s o armazenados em um reservat rio dentro do dispositivo. Esse reservat rio ligado a um vaporizador, que transforma o l quido em fuma a. Na ponta que corresponderia ao filtro, o usu rio pode tragar esse vapor, como se estivesse fumando um cigarro comum.

Patch de nicotina Como o cigarro eletr nico , ele n o tem o mon xido de carbono e o alcatr o... Adesivos di rios de 7mg, 14 e 21mg Diminuir a cada quatro semanas. D mal estar... O adesivo desgruda... N o funciona em homens peludos... Por que usar pacht ou cigarro eletr nico se podemos usar o cigarro?

Melhor medicaes para abstinncia- CHAMPIC Varenciclina start 1 week before target quit date give orally with full glass of water after eating 0.5 mg once daily for 3 days 0.5 mg twice daily for days 4-7 1 mg twice daily for 11 weeks

Como funciona Varenicline binds with high affinity and selectivity at alpha-4- beta-2 neuronal nicotinic acetylcholine receptors. Varenicline exerts its effect by producing agonist activity at a sub-type of the nicotinic receptor while also preventing nicotine binding to alpha-4-beta-2 receptors .

A cada 8 , um resolve systematic review of 44 randomized trials evaluating selective nicotine receptor partial agonists (varenicline) in adults with tobacco use disorder compared to placebo, abstinence rates at 24 weeks were significantly increased with varenicline 2 mg/day for 12 weeks in analysis of 27 trials with 12,625 adults risk ratio (RR) 2.24 (95% CI 2.06-2.43) NNT 7-9 with abstinence at 24 weeks

ibupropiona monotherapy dosing for smoking cessation 150 mg/day bupropion extended-release orally for 3 days beginning 1-2 weeks prior to quit date after first 3 days, increase dose to 150 mg orally twice daily for 7-12 weeks consider continuing bupropion SR 150 mg daily up to 6 months after quit date discontinue therapy if patient has not shown significant progress toward abstinence by 7 weeks contraindicated with seizures, eating disorders, or monoamine oxidase inhibitor (MAOI) in past 2 weeks most common adverse events include insomnia (reported in 35%-40%) and dry mouth (reported in 10%) bupropion label has warning of increased risk of suicidal ideation and behavior, but rate appears low(2) bupropion monotherapy appears to improve smoking cessation rates (level 2 [mid-level] evidence)

Usar benzodiazepnicos para ajudar Enquanto a abstin ncia est em jogo e a evolu o da verenciclina est entrando na jogada utilizo: Lorax 2mg de duas a tr s vezes ao dia ou lexotan 6mg .....

Telefone do mdico para crises No mundo, utiizam sistemas de acompanhamento ao line, grupos, hot line, equipe multiprofissional Eu dou meu telefone para o paciente e pe o para ele me ligar quando est se sentindo mal .. e apoio o mesmo para continuar o tratamento e n o desistir.

Nada de extremismo. Liberalismo no trato e na mente. Se voc est negociando uma tentativa de para de fumar , qualquer discurso inflamado, falso moralista n o funciona. Estaremos ao lado do paciente com cigarro , sem cigarro e com muitas outras mis rias.........