Treatment Strategy ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition
15.2 The Counselling Process
Duringtheinitialconsultation,thepatient’shistoryistakenandinformationiselicited concerninganyconcurrentillnessesthatmightberelevantintermsofsmokingcessation. The Fagerström Test is administered to determine the degree of nicotine dependence Table4.5in Chap.4 .Smokersundergoasituationalanalysistodeterminehoweasily theycanbeprovokedtosmoke,andtheCOcontentinexpiredairandforcedexpiratory volumein1sFEV 1 aremeasured.Theyareinformedindetailabouttheharmfuleffects ofsmoking,andtheeffectsofnicotineandthoseoftobaccosmokeanditsconstituentsare discussedseparately.Themodeofactionofthevariousnicotineproductsisthenexplained. Once smokers have consented to NRT, one or perhaps two nicotine products are pre- scribed,dependingontheextentofsmoking,theFagerströmTestscoreandCOlevelsin expiredair. Futureex-smokersareissuedwithaninformationbookletwrittenintheInstituteandare referredtothenearestpharmacistwithaprivateprescriptionandpreciseinstructionson howthenicotineproductsaretobeused.Patientsaretoldtostartusingthenicotineprod- uctsthatsamedayintheformsupplied.Adateisalsoixedforthenextappointment.The initialconsultationlastsfor1-h,givingsmokerstheopportunitytooutlinetheirmotivesfor smoking.Informationsessionsindialogueformathavebeenassessedpositively. Theappointmentscheduleforindividualsmokerswhowishtoquitdependsonthe progressmade.Weeklyappointmentsaremadeinitially,followedlaterbyappointments every2weeksandthenevery4weeks.Interimtelephonecounsellingisoftenconsidered helpful.Inallcases,thetargetisfortheex-smokertoreportanoutcomeoftobaccoabsti- nenceafter6months.Thenumbern=6–12anddurationofsubsequentcounsellingses- sionswilldependuponthesuccessoftherapy. Contrarytowhatisstatedintheprescribinginformation,nicotineproductsareusedin double or triple combinations, depending on the assessed severity of dependence see Table11.3in Chap.11 .Additionalindividualcounsellingforsmokersisessentialand booststhesuccessrate.Thedurationoftreatmentisguidedbytheactiveandsuccessful cooperationoftheex-smokerandmayrangefrom4to12weeks.Thenicotinedoseadmin- isteredinitiallyisreducedasrapidlyaspossible:thismeansthatthepatient’scravings shouldbeextremelyminimalorabolishedaltogether.Nicotinepatcheswithanicotine releaserateof1.5mghareprescribedtobewornonlyfor16hduringtheday.Thepatch doseisreducedbyhalvingthepatch–thoughthisisonlypossiblewithNicorettepatches. Nicotine chewing gum andor nasal spray are used in addition, with treatment supple- mentedbybothproductstogetherinexceptionalcasesonlyseeTable11.3in Chap.11 . IfsmokerswhowishtoquitdonotreceiveNRTwithnicotinedosesthataresimilarto thoseobtainedfromcigarettesmoking,theyrelapseatonce.Naturally,thesehighinitial dosesmustbereducedasrapidlyaspossible,butinawaythatreliablypreventsrelapses. Theriskofadverseeffectsthroughtointoxicationexistsonlyifex-smokersadditionally smokelargerquantitiesofcigarettesduringthisperiod.15.3 Experiences with Outpatient Smoker Counselling
Inthe2.5yearssincetheCentrehasbeeninexistence,atotalof1,000smokers,primar- ily from Thuringia but also from other regions of Germany, have enrolled with the intentionofquittingsmoking.History-takingrevealedthatthesepatientswerehighlydis- satisiedwiththeirsmokerstatus,andmanyofthemadmittedthatforyearstheyhad wantedtoquitthehabit,buthadbeenpreventedfromdoingsobytheirdegreeofdepen- dence.Overtheinterveningperiod,smokersforwhomsmokingcessationisanurgent necessityonmedicalgroundshavealsobeenreferredtotheCentrebytheirdoctors.After an initial consultation, patients from other German regions have then undergone tele- phonecounsellingandsuccessfullyachievedsmokingcessation.Amongthepatientsat theCentre,ivehadalreadywithdrawnfromalcoholandsuccessfullyremainedtobacco- abstinentfor6months. Onaverage,femalesmokershavesmoked20cigarettesdayfor17years,whilemale smokershavesmoked25cigarettesdayfor20–25years.Theveryheaviestsmokersconsume 80–100cigarettesday.Attemptsatsmokingcessationinitiatedbythesmokersthemselves havelastedforamaximum4weeksinwomenandgenerallyforonly1weekinmen. TheFagerströmTestinwomenhasrevealedscoresof4–6forthemostpart,withscores of7–10inisolatedcasesonly,whereasinmenscoresof4–6or7–10wererecordedwith equalfrequency.Atthestartoftreatment,thesmokershadanaverageCOlevelinexpired airof21ppm.Onthecompletionofsuccessfultreatment,levelsof5ppmwererecorded. COlevelsof80ppmweremeasuredinitiallyinfourcases.Forex-smokers,themeasure- mentofthisvariablewasanimportantmarkerofsuccessincaseswheresmokingcessation wasachieved. Further appointments with ex-smokers at weekly or fortnightly intervals are useful, particularlyatthestartoftreatment.Approximately25ofsmokerswhoattendairst appointmentfailtoreturnsubsequently.Afurther25giveupthetreatmentafter4–8 weeksbecausetheyhaverelapsed.Alsoofimportanceisthepatients’experienceofleav- ingtheirstconsultation–suppliedwithNRTproducts–withouthavingthecravingto smoke. This abstinence from smoking was also conirmed by virtually all ex-smokers 97duringthefollowingweekandshouldbeinterpretedasakeyexperience:“Thefeel- ingthatitisnotnecessarytosmoke.”Inthiscontext,itisimportantthatsmokersobtain theirnicotineproductsimmediatelyfromanearbypharmacy.Ifthecontinuoussupplyof nicotineisnotguaranteedimmediatelyaftertheirstconsultation,patientsturnbackto cigarettesandthus,starttosmokeagain.Parts
» Tobacco Plants and Their Origin Use of Tobacco for Religious Purposes
» The Appropriation of Tobacco by Europeans
» Development of the Cigarette
» Objections to Smoking on Health Grounds
» Women Won Over by the Cigarette
» The Medical Use of Tobacco in the Nineteenth Century
» Tobacco Research in the Twentieth Century
» Tobacco Consumption in the Twentieth Century
» Cigarette Smoking in the USA Since 1965
» Cigarette-Related Mortality in Different Countries
» Smokers and Other Risk Factors
» Smoking Behaviour and Educational Level in the EU
» Non-Disclosure of Findings by the Tobacco Industry
» The Cigarette as a Vehicle for Nicotine Release
» Modifications of Nicotine Release
» Maintaining Nicotine Dependence Nicotine and Dependence
» Marketing of Cigarettes with a “Reduced” Health Risk
» Compensatory Behaviour by Smokers
» Optimising Nicotine Release Nicotine and Dependence
» Importance of Absorption Rate
» Ammonium and pH Manipulation
» Cigarettes with Reduced Tar Yield
» Agonists and Antagonists of the nAChR and its Subtypes
» Effects of Nicotine on Receptors in Different Organs
» Metabolic and Hormonal Effects of Nicotine
» Central Nervous System Effects of Nicotine
» Types of Dependence Nicotine Dependence
» Molecular Biological Aspects of Dependence
» Genetic Aspects Nicotine Dependence
» Withdrawal Symptoms Nicotine Dependence
» Immunological Reactions Caused by Cigarette Smoking
» Association Between Smoking and Lung Cancer
» Tobacco-Specific Carcinogens Genetic Factors That Increase the Risk for Bronchial Carcinoma
» The Cytochrome P450 and GST System and Carcinogenesis
» Peptide Receptors, Genetic Factors That Increase the Risk for Bronchial Carcinoma
» Exogenous Factors and Lung Cancer
» Pathophysiology of COPD Cigarette Smoking and COPD
» Genetic Factors Important Risk Factors for COPD
» Occupational and Environmental Factors
» Caveats Concerning the Informative Value of Studies
» Cigarette Smoking and Bronchial Asthma in Adults
» Bronchial Asthma in Children
» Other Lung Diseases Influenced by Cigarette Smoking
» Coronary Artery Disease and Myocardial Infarction
» Changes in Endothelial Function and Microcirculation
» Microcirculation and O Systemic Vascular Changes
» Arteriosclerotic and Inflammatory Vascular Reactions
» Genetic Factors Blood Coagulation and Fibrinolysis
» Nicotine and Ischaemic Heart Disease
» Cognitive Impairment Central Nervous System
» Influence on Cognitive Performance
» Intellectual Impairment in Childhood
» Smoker Personality Profiles and Genetic Inheritance of Smoking
» Peculiarities of the Smoker’s Personality
» Reasons for Increased Cigarette Consumption
» Comorbidity Between Depression and Smoking
» Extent of Cigarette Consumption
» Effects of Smoking in Forms of Dementia
» Smoking and Parkinson’s Disease
» Diabetic Retinopathy Ocular Diseases
» Graves’ Ophthalmopathy Ocular Diseases
» Macular Degeneration Ocular Diseases
» Ocular Tumours Ocular Diseases
» Retinal Detachment Ocular Diseases
» Lipid and Cholesterol Metabolism
» Insulin Resistance Diabetic Nephropathy
» Oesophageal Cancer Gastrointestinal Tract
» Gastrointestinal Ulcers Gastrointestinal Tract
» Cancers of the Gastrointestinal Tract
» Pancreatic Cancer Gastrointestinal Tract
» Toxic Substances and Inducers
» Kidney Cancer Urinary Tract Diseases
» Bladder Cancer Urinary Tract Diseases
» Prostatic Hyperplasia and Prostatic Cancer
» Fertility Disorders Urinary Tract Diseases
» Vitamin D and Oestrogen Metabolism
» Osteoporosis Disorders of Mineral Metabolism and Bone
» Hip Fractures Disorders of Mineral Metabolism and Bone
» Skin Changes Skin and Mucosa
» Skin Tumours Skin and Mucosa
» Breast Cancer Skin and Mucosa
» Effects of Smoking on the Placenta
» Malformations Possibly Caused by Smoking
» Smoking and Sudden Infant Death Syndrome SIDS
» Effects of Nicotine on the Foetus
» Medical Care Costs Attributable to Smoking During Pregnancy
» ETS in the Workplace and at Home
» Fibrinogen Cholesterol Endothelium and Platelets
» Markers of Inflammation Changes at the Molecular and Cellular Level
» Passive Smoking During and After Pregnancy
» Coronary Heart Disease Cardiovascular Disease
» Stroke and Subarachnoid Haemorrhage
» Respiratory Tract in Children and Teenagers
» Bronchial Carcinoma Respiratory Tract
» Indications and Diagnostic Considerations
» Self-Help Interventions by the Smoker
» Physician Advice for Smoking Cessation
» Group Behaviour Therapy Programmes
» Mass Media Communication Strategies
» E-Learning, Email and Internet for Smoking Cessation
» Evaluation of Nicotine Products
» Nicotine Chewing Gum Nicotine
» Nicotine Sublingual Tablet Nicotine Nasal Spray
» Treatment and Dosage Nicotine
» Nicotine Chewing Gum Adverse Events Associated with NRT
» Nicotine Patch Adverse Events Associated with NRT
» Nicotine Nasal Spray Adverse Events Associated with NRT
» Nicotine Inhaler Adverse Events Associated with NRT
» Nicotine Sublingual Tablet Adverse Events Associated with NRT
» Nicotine Lozenge Adverse Events Associated with NRT
» Drug Interactions During Smoking Cessation
» Contraindications for the Use of Nicotine Products
» Nicotine Formulations as OTC Products
» Contraindications and Drug Interactions
» Tranquillisers and Buspirone Other Pharmacotherapies
» Various Antidepressants Other Pharmacotherapies
» Opioid Antagonists Other Pharmacotherapies
» Silver Acetate Other Pharmacotherapies
» Therapeutic Monitoring in Smoking Cessation
» Ischaemic Heart Disease Special Therapeutic Situations
» Pregnancy Special Therapeutic Situations
» Weight Gain Special Therapeutic Situations
» Alcohol Consumption Special Therapeutic Situations
» Organic Depression Organic Depression and Schizophrenia
» Schizophrenic Patients Organic Depression and Schizophrenia
» Interactions Between Cigarette Smoking and Administration of Psychopharmaceuticals
» Pre-operative Smoking Cessation Special Therapeutic Situations
» Social Influence Inoculation Strategy
» Life Skills Strategy Prevention Programmes for Schools
» Class 2000 Health Promotion Programme
» Trier University Health Programme Long-Term Studies
» Role of Teachers in Primary Prevention
» Prevention by Restricting Sales of Tobacco Products to Minors
» Role of the Mass Media in Sales of Tobacco Products to Adolescents
» Role of Government and Community in Primary Prevention
» Effect of Tobacco Industry Advertising Messages
» Tobacco Advertising and Adolescent Smoking Initiation
» Advertising with “Light” Cigarettes
» Smoking Bans in Public Buildings and Public Spaces
» Tobacco Industry, Governmental and Non-governmental Organisations
» Politicians and Their Attitude to Smoking
» Scientists and the Tobacco Industry
» Governmental Control of Toxic Tobacco Constituents
» Bans on Advertising in Various Countries
» Tobacco Industry: Playing Down the Risks of Smoking and Passive Smoking
» Smoking and Non-smoking: Weighing the Benefits
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