What is the public health impact of tobacco consumption?
According to estimates of the World Health Organization, annually die about five million people around the world as a result of this consumption. If effective measures to prevent and control are not imposed, within twenty to thirty years, will be attending the annual death of about ten million people worldwide. In Portugal, tobacco use is, as throughout the world, a major cause of morbidity and preventable mortality. It is estimated that in 2000 has been responsible for 85% of deaths due to lung cancer, 26% of all cancer deaths and 9% of all deaths from cardiovascular diseases in men checked. This consumption was also responsible for about 22% of all deaths, 18% of deaths from cardiovascular disease and 65% of deaths from chronic obstructive pulmonary disease observed in men 35 to 69 years for 26% of deaths from cancer lung and 17% of deaths due to chronic obstructive pulmonary disease observed in women (35-69).
That tobacco smoke constituents?
Tobacco smoke is an aerosol comprising a gaseous phase and a particulate phase. In addition to nicotine, it contains more than 4,000 substances, several of which have toxic, irritant effects such as carbon monoxide to, acetone, methane, formaldehyde, and ammonia, other with a carcinogenic effect, such as aromatic hydrocarbons polycyclic, N-nitrosamines, aromatic amines, aldehydes, various heavy metals and radioactive substances such as polonium-210. According to European directives on labeling of tobacco products must be mentioned the nicotine levels, carbon monoxide and tar.
What effects can cause the tobacco constituents?
Nicotine has psychoactive properties, changing moods. Reaches the brain within seconds after absorption through the lungs and / or mucosa of the mouth, nasal cavity and oropharynx, spreading through the blood stream to the entire organismo.Os effects of nicotine on the central nervous system are crucial in the development tobacco dependence, also serving as the skeletal muscles and the cardiovascular system;
Tar causes yellowing of the fingers and teeth of smokers. The tar contains more than 3 500 chemicals, including powerful carcinogens such as polycyclic aromatic hydrocarbons, nitrosamines;
Carbon monoxide: is an odorless gas that, when inhaled in large quantities, becomes mortal. is formed during the combustion of tobacco products. It is toxic to the body, reducing the blood's ability to carry oxygen from the lungs to the tissues and organ cells. It is associated with the development of ischemic heart disease.
What criteria are used to evaluate tobacco dependence?
A strong desire or compulsion to take the substance;
Difficulty in controlling consumption, in terms of its beginning, its end or its intensity;
withdrawal syndrome;
Development of tolerance;
progressive loss of interest in social activities, work or leisure, due to the use of the substance, or increase the time devoted to obtaining or its use;
Persistence consumption, even when there are already apparent disease symptoms.
In addition to the social factors, there is a genetic influence in the development of tobacco dependence?
Genetic differences in brain nicotine receptors may also help explain a large part of the interindividual variability concerning the initiation and maintenance of consumption. Nicotine is a psychomotor stimulant and the new tilizadores, reduces reaction time, improves attention and memory, reducing stress and anxiety and decreases the appetite. However, it induces tolerance, or repeated exposure to the same amount of nicotine leads to reduction of the effects observed initially, which can lead to increased doses consumed.
What is the withdrawal syndrome?
The nicotine withdrawal syndrome is characterized by a series of characteristic symptoms such as irritability, anxiety, depression, uneasiness, physical discomfort, headache, and sleep disorders, among others. In addition to these symptoms, it frequently occurs the urgent need to pick up a cigarette, increased appetite and difficulty concentrating. The symptoms of the withdrawal syndrome commence after 2-12 hours and reach a peak by 24-48 hours after smoking cessation. Most symptoms lasts about 4 weeks, but the feeling of hunger and the need of nicotine can last 6 months or more. Symptoms of withdrawal syndrome may mask or worsen the symptoms of other psychiatric disorders or side effects of other drugs.
What is the importance of smoking cessation for the health of the community?
Based on estimates from the World Bank and WHO, investment in smoking cessation is the most effective way to achieve in the short and medium term, improvements in morbidity and mortality indicators related to tobacco consumption. In fact, unless the current smokers to stop smoking, the number of deaths related to tobacco consumption will continue to increase in coming years, given the time lag between the onset of smoking and the diseases associated with him. According to estimates, by 2020 if half of current smokers quit, the cumulative number of deaths averted in 2050, one hundred and eighty million of will.
What are the health benefits associated with smoking cessation?
Smoking cessation has always led to improved health status of the individual. Promotes immediate benefits in both genders at all ages (although larger in younger age) in subjects with or without smoking-related diseases:
What other advantages we can mention about smoking cessation?
Apart from the above, stop smoking before or during early pregnancy reduces the risk of having a baby with low birth weight to levels of non-smoking women. There is also a reduction of morbidity and mortality in cases of peripheral arterial disease, peptic ulcer disease, cervical cancer and chronic obstructive pulmonary disease (COPD). They are still belittle other benefits of smoking cessation, such as economic, sensory, aesthetic and improved self-esteem.
There are priority criteria for referral of smoking to a smoking cessation consultation?
Smoking seriously Look upon quitting smoking in the next 30 days;
Smokers who smoke the cigarette 1 the first 30 minutes after waking;
Smokers who consume 20 or more cigarettes per day;
Smokers who in a previous attempt, even with adequate drug treatment, could not remain without smoking and registered an intense withdrawal syndrome;
Smoker, having quit smoking, presenting a severe withdrawal syndrome;
Smokers with tobacco-related diseases, in particular COPD and lung tumor;
Smokers with ischemic heart disease, cardiac arrhythmias and hypertension not controlled;
Smokers with other addictive behavior (alcohol, illicit drugs, cafeísmo, compulsive gambling, etc.);
Smoking stabilized psychiatric illness;
pregnant smokers or breastfeeding, and women in family planning;
Smoking children or adolescents;
Smoking in a health establishment;
elderly smokers.
What factors can predict the success or failure of smoking cessation?
Gender (lower probability of success in women, although not all studies confirm this, greater concern with weight gain);
educational level (more likely to succeed in smokers with higher education level);
tobacco amount smoked / dependence level (less likely to succeed in smokers with high dependency);
previous attempt maintained (most likely to succeed in smokers with previous attempts);
Depression (lower probability of success);
Factors family of genetic or behavioral (less likely to succeed if heavy smokers direct family members);
Relapse in the two weeks after D-Day (less likely to succeed).
Relapse is a major problem during the smoking cessation process. What strategies can be used to prevent relapse?
Identify high-risk situations and triggering stimuli the urgent desire to smoke;
Learn to avoid high-risk situations and triggering stimuli;
Train previously practical approaches to dealing with high-risk situations (take a deep breath, drink water, walk, call a friend);
Reduce or eliminate other behaviors usually associated with tobacco consumption – coffee, alcohol and sweets;
Avoid being in the vicinity of people smoking;
Prepare a strategic plan to address a possible lapse of the situation so that it does not become a relapse. In the case of having been earlier relapses, its cause must be analyzed in order to draw conclusions for a next attempt;
Adopt a more active and healthy lifestyle.
In a first phase of smoking cessation, the role of the healthcare team?
Health professionals should be able to establish a relationship of empathy with the smoker in order to avoid confrontation and to help resolve the ambivalence about to quit. Motivational interviewing is a form of directive counseling, person-centered, to stimulate a behavioral change through operation of mechanisms and resolution of ambivalence and enhancing the level of readiness for change, with the following objectives:
Increase awareness of the problem (the sense of importance of the problem and the need for change);
Explore and help resolve the ambivalence;
Help overcome obstacles;
Support the decision-making process for change.
How important is the use of medications to quit smoking?
Smokers who want to quit smoking, in particular those with average consumption of more than 10 cigarettes a day, should be encouraged to use drug therapy, since the success of smoking cessation increases significantly relative to smokers who stop smoking without support. The drugs currently recommended for smoking cessation can be classified as first and second line, as show more or less effectively and more or fewer side effects. First line to consider nicotine replacement therapy (NRT), in their various pharmaceutical formulations and bupropion. second-line drugs are considered nortriptyline and clonidine. Varenicline, recently introduced in the market, has expanded the range of pharmacological options available.
There is the possibility of a combined drug treatment?
Although there is still no precise recommendations on the use of combination therapy, it is known that the combination of drugs can contribute to the achievement of therapeutic added benefits. This combination may include two types of therapeutic formulations of NRT, whether or not associated with bupropion.
What are the main ideas to keep in mind to quit smoking?
Have willpower;
Establish realistic goals and objectives;
Seek the support of health professionals.