Smoking Lec OSPAP 2024 PDF

WEE K 1 3 OSPAP Programme Smoki ng Waton Rebecca [email protected] Slide 1 MPMH15 - WEE Learning K 1 3 Outcomes To describe the current status of...

WEE K 1 3 OSPAP Programme Smoki ng Waton Rebecca [email protected] Slide 1 MPMH15 - WEE Learning K 1 3 Outcomes To describe the current status of tobacco use in England To understand the harm associated with tobacco use To know the strategies employed within the UK to tackle tobacco use To describe the role of pharmacy in supporting the harm reduction for tobacco To be able to conduct a smoking cessation consultation with a patient Slide 2 MPMH15 - WEE K 1 Role of Pharmacy in Smoking 2 Cessation Overview of the evidence for smoking cessation (Anderson, Blenkinsopp and Armstrong, 2009): – Community pharmacist trained in behaviour- change methods are effective in helping clients stop smoking (B1) – Community pharmacy-based stop smoking services are cost effective (B1) – Abstinence rates from one-to-one treatment services provided by community pharmacists and primary care nurses are similar. Rates are lower for specialist one-to- one advice than group interventions with specialist behavioural support (B3) – Training increases knowledge, self-confidence and positive attitude of pharmacists and their staff in relation to smoking cessation (B1) – Involving B1 = Individual pharmacy Randomised support staff may increase the Controlled Trials B3 = Individual well-designed non-experimental studies, controlled statistically if appropriate. provision Includes studies of brief using case advice and control, longitudinal cohort,recording matched pairsof smoking or cross-sectional status random sample in patient methodologies, medication plus records well designed qualitative (B3) studies and well-designed analytical studies including secondary analysis Slide 3 MPMH15 -  Name the tobacco… 2 3 1 4 7 8 6 9 1 0 5 11 Slide 4 MPMH15 - WEE Tobacco in Images - K 1 2 Glamourous Slide 5 MPMH15 - WEE Tobacco in Images - K 1 2 Safe? Slide 6 MPMH15 - WEE Tobacco in Images - K 1 2 Deadly Slide 7 MPMH15 - WEE Hazardous contents of K 1 2 tobacco (WHO, 2006) Cigarettes contain more than 4,000 compounds, many of which are toxic and can cause damage to healthy tissue Tar, which is mostly deposited in the lungs, contains a combination of chemicals, many of which are known carcinogens Nicotine is the psychoactive drug in cigarettes which also affects the cardiovascular Slide 8 of MPMH15 - system WEE The Scale of the Problem K 1 2 (OFNS 2022) In 2022, 12.9% of people aged 18 years and above smoked cigarettes, which equates to around 6.4 million people The proportion of current smokers in the UK has fallen significantly from 14.1% in 2019. 14.6% of men smoked compared with 11.2% of women. Those aged 25 to 34 years had the highest proportion of current smokers (16.3%). However, those using e-cigarettes Slide 9 has MPMH15 increased - from 7.7% in 2021  The scale of the problem (OFNS 2022) In the UK, around 22.8% people in routine and manual occupations smoked, this is just under 3 times higher than people in managerial and professional occupations (8.3%). Unemployed people were more likely to be smokers than those who were employed (20.5% vs. 12.7%) In Great Britain, 45.4% of people who currently smoked said they wanted to quit https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adults mokinghabitsingreatbritain/2022 Slide 10 MPMH15 - WEE Health burden of smoking K 1 2 (NHS digital 2020) In 2019/20…….. 506,100 hospital admissions attributable to smoking. Similar to 2018/19 but 10% higher than 2009/10 when it was 461,700 74,600 deaths attributable to smoking. Decrease of 3% from 2018 (77,000) and 9% from 2009 (82,000) 710,000 prescription items to help people stop smoking dispensed. Decrease of 4% from 2018/19 (740 thousand) and 71% from 2009/10 (2.48 million) https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-public-health/2021 Slide 11 MPMH15 -  The cost of smoking to society Research commissioned by ASH (2021) has shown that the total cost to society (in England) is approximately £17.3 billion a year. This includes: – The cost to the NHS of treating diseases caused by smoking in England which is approximately £2.5 billion a year – Loss in productivity to the UK economy (£14.1bn) – Social care costs of older smokers (£1.2bn) – Costs of fires caused by smokers’ materials (£328m) Interestingly in 2022-23, the treasury earned £10bn in revenue from tax. https://ash.org.uk/uploads/EconomicImpactSmokeFreeUK-FINAL_2022-03-22-115123_xbkt.pdf?v=1647949 Slide 12 MPMH15 - 883 Slide 13 MPMH15 - WEE Smoking is an K 1 2 addiction Up-regulation of nicotinic receptors of smokers mean that reduction in nicotine intake causes symptoms of withdrawal Nicotinic receptors stimulate production of dopamine which causes feelings of satisfaction and reward It is a physical addition as well as psychological The most successful quite attempts address both of these components Slide 14 through: MPMH15 - WEE Physical K 1 2 Addiction Reducing nicotine intake in smokers causes withdrawal symptoms Short term withdrawal symptoms include: – Light headedness, difficulty concentrating, sleep disturbance, depressed mood, irritability and restlessness Longer term patients may experience: – Increased appetite and weight, constipation and mouth ulcers Most last only up to 4 weeks The urge to smoke can continue for more than 10 weeks after quitting Slide 15 MPMH15 - WEE Re-normalisation of the K 1 2 body After quitting cigarette smoking, the body begins to re-normalise: – After 20 minutes heart rate and BP returns to normal – After 12 hours reduction in carbon monoxide in lungs (can also be used for monitoring purposes) – Oxygen levels return to normal – Coughing as cilia in the lungs being to work and breathing becomes easier – Lung function increased – After 30 days risk of heart attack and Slide 16 MPMH15 -  https://makesmokinghistory.co.uk/app/uploads/2022/11/CURE-2022-A-Helping-Hand-v2.0-final-version. pdf Slide 17 MPMH15 - WEE Psychological K 1 2 Addiction Is the person ready and motivated to quit? From set quit date “Not to have a single puff” Removal of smoking ‘prompts’ such as ash trays, lighters etc Strategies to cope with urges to smoke and Slide 18 distraction MPMH15 - from ‘missed’ WEE NHS Stop Smoking K 1 2 Services Intervention Settings types – Children’s centres – Closed group – Community – Couple/ family – Community – Drop-in clinics psychiatric – One-to-one – Dental support – General Practice – Open group – Hospital Pharmacotherapy – Telephone – Maternity – support NRT – Military base – Bupropion – Pharmacy – Varenicline – Prison – Combinations of the – Psychiatric above hospital – School – Workplace Slide 19 MPMH15 - WEE Helping people to quit K 1 (BMA and 2 RPS, 2014) Nicotine Replacement Therapy (NRT) – Facilitates the gradual withdrawal of nicotine – Available in a range of formulations and dosage routes – Combinations can be used to help provide a ‘baseline’ of nicotine that can be ‘topped up’ at point of increased urge to smoke – Mainly chosen based on patient preference – Tailored based on level of dependence – Counselling on use and managing patient expectations is an important aspect of their use Slide 20 – Although MPMH15 - contains nicotine, safer than WEE Helping people to K 1 2 (GlaxoSmithKline UK) quit Bupropion (Zyban) – POM – Noradrenaline and dopamine re-uptake inhibition – Reduces severity of withdrawal symptoms and reduces urge to smoke – Start 1-2 weeks before quit date – Common side effects include dry mouth, GI disturbances, taste disturbance, agitation, anxiety, dizziness, depression, headache, impaired Slide 21 concentration, MPMH15 - insomnia, tremor, fever, WEE Helping people to quit K 1 2 (Pfizer, Thistle Pharma (unlicensed)) Varenicline (Champix▼) - back in stock January 2025 – POM – Partial agonist at nicotinic receptors which helps to reduce withdrawal symptoms, and also prevents ‘reward’ from intake of nicotine – Reduces severity of withdrawal symptoms and reduces urge to smoke – Start 1-2 weeks before quit date – Common side effects include GI disturbances, appetite changes, dry mouth, taste disturbance, headache, drowsiness, dizziness, sleep disorders, abnormal dreams – Rarely it can cause suicidal behaviour Slide 22 MPMH15 -  Helping people to quit (Consilient Health) Cytisine o POM o Works in a similar way to Champix, binding at Nicotinic receptors o Similar S/Es to Champix but less common o Standard course of treatment is 25 days but could be more effective for use up to 12 weeks (unlicenced) o Not recommended for Under 18s or Over 65s WEE Helping people to quit K 1 2 (Croghan, 2011) Behavioural support – Important in combination with all pharmacological treatments – Structured programme of usually up to 12 weeks – Patient has a consultation with a trained smoking cessation adviser every 1-2 weeks – Consultations will usually include: Information on consequences of smoking Information on withdrawal symptoms Assess current readiness and ability to quite Assess past history of quit attempts Setting a quite date and preparation for stopping smoking Assessment of smoking behaviour e.g. Heaviness of Smoking Index Carbon monoxide or cotinine testing Addressing any ‘slips’ Effectiveness of pharmacotherapy being used Reinforce importance of abstinence and ‘not a puff’ rule Supports development of ‘coping’ mechanisms and relapse prevention Congratulate on any progress Arrange supply of pharmacotherapy Slide 24 MPMH15 - WEE K 1 Heaviness of Smoking Index (Heatherington et al., 1991) 2 Scores: 1-2 = Low dependence 3 = Low to moderate dependence 4 = Moderate dependence 5-6 = High dependence SlideWill 25 influenceMPMH15 NRT -  Alternatively, conduct the Fagerström Test for Nicotine Dependence (FTND) as a quantitative measure of nicotine dependence Slide 26 MPMH15 - WEE Carbon Monoxide K 1 2 Testing (Crogan, 2011) Measures the quantity of carbon monoxide in expired air Used to assess nicotine dependence objectively Used at initial assessment and to validate quit status at 4 weeks Clients hold their breath for 15-20 seconds then blow into the detector Non-smoker should have