Reducing Tobacco Dependence

Question 1

What are the health risks of smoking?

Answer 1

2X risk CVS disease

5 x More likely to have microbiological confirmed influenza

3 X relative risk sudden infant death

11 x relative risk of lung cancer

Question 2

Markers of addiction

Answer 2

Use despite knowledge of harmful consequences

Cravings in abstinence

Failure of attempts to stop

Withdrawal symptoms abstinence

Question 3

How does smoking cause addiction?

Answer 3

Nicotine acts on nicotine acetylcholine receptor stimulating dopamine release -> satisfaction -> chronic exposure Ach enters upregulated state (increased affinity and functional sensitivity to an agonist) -> drop nicotine leads to craving/ withdrawal

1-2 puffs binds 50% Ach receptors

Ach takes between 6-12 weeks to desensitise (how long give NRT)

Question 4

How to treat smoking?

Answer 4

Smoking cessation (nicotine patches - long acting. Champix, buprofenon, nicotine gum, spray - short acting)

Statin primary prevention

Antihyoertensives in mild hypertension

Screening cervical cancer

Question 5

3As

Answer 5

Ask and record smoking status

Advice pt of health benefits

Act on patients response.