Department of Family Medicine Smoking Cessation Counselling By: Lucie Desjardins Bscn R.N Certified Smoking Cessation Counsellor from CAMH

Fast Facts on Tobacco Use in Canada Tobacco kills 1 in 5 Canadians or 45,000 peoples every year Economic impact of smoking is estimated at 17 billions every year Tobacco related disease for at least 500,000 hospital day each year 17.5 % of Canadian age 15 and over are current smokers Department of Family Medicine

Why Should Health Professionals Get Involved? Tobacco is the first cause of preventable death in Canada Successful intervention exist 1 pack a day at $10/pack = $3,600/year Lung cancer treatment = $19,000/yr per person Smoking cessation counselling session is way cheaper and is one of the most cost – effective intervention a clinician can perform after immunization Smoking tobacco should be treated as a chronic disease, the same as we do for hypertension and diabetes Department of Family Medicine

Involving health care professionals Multiple quit attempts may be necessary Past failure does not prevent future success Optimal intervention is 31-90 minutes for estimated abstinence Rate of 26.5% (1 in 4) Department of Family Medicine

What Are Tobacco And Nicotine? Tobacco is a plant that contains nicotine Nicotine is one of the major addictive component in tobacco More than 60 carcinogens are in cigarette smoke To name a few: Arsenic – a deadly poison used in insecticides Formaldehyde – used to preserve dead body Cadmium – highly poisonous metal used in battery Shellac – wood varnish Ammonia – cleaning agent Department of Family Medicine

Tobacco and Nicotine - Background Tar – toxic chemical found in cigarette is a contributing factors causing C.O.P.D. and respiratory problem In solid form, tar is brown, tacky substance that is left behind on the end of cigarette filter. It stains a smoker's teeth and fingers brown and coats everything it touches with brownish–yellow film, imagine that settling into the delicate pink tissue of lungs!!! Department of Family Medicine

Department of Family Medicine Carbon Monoxide (co) Toxic gas that is produced when there is combustion of any product including tobacco When inhaled (Co) compete with O2 in the blood stream to form COHB( carbonxyhaemoglobine) This starves the body tissue of O2, CO can remain in the bloodstream for up to 24 hrs. It takes 8 hrs to see a decreased level A normal level of CO in blood stream is below 6 ppm A smoker can have up to 50 ppm Department of Family Medicine

Department of Family Medicine Carbon Monoxide It is hard to believe but cigarette users inhale 4 times the amount of CO found in car exhaust There is a tool that calculates the level of CO. It is called PICO (piCO+smokerlyzer (Breath Carbon Monoxide (CO) Monitor). The patient takes a deep breath and keeps the air in their lungs for 8 - 10 seconds then need to blow in the device. This give me the measurement of COHB% AND PPM OF CO in the blood. If you do the test, you can explain to the client their level and this can become a good source of motivation as the level will decrease once they cut down on their cigarette intake and will return to normal once an individual quits smoking When the level of CO decreases, the client has more energy, skin coloration in the face gets more pink than grey Department of Family Medicine

What Your Carbon Monoxide Levels? 0-5 Non-smoker levels 20 ppm Loss of oxygen to vital organs 35 ppm Legal limit for 8 hr workplace exposure 50 ppm Air pollution emergency 60 ppm Headaches, nausea, nervous system slows down, difficulty thinking clearly, vision difficulties Department of Family Medicine

VIDEO – Quitting Smoking is a Journey Department of Family Medicine

Algorithm for tailoring pharmacotherapy Department of Family Medicine

Medications for quitting smoking Department of Family Medicine

Costs of Smoking vs Pharmacotherapy Note: Dispensing fees vary between pharmacies and costs may slightly differ between chains Department of Family Medicine

Fagerstrom test for nicotine dependence Department of Family Medicine

Bruyère questionnaire for smokers Department of Family Medicine

Counselling session for smoking cessation Department of Family Medicine

Counselling session for smoking cessation - 2 Department of Family Medicine