SGARA BIRAKMA YNTEMLERDo. Dr. Sait KarakurtMarmara niversitesi Tp Fakltesi Gs Hastalklar ve Youn Bakm Ana Bilim Dal

SGARANIN ZARARLARI BamllkHastalk ve lmKarsinojenlerZehirli gazlarTm kanserlerin %30uKronik bronitlilerin%66sDamar hastalklarnn %13Sigara ime arzusuSigara iimiNikotin KISIR DNGPeto R et al. Mortality from smoking in developed countries 1950 - 2000: Indirect estimates from National Vital Statistics. Oxford University Press 1994

SGARANIN ZARARLARIHer 5 lmden biri sigara iimine bal

Sigara ienlerin yars sigara ile ilgili hastalklardan erken yata lrler.

NKOTN=bamllk yapc madde

Beyinde norepinefrin ve dopamin dzeylerini direkt olarak ykseltir

Uyarcdr, stimlan ve forik etki oluur

nsana keyif verici etkiler oluturur

Nikotinin fizyolojik etkileriNoradrenalin ve dopamin salgsn arttrrEnerjiyi arttrrKonsantrasyonu arttrrEl - gz koordinasyonunu artrrfori yapartah azaltr

SGARA ME ALIKANLIISigara alkanlna yol aan faktrlerPsikolojikSosyalDavransal

Sigaray brakmaya doru deien davran modeliDnme ncesi dnemDnme dnemiBasn, yayn organlarArkadaAileSalk alanHamilelik, ocuklarHastalklar.Hazrlk dnemiHarekete geme dnemi

SGARA ENLER SGARAYI BIRAKMAK STYORLAR MI?

Sigara ienlerin %67si sigaray brakmak istiyor. Gnde 10 adetten daha az sigara ienlerin sigara brakma istekleri az bulunmutur.

OU SGARA CSNN YARDIMA HTYACI VARDIRHughes JR et al. Smoking cessation among self-quitters. Health Psychol 1992; 11: 331-4Sigaray kendiliindenbrakanlar(%) Sigaray braktktan sonra geen gnler

Sknt hissiSinir bozukluu, kzgnlkHassasiyetUyuma glKonsantrasyon bozukluuBa arsYorgunluktah art

Yoksunluk belirtileri birka saatte balar, 2-3 gnde en yksek dzeye ulaarak genellikle 3-4 haftada sona erer.

Nikotin yoksunluk belirtileri

Sigara braktrma polikliniiZAMANLAMAGRMENCELEMELERSolunum fonksiyon testiAkcier grafisiHemogram, kan yalarKarbonmonoksit lmDANIMA+LA TEDAVSTAKP

Bamllk derecesi-Fagerstrm Skalas Gnde ne kadar sigara iiyorsunuz?< 10011- 20121-30231> 3 lk sigaranz sabah kalktktan ne kadar sonra iersiniz?

lk 5 dk iinde 36- 30 dk 231- 60 dk 11 saatten > 0

Bamllk derecesi- Fagerstrm SkalasSigara ime yasa olan yerlerde zorlanyor musunuz?Evet1Hayr0En fazla vazgemek istemediiniz sigara hangisi?Sabah ilk sigara1Dierleri0Gnn ilk saatlerinde daha sonraki saatlere gre daha sk m iiyorsunuz?Evet1Hayr0Gnn byk blmn yatakta geirmenize yolaan bir hastalnz olsa da ier misiniz?Evet1Hayr0

Bamllk derecesi-Fagerstrm Skalas0-2ok dk3-4Dk5Orta6-7Yksek8-10ok yksek

KARBONMONOKST LM

Akcier grafisiNormalKronik obstrktif akcier hastal

Bilgisayarl akcier tomografisi

normalKOAH

normalKOAH

normalKOAH

Sigaray brakma ekli Baar oran

Aniden brakma % 80 Azaltarak brakma % 6Sigara birden braklmaldr

SGARA BIRAKMA YNTEMLER-farmakoterapiNikotin replasman tedavisiNikotin bantlarNikotin sakzNikotin nazal spreyNikotin inhalerNikotin d tedavilerYava salnan bupropionNortriptilin?Klonidin?

Plazma nikotin dzeyleri

Nikotin bantlar (7-14-21 mg)En az 10-15 adet/gn sigara kullananlarda daha yararl8 haftalk tedavi yeterli24 saat takmak ile sadece uyanklk dneminde takmak arasnda fark yokDoz azaltlarak ya da aniden kesilebilir.

Nikotin sakz (2-4mg)Gerektiinde ya da belli zaman aralklarnda dzenli olarak kullanlabilir.Gnde 24 adete kadar kullanlabilirAr iicilerde (25adet/gn) 4mglkSigaraya gre orta derecede kan nikotin dzeyi salar.8-12 haftalk tedavi

Nikotin nazal sprey ve inhalasyon formuNikotin en hzl burun mukozasndan emilir.nhalasyon formu akcierlere ulaamaz ve az mukozasndan emilir.3-6 ay tedavi

NKOTN REPLASMAN TEDAVSNN (NRT) SGARA BIRAKTIRMAYA ETKSNRTnin kullanm sigaray brakma orann 2 katna karr.SADECE RADENRT KULLANIMI 2

NKOTN REPLASMAN TEDAVS KONTRENDKASYONLARINikotin replasman tedavisi sigara imekten daha gvenlidir.Hamilelik Kontrolsz kardiyovaskler hastalk

BUPROPON (150 mg tablet)Antidepresan Dopaminerjik ve noradrenerjik etkiliSigara brakma tarihinden 1 hafta nce balanr3 gn 1 tablet/gn, daha sonra 12 saatte bir 1 tabletEpilepside kontrendike6 aya kadar kullanlabilirPlaseboya gre sigara brakma orann 2 kat arttrr

BUPROPONUN SGARA BIRAKTIRMAYA ETKSBupropion kullanm sigaray brakma orann 2 katna karr.SADECE RADEBUPROPONKULLANIMI 2

BAARI ORANLARIDanma+ila tedavisi ile 1 ylda %25-30

Sigaray braktktan sonra kilo artBeklenen 2.5-4.5 kg 13 kg zeri nadir (kadn, beyaz olmayanlar ve ar sigara ienler)Nikotin yoksunluk semptomlarnn erken dnemlerinde ek neri yaplmazDiyetEgzersiz

20 dakika sonra

8 saat sonra 24 saat sonra...

Kan basnc ve kalp atlar dzelir.

Kandaki nikotin ve CO miktar yarya der.

CO vcuttan tamen atlr; Akcier sigara kaynakl mukusu temizlemeye balar;Kalp krizi riski azalmaya balar.SGARAYI BIRAKMANIN YARARLARI

SGARAYI BIRAKMANIN YARARLARI

48 saat sonra

72 saat sonra

2-12 hafta sonra...

Vcut nikotinden tamamen temizlenir.

Nefes almak kolaylar, enerji seviyesi ykselir.

Kan dolam daha salkl gerekleir;Yrmek ve komak kolaylar.

SGARAYI BIRAKMANIN YARARLARI

3-9 ay sonra

1 yl sonra

2-4 yl sonra

10 yl sonra

ksrk ve gsteki hrlt azalr;Nefes alma sorunlar iyileir.

Kalp hastal riski yarya iner.

nme riski byk oranda der.

. lm riski hi imeyenler ile ayn olur.

Key Communication Messages :Withdrawal from nicotine can lead to nicotine cravingsThese cravings can be a major barrier to successfully giving up smokingSlide 43 - The cigarette - a dirty syringeObjective :Nicotine drives the smoking habit. Confirm that smoking is a vicious circleSlide 35 - The smoking habitObjective :Demonstrate the role of nicotine in smoking, and the different aspects of smoking - the social and behavioural practicesKey Communication Messages :Nicotine has been clearly established as the source of dependence to smoking tobacco1. Each time cigarette smoke is inhaled, a direct nicotine hit in the brain occurs. Nicotine stimulates the same central reward pathway in the brain (the mesolimbic dopamine pathway) that is affected by drugs such as heroin and cocaine2 There is more to cigarette dependence than getting a hit. Smokers come to associate the smell of tobacco, the scratch in the throat when inhaling smoke and the activity of smoking with the nicotine reward. This ritual of smoking is a behavioural process2In addition, smoking is often associated with certain social situations such as being in a pub, meals and the morning cup of coffee

References :1.Orleans CT, Slade J. Nicotine Addiction: Principles and Management 1993; (2): 24-452.West R. Getting serious about stopping smoking. A report for No Smoking Day 1997Slide 32 - How many smokers want to quit ?Objective :To show that the majority of smokers would like to quitKey Communication Messages :Across both sexes the majority of smokers want to quit1More than two thirds of smokers (67%) want to quit1 Lighter smokers (less than 10 cigarettes a day) are slightly less likely to want to quit1

Reference :1. Living in Britain 1996, General Household SurveySlide 37 - Most smokers need help to quitObjective :To gain agreement that quitting smoking is difficult and requires more than just willpowerKey Communication Messages :The poor success rate of quitting smoking is primarily due to nicotine dependence1. Similar reports show that after 30 days, only 19% of smokers quitting on their own are still abstinent, reducing to 8% after 6 months2The case is clear that smokers need more than just willpower alone to help them quit

References :1.Shiffman S. Critical review of the current status of smoking cessation in the USA. Tobacco Control 1995; 4 (suppl 2): S3-S242.Hughes JR et al. Smoking cessation among self-quitters. Health Psychol 1992; 11: 331-4Slide 45 - The case for nicotine replacement therapy (NRT)Objective :To demonstrate that NRT is much more effective in helping smokers quit than willpower aloneKey Communication Messages :Using willpower alone is the most commonly tried method of giving up smoking, however, only about 3% of smokers are still cigarette-free after 6 months1. Part of the problem is that successful quitting needs careful thought and motivationNicotine replacement therapy (NRT) has been shown to double success rates in certain groups2In patients in general practice it increases success rates when combined with advice and support from health professionals3, 4

References :1.Hughes JR, Gulliver SB, Fenwick JW et al. Smoking cessation among self-quitters. Health Psychology 1992; 11 (5): 331-3342.Hughes JR. Risk-benefit assessment of nicotine preparations in smoking cessation. Drug Saf 1993; 8: 49-563.Imperial Cancer Research Fund General Practice Research Group. Randomised trials of nicotine patches in General Practice: results at one year. BMJ 1994; 308: 1476-74.Stapleton JA et al. Dose effects and predictors of outcome in a randomised trial of nicotine patches in General Practice. Addiction. 1995; 90: 31-42Slide 45 - The case for nicotine replacement therapy (NRT)Objective :To demonstrate that NRT is much more effective in helping smokers quit than willpower aloneKey Communication Messages :Using willpower alone is the most commonly tried method of giving up smoking, however, only about 3% of smokers are still cigarette-free after 6 months1. Part of the problem is that successful quitting needs careful thought and motivationNicotine replacement therapy (NRT) has been shown to double success rates in certain groups2In patients in general practice it increases success rates when combined with advice and support from health professionals3, 4

References :1.Hughes JR, Gulliver SB, Fenwick JW et al. Smoking cessation among self-quitters. Health Psychology 1992; 11 (5): 331-3342.Hughes JR. Risk-benefit assessment of nicotine preparations in smoking cessation. Drug Saf 1993; 8: 49-563.Imperial Cancer Research Fund General Practice Research Group. Randomised trials of nicotine patches in General Practice: results at one year. BMJ 1994; 308: 1476-74.Stapleton JA et al. Dose effects and predictors of outcome in a randomised trial of nicotine patches in General Practice. Addiction. 1995; 90: 31-42