1 1. Tobacco Addiction and Nicotine Dependence 2. Nicotine Replacement Therapy and Treatment Approaches

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1. Tobacco Addiction and 1. Tobacco Addiction and Nicotine DependenceNicotine Dependence

2. Nicotine Replacement 2. Nicotine Replacement Therapy and Treatment Therapy and Treatment

ApproachesApproaches

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Statistics of Hong KongStatistics of Hong Kong

793,200 daily & occasional smokers in 793,200 daily & occasional smokers in 2006, or 14% of population aged 15 or 2006, or 14% of population aged 15 or overover

Of 2006 population, 24.5% of men and Of 2006 population, 24.5% of men and 4% of women are every day smokers4% of women are every day smokers

59.6% of daily smokers started smoking 59.6% of daily smokers started smoking before age 19before age 19

Men on average smoked 14 cigarettes a Men on average smoked 14 cigarettes a day, women smoked 10 cigarettes a day day, women smoked 10 cigarettes a day

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Tobacco dependenceTobacco dependence

Tobacco dependenceTobacco dependence==

PharmacologicalPharmacological(nicotine) (nicotine)

++Behavioural dependenceBehavioural dependence

(hand-to-mouth ritual)(hand-to-mouth ritual)

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What is in tobacco smokeWhat is in tobacco smoke

Tobacco smoke contains over 4,000 Tobacco smoke contains over 4,000 chemicals, including at least 50 that chemicals, including at least 50 that are known to cause cancerare known to cause cancer

Three of the main components are Three of the main components are nicotine, carbon monoxide and tarnicotine, carbon monoxide and tar

Nicotine is what makes smoking Nicotine is what makes smoking addictive, while carbon monoxide addictive, while carbon monoxide and tar can cause serious diseasesand tar can cause serious diseases

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NicotineNicotine Powerful, fast-acting drug and is one of the most adPowerful, fast-acting drug and is one of the most ad

dictive substances on the planetdictive substances on the planet Most people who smoke become dependent on the Most people who smoke become dependent on the

nicotine they get from cigarettesnicotine they get from cigarettes Nicotine has many complex effects on the body, incNicotine has many complex effects on the body, inc

luding increasing the heart rate and blood pressure, luding increasing the heart rate and blood pressure, and speeding up the metabolismand speeding up the metabolism

Nicotine also affects the mood and behaviour of the Nicotine also affects the mood and behaviour of the smokersmoker

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NicotineNicotine Nicotine acts as an agonist at nicotinic cholinergic rNicotine acts as an agonist at nicotinic cholinergic r

eceptors at the autonomic ganglia, neuromuscular jeceptors at the autonomic ganglia, neuromuscular junctions and in the brainunctions and in the brain

Nicotine’s positive reinforcing properties are belieNicotine’s positive reinforcing properties are believed to be the result of the release of neurotransmittved to be the result of the release of neurotransmitters includingers including AcetylcholineAcetylcholine Beta-endorphinBeta-endorphin DopamineDopamine NoradrenalineNoradrenaline Serotonin and othersSerotonin and others

that mediate pleasure, arousal, elevated mood, appthat mediate pleasure, arousal, elevated mood, appetite, and other desirable psychological statesetite, and other desirable psychological states

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NicotineNicotine

Nicotine activates the dopamine reward pathwNicotine activates the dopamine reward pathway in midbrain, a network of nerve tissues that ay in midbrain, a network of nerve tissues that elicits feelings of pleasureelicits feelings of pleasure

Immediately after inhalation, a bolus of nicotiImmediately after inhalation, a bolus of nicotine enters the CNS, stimulating release of dopane enters the CNS, stimulating release of dopamine which induces nearly immediate feelings mine which induces nearly immediate feelings of pleasure, along with relief of symptoms of nof pleasure, along with relief of symptoms of nicotine withdrawalicotine withdrawal

Rapid dose response reinforces repeated admiRapid dose response reinforces repeated administration and perpetuates smoking behaviournistration and perpetuates smoking behaviour

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NicotineNicotine Chronic administration of nicotine has been Chronic administration of nicotine has been

shown to result in an increased number of nshown to result in an increased number of nicotine receptors in specific areas of brainicotine receptors in specific areas of brain

Receptor upregulations leads to developmenReceptor upregulations leads to development of tolerance (repeated dose produce less of t of tolerance (repeated dose produce less of an effect than did the initial exposure)an effect than did the initial exposure)

Tobacco users become adept (highly skilled) Tobacco users become adept (highly skilled) at titrating their nicotine levels throughout tat titrating their nicotine levels throughout the day to avoid withdrawal symptoms, to mahe day to avoid withdrawal symptoms, to maintain pleasure and arousal, and to modulatintain pleasure and arousal, and to modulate moode mood

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TarTar Sticky brown substance that stains Sticky brown substance that stains

smokers’ fingers and teeth yellowy brownsmokers’ fingers and teeth yellowy brown When a smoker inhales, about 70 per cent When a smoker inhales, about 70 per cent

of the tar in the smoke stays in the lungsof the tar in the smoke stays in the lungs Many of the substances in tar are already Many of the substances in tar are already

known to cause cancerknown to cause cancer Irritants in tar can also damage the lungs Irritants in tar can also damage the lungs

by causing narrowing of the bronchioles, by causing narrowing of the bronchioles, and damaging the cilia that help protect and damaging the cilia that help protect the lungs from dirt and infectionthe lungs from dirt and infection

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Carbon monoxideCarbon monoxide A poisonous gas found in high A poisonous gas found in high

concentrations in tobacco smokeconcentrations in tobacco smoke Large amounts can killLarge amounts can kill Carbon monoxide lowers the oxygen in Carbon monoxide lowers the oxygen in

the bloodstream by up to 15 per cent, the bloodstream by up to 15 per cent, cutting down the efficiency of the lungscutting down the efficiency of the lungs

Cells and tissues need oxygen to function Cells and tissues need oxygen to function efficientlyefficiently

Carbon monoxide is especially harmful Carbon monoxide is especially harmful during pregnancy as it reduces the during pregnancy as it reduces the amount of oxygen carried to the womb amount of oxygen carried to the womb and babyand baby

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Other chemicals in Other chemicals in cigarette smokecigarette smoke

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Risks of continued Risks of continued smokingsmoking

Heart and Heart and circulatiocirculationn

Coronary heart disease, heart Coronary heart disease, heart attacks, arteriosclerosisattacks, arteriosclerosis

CancersCancers Lung, mouth, nose and throat, laryLung, mouth, nose and throat, larynx, oesophagus, pancreas, bladder,nx, oesophagus, pancreas, bladder, stomach, leukemia, kidney stomach, leukemia, kidney

RespiratoRespiratoryry

Chronic bronchitis, chronic Chronic bronchitis, chronic obstructive pulmonary disease, obstructive pulmonary disease, emphysema (swollen with air), emphysema (swollen with air), recurrent infections in airways, recurrent infections in airways, loss in pulmonary functionsloss in pulmonary functions

OthersOthers Impotence, peptic ulcers, Impotence, peptic ulcers, adverse effects on fertilityadverse effects on fertility

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Why it is worth giving upWhy it is worth giving up

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Benefits of quittingBenefits of quitting

Save moneySave money Provide your beloved ones a smoke-free enviProvide your beloved ones a smoke-free envi

ronmentronment Be free from the odour of smokingBe free from the odour of smoking Get rid of tar-stained teeth and fingersGet rid of tar-stained teeth and fingers Establish a healthy lookEstablish a healthy look Improve your sense of taste and smellImprove your sense of taste and smell Be less likely in getting heart disease, stroke Be less likely in getting heart disease, stroke

or canceror cancer

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Ways to stop smokingWays to stop smoking Cold turkeyCold turkey

Stopping smoking immediately and completelyStopping smoking immediately and completely Cutting downCutting down

Reducing the number of cigarettes over a period of timeReducing the number of cigarettes over a period of time If the period is too long, it may make giving up more If the period is too long, it may make giving up more

difficultdifficult PharmacotherapyPharmacotherapy

As assistance to smoking cessationAs assistance to smoking cessation Alternative treatmentsAlternative treatments

Hypnosis, acupuncture and complementary therapies Hypnosis, acupuncture and complementary therapies may helpmay help

No formal evidence for efficacyNo formal evidence for efficacy

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Cold turkeyCold turkey Stopping without any kind of aidStopping without any kind of aid Despite its addictive nature, nicotine Despite its addictive nature, nicotine

does not hang around in body long (about does not hang around in body long (about 48 hours) once you have stopped 48 hours) once you have stopped smokingsmoking

Although physical symptoms can be more Although physical symptoms can be more extreme in the early few days, they fade extreme in the early few days, they fade away within the first two or three weeks.away within the first two or three weeks.

Most people give up smoking using this Most people give up smoking using this methodmethod

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Cutting downCutting down Smoke only half of each cigaretteSmoke only half of each cigarette Each day, postpone the lighting of first cigarette Each day, postpone the lighting of first cigarette

1 hour1 hour Decide to smoke only during odd or even hours of Decide to smoke only during odd or even hours of

the daythe day Decide beforehand how many cigarettes to smoke Decide beforehand how many cigarettes to smoke

during the day. For each additional cigarette, give during the day. For each additional cigarette, give a dollar to favorite charitya dollar to favorite charity

Change the eating habits to help cutting downChange the eating habits to help cutting down Reach for a glass of juice instead of a cigarette Reach for a glass of juice instead of a cigarette

for a "pick-me-up”for a "pick-me-up”

Cutting down can help quitting, but it's not a Cutting down can help quitting, but it's not a substitute for quittingsubstitute for quitting

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PharmacotherapyPharmacotherapy

Pharmacotherapy in smoking Pharmacotherapy in smoking cessation can be classified ascessation can be classified as Nicotine replacement therapyNicotine replacement therapy Non-nicotine replacement therapyNon-nicotine replacement therapy

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Nicotine replacement Nicotine replacement therapy (NRT)therapy (NRT)

Allow smokers to overcome the Allow smokers to overcome the physiological dependence on physiological dependence on nicotine by gradually reducing nicotine by gradually reducing nicotine intakenicotine intake

Provides smokers with craving relief, Provides smokers with craving relief, but without the other harmful but without the other harmful ingredients in tobaccoingredients in tobacco

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How nicotine replacement How nicotine replacement therapy (NRT) workstherapy (NRT) works

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How nicotine replacement How nicotine replacement therapy (NRT) workstherapy (NRT) works

Nicotine from NRT is well absorbedNicotine from NRT is well absorbed Onset of action of NRT is not as Onset of action of NRT is not as

rapid as cigarette smokingrapid as cigarette smoking Patients who use NRT become less Patients who use NRT become less

habituated to the nearly immediate, habituated to the nearly immediate, reinforcing effects of nicotinereinforcing effects of nicotine

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Clinical efficacyClinical efficacy Reduces physical withdrawal symptoms Reduces physical withdrawal symptoms

and lets one concentrate on the other and lets one concentrate on the other changes needed to make as one quits changes needed to make as one quits smokingsmoking

Studies have shown that the use of NRT Studies have shown that the use of NRT could double the chance of successcould double the chance of success

Up to 6 times if receiving thorough counselingUp to 6 times if receiving thorough counseling However, the most important factor for However, the most important factor for

successful smoking cessation still lies on successful smoking cessation still lies on the will to quitthe will to quit

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Nicotine replacement Nicotine replacement therapytherapy

IncludesIncludes Nicotine gumNicotine gum Nicotine patchNicotine patch Nicotine inhalerNicotine inhaler Nicotine sublingual Nicotine sublingual

tablet (available in tablet (available in other countries)other countries)

Nicotine nasal Nicotine nasal spray (available in spray (available in other countries)other countries)

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Nicotine gumNicotine gum

Nicotine in an ion-exchange resin in gNicotine in an ion-exchange resin in gum baseum base

Absorption occurs at the buccal mucosAbsorption occurs at the buccal mucosaa

Intermediate in CNS delivery speedIntermediate in CNS delivery speed Serum nicotine levels reach a peak in 2Serum nicotine levels reach a peak in 2

0-30 minutes0-30 minutes

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Products availableProducts available Nicotinell®Nicotinell®

Fruit/mint chewing Fruit/mint chewing gum 2 mg, 4 mggum 2 mg, 4 mg

Nicorette®Nicorette® Ordinary/freshmint Ordinary/freshmint

chewing gum 2 mg, chewing gum 2 mg, 4 mg4 mg

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Which smokers are most suitableWhich smokers are most suitable Smokers with an irregular smoking Smokers with an irregular smoking

patternpattern Provides oral gratificationProvides oral gratification 4 mg gum most suitable for highly 4 mg gum most suitable for highly

dependent smokersdependent smokers More than 20 cigarettes per dayMore than 20 cigarettes per day First cigarette within 20 minutes of wakingFirst cigarette within 20 minutes of waking

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Nicotine gumNicotine gum Reference dosage and duration of useReference dosage and duration of use

For people who smoke more than 20 cigarettes For people who smoke more than 20 cigarettes per day, they may require 4 mg preparationper day, they may require 4 mg preparation

For those who smoke less than 20 cigarettes per For those who smoke less than 20 cigarettes per day, the 2 mg preparation is usually sufficientday, the 2 mg preparation is usually sufficient

Initial dosage 8 to 12 pieces per dayInitial dosage 8 to 12 pieces per day Daily dosage should not exceedDaily dosage should not exceed

25 pieces of 2 mg gum25 pieces of 2 mg gum 15 pieces of 4 mg gum15 pieces of 4 mg gum

The optimal duration of use for most people is The optimal duration of use for most people is about 12 weeksabout 12 weeks

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Instruction to use nicotine gumInstruction to use nicotine gum ““Bite-park” chewing methodBite-park” chewing method Each gum can last for 30 minutesEach gum can last for 30 minutes

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Tips for using nicotine gumTips for using nicotine gum Avoid acidic beverages such as coffee, Avoid acidic beverages such as coffee,

juice or soft drink 15 minutes before or juice or soft drink 15 minutes before or while using the gumwhile using the gum

Correct usage of NRT is very important. Correct usage of NRT is very important. Incorrect method of chewing not only Incorrect method of chewing not only affect the effectiveness of the nicotine affect the effectiveness of the nicotine gum, it may also cause side effects such gum, it may also cause side effects such as sore throat, hiccup or heartburnas sore throat, hiccup or heartburn

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Contraindications and WarningsContraindications and Warnings Nicotine gum should be avoided in individuals Nicotine gum should be avoided in individuals

with recent myocardial infarction, unstable with recent myocardial infarction, unstable angina pectoris, serious cardiac arrhythmias, angina pectoris, serious cardiac arrhythmias, or active duodenal or gastric ulcersor active duodenal or gastric ulcers

Pregnant smokers should always be advised to Pregnant smokers should always be advised to stop smoking completely without using NRTstop smoking completely without using NRT

Use of nicotine gum by the pregnant smoker Use of nicotine gum by the pregnant smoker should only be initiated following advice from should only be initiated following advice from a physician. a physician.

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Side effectsSide effects flatulenceflatulence IndigestionIndigestion NauseaNausea Unpleasant tasteUnpleasant taste HiccupHiccup Sore moth, throat and jawSore moth, throat and jaw

Correct use of the gum is important in Correct use of the gum is important in maintaining sufficient nicotine levels maintaining sufficient nicotine levels while minimizing side effectswhile minimizing side effects

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Nicotine lozengeNicotine lozenge

Product availableProduct available Nicotinell® lozengeNicotinell® lozenge

1 mg nicotine in a su1 mg nicotine in a sugar-free mint flavourgar-free mint flavoured baseed base

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Absorption occurs at the buccal mucosaAbsorption occurs at the buccal mucosa Intermediate in CNS delivery speed, simIntermediate in CNS delivery speed, sim

ilar to nicotine gumilar to nicotine gum Serum nicotine levels reach a peak in 2Serum nicotine levels reach a peak in 2

0-30 minutes0-30 minutes Unlike gum, lozenge actually provides Unlike gum, lozenge actually provides

more nicotine because it dissolves compmore nicotine because it dissolves completely, delivering the entire doseletely, delivering the entire dose

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Which smokers are most suitableWhich smokers are most suitable Smokers with low nicotine dependency (leSmokers with low nicotine dependency (le

ss than 20 cigarettes per day)ss than 20 cigarettes per day) Also good for those who cannot chew gum,Also good for those who cannot chew gum,

e.g. dentures e.g. dentures InstructionsInstructions

Suck a lozenge until flavour becomes stroSuck a lozenge until flavour becomes strongng

Hide lozenge between the gum and cheekHide lozenge between the gum and cheek Each lozenge lasts about 30 minutesEach lozenge lasts about 30 minutes

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Reference dosage and duration of Reference dosage and duration of useuse 1 lozenge every 1 to 2 hours1 lozenge every 1 to 2 hours 8 to 12 lozenge per day8 to 12 lozenge per day Not more than 25 pieces per dayNot more than 25 pieces per day Aim to cut down in 3 monthsAim to cut down in 3 months Not to be used for more than 6 monthsNot to be used for more than 6 months

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Contraindications and warningsContraindications and warnings Similar to nicotine gumSimilar to nicotine gum

Side effects (due to swallowed Side effects (due to swallowed nicotine)nicotine) HeartburnHeartburn HiccupHiccup NauseaNausea HeadacheHeadache

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Nicotine patchNicotine patch

Transdermal delivery systemTransdermal delivery system The skin patch delivers a steady dose oThe skin patch delivers a steady dose o

f nicotine through the skinf nicotine through the skin This reduces craving for nicotine and lThis reduces craving for nicotine and l

ets one focus on changing the behavioets one focus on changing the behaviors which associate with tobacco use rs which associate with tobacco use

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Delivers nicotine to CNS more slowly tDelivers nicotine to CNS more slowly than other dosage formshan other dosage forms

6-8 hours to reach peak serum levels6-8 hours to reach peak serum levels Higher doses of transdermal nicotine aHigher doses of transdermal nicotine a

ppear to be more effective than lower ppear to be more effective than lower dosesdoses

Largest strength and moderate strengtLargest strength and moderate strength patches for initial treatmenth patches for initial treatment

Lowest strength for tapering onlyLowest strength for tapering only

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Nicotine patchNicotine patch Products availableProducts available Nicotinell TTS®Nicotinell TTS®

21 mg (30 cm21 mg (30 cm22)) 14 mg (20 cm14 mg (20 cm22)) 7 mg (10 cm7 mg (10 cm22))

per 24 hoursper 24 hours Nicorette®Nicorette®

15 mg (Step 1)15 mg (Step 1) 10 mg (Step 2)10 mg (Step 2) 5 mg (Step 3)5 mg (Step 3)

per 16 hoursper 16 hours

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Nicotinell® TTS patchNicotinell® TTS patch 24-hour patch24-hour patch Useful if patient usually gets up for a cigarUseful if patient usually gets up for a cigar

ette during the nightette during the night May disturb sleepMay disturb sleep

Nicorette® patchNicorette® patch 16-hour patch16-hour patch For regular smokersFor regular smokers

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Which smokers are most suitableWhich smokers are most suitable Smokers with a regular smoking patternSmokers with a regular smoking pattern Moderately dependent smokers (10-20 cigModerately dependent smokers (10-20 cig

arettes per day)arettes per day) Those who preferThose who prefer

The convenience of a patchThe convenience of a patch Not to chew gum or suck lozenge, e.g. dentureNot to chew gum or suck lozenge, e.g. denture

s, dental problems, dental problem Those with gastric ulcer or diabetesThose with gastric ulcer or diabetes Those with low behavioural dependenceThose with low behavioural dependence

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Tips for using Nicotine PatchTips for using Nicotine Patch 16-hour patch16-hour patch

Keep the patch attached at all times except Keep the patch attached at all times except sleeping hourssleeping hours

Remove the patch before you go to bedRemove the patch before you go to bed Apply a new patch in the morningApply a new patch in the morning

24-hour patch24-hour patch The patch should be attached at all timesThe patch should be attached at all times Change it daily at a regular timeChange it daily at a regular time

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Tips for using nicotine patchTips for using nicotine patch Apply to clean, dry and non-hairy sites Apply to clean, dry and non-hairy sites

on upper body including arms and backon upper body including arms and back Do not apply to inflamed or broken skinDo not apply to inflamed or broken skin Do not apply any sorts of cream, Do not apply any sorts of cream,

powder or medication over the same powder or medication over the same site of the patchsite of the patch

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Nicotine patchNicotine patch Tips for using nicotine patchTips for using nicotine patch

Gently press the patch onto the site you have Gently press the patch onto the site you have chosen for 10 minuteschosen for 10 minutes

Avoid touching the adhesive side of the patch Avoid touching the adhesive side of the patch during applicationduring application

Do not peel it off to check whether it is fixed Do not peel it off to check whether it is fixed or notor not

Usually the patch will not drop off even during Usually the patch will not drop off even during bathing or swimmingbathing or swimming

If it comes off, apply a new oneIf it comes off, apply a new one Wash hands after application to avoid local Wash hands after application to avoid local

contamination of the eyescontamination of the eyes

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Nicotine patchNicotine patch Tips for using nicotine patchTips for using nicotine patch

Daily change the patch site so as to avoid skin Daily change the patch site so as to avoid skin irritationirritation

Wait for at least 3 days before using the same Wait for at least 3 days before using the same area againarea again

Unnecessary prolonged application not only Unnecessary prolonged application not only affects the effectiveness of the nicotine patch, affects the effectiveness of the nicotine patch, it may also cause skin irritationit may also cause skin irritation

Before disposing a patch, fold it in half with Before disposing a patch, fold it in half with the sticky sides togetherthe sticky sides together

Dispose patches out of reach of childrenDispose patches out of reach of children

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Reference dosage and duration of useReference dosage and duration of use 16-hour and 24-hour patches to suit 16-hour and 24-hour patches to suit

different people's needsdifferent people's needs Treatment begins withTreatment begins with

15 mg (Step 1) or 10 mg (step 2) for 16-hour 15 mg (Step 1) or 10 mg (step 2) for 16-hour patchpatch

21 mg (30 cm21 mg (30 cm22) or 14 mg (20 cm) or 14 mg (20 cm22) for 24-) for 24-hour patchhour patch

Transfer to lower dose patch after 12 Transfer to lower dose patch after 12 weeks then taper offweeks then taper off

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Side effectsSide effects Generally well toleratedGenerally well tolerated Patients discontinue nicotine patch because:Patients discontinue nicotine patch because: Pruritus at the patch sitePruritus at the patch site

Patient may be able to tolerate a different brandPatient may be able to tolerate a different brand Insomnia or vivid dreamsInsomnia or vivid dreams

Remove the patch at bedtime (i.e. using the 16-hoRemove the patch at bedtime (i.e. using the 16-hour patch) usually minimizes or eliminates sleep diur patch) usually minimizes or eliminates sleep disturbancessturbances

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Nicotine inhalerNicotine inhaler

The size and shape The size and shape of the inhaler of the inhaler resembles a resembles a cigarettecigarette

A replaceable A replaceable cartridge that fits cartridge that fits inside the inhaler inside the inhaler releases small releases small amount of nicotine amount of nicotine when one inhales when one inhales air through itair through it

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Inhalation causes air saturated with vaInhalation causes air saturated with vaporized nicotine to be drawn into the uporized nicotine to be drawn into the upper respiratory tractpper respiratory tract

Absorption occurs in the buccal mucosAbsorption occurs in the buccal mucosaa

Useful for people who miss the hand-tUseful for people who miss the hand-to-mouth action of smokingo-mouth action of smoking

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Product availableProduct available Nicorette® inhalerNicorette® inhaler

10 mg nicotine in porous polyethylene cat10 mg nicotine in porous polyethylene catridges packed in closed blister traysridges packed in closed blister trays

With reusable mouthpiece inhalerWith reusable mouthpiece inhaler

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How supplied How supplied Each cartridge contains 10 mg nicotineEach cartridge contains 10 mg nicotine Continuous puffing (e.g. 3 to 4 times a Continuous puffing (e.g. 3 to 4 times a

minute), the cartridge can last for about minute), the cartridge can last for about 20 minutes20 minutes

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Which smokers are most suitableWhich smokers are most suitable Highly behavioural-dependent smokersHighly behavioural-dependent smokers Smokers of 20 or less cigarettes per daySmokers of 20 or less cigarettes per day Those with dental problems or cannot cheThose with dental problems or cannot che

w gum or suck lozengew gum or suck lozenge

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Reference dosage and duration of useReference dosage and duration of use

Initial treatment period is normally 3 Initial treatment period is normally 3 monthsmonths

Gradually reduce dosage during next 6 to Gradually reduce dosage during next 6 to 8 weeks8 weeks

Use beyond 6 months is not recommendedUse beyond 6 months is not recommended

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Nicotine inhalerNicotine inhaler Instructions for the use of Nicotine Instructions for the use of Nicotine

InhalerInhaler Pull apart the two sections of the inhalerPull apart the two sections of the inhaler Place a cartridge inside the inhalerPlace a cartridge inside the inhaler Re-assemble the inhaler. As you push the two Re-assemble the inhaler. As you push the two

sections together, the inhaler pierces the seal sections together, the inhaler pierces the seal on each end of the cartridgeon each end of the cartridge

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Instructions for the use of Nicotine Instructions for the use of Nicotine InhalerInhaler Suck the mouthpiece. Breathe in gently Suck the mouthpiece. Breathe in gently

drawing the air into the mouth and hold drawing the air into the mouth and hold the air for a few seconds before the air for a few seconds before breathing out.breathing out.

One may also puff on the inhaler for One may also puff on the inhaler for several times (e.g. 3 to 4 times a several times (e.g. 3 to 4 times a minute)minute)

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Tips for using the nicotine inhalerTips for using the nicotine inhaler No difference between shallow puffing No difference between shallow puffing

and deep inhalationand deep inhalation Works best at room temperatureWorks best at room temperature One may feel a slight soreness or One may feel a slight soreness or

dryness in mouth and throat in the first dryness in mouth and throat in the first few days. Drink more water to relieve few days. Drink more water to relieve the sensationthe sensation

Avoid acidic beverages such as coffee, Avoid acidic beverages such as coffee, juice or soft drink 15 minutes before or juice or soft drink 15 minutes before or while using the inhalerwhile using the inhaler

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Nicotine inhalerNicotine inhaler Tips for using the nicotine inhalerTips for using the nicotine inhaler

Nicotine strength is reduced when the Nicotine strength is reduced when the sealing is brokensealing is broken

Open cartridges should not be used the next Open cartridges should not be used the next dayday

Cartridges contain nicotine even after use Cartridges contain nicotine even after use and should be disposed of as normal and should be disposed of as normal household waste out of the reach of childrenhousehold waste out of the reach of children

Always keep cartridges and inhaler in Always keep cartridges and inhaler in closed plastic container provided when not closed plastic container provided when not in usein use

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Side effectsSide effects Minor mouth and throat irritationMinor mouth and throat irritation CoughCough RhinitisRhinitis

Tolerance to irritating effects usually Tolerance to irritating effects usually occurs within a day or twooccurs within a day or two

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Other nicotine replacement Other nicotine replacement therapy dosage formstherapy dosage forms

Other nicotine replacement therapy Other nicotine replacement therapy forms (not available in Hong Kong)forms (not available in Hong Kong) Nicotine sublingual tabletNicotine sublingual tablet Nicotine nasal sprayNicotine nasal spray

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Nicotine sublingual Nicotine sublingual tablettablet

Nicorette® microtabNicorette® microtab 2 mg microtab packed i2 mg microtab packed i

n blister disksn blister disks With dispenser to assist With dispenser to assist

in removing the tablets in removing the tablets from the blisterfrom the blister

To be dissolved under tTo be dissolved under the tongue and NOT swahe tongue and NOT swallowed or chewed llowed or chewed First-pass effect will decrFirst-pass effect will decr

ease the amount of nicotiease the amount of nicotinene

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Nicotine sublingual Nicotine sublingual tablettablet

DosageDosage < 20 cigarettes per day: 1 microtab every h< 20 cigarettes per day: 1 microtab every h

ourour > 20 cigarettes per day: 2 microtabs every > 20 cigarettes per day: 2 microtabs every

hours if requiredhours if required Not more than 40 microtabs per dayNot more than 40 microtabs per day Aim to reduce dosage after 12 weeksAim to reduce dosage after 12 weeks Do not use microtabs for more than 6 monDo not use microtabs for more than 6 mon

thsths

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Nicotine nasal sprayNicotine nasal spray

Nicorette® nasal sprNicorette® nasal sprayay

0.5 mg/spray nicoti0.5 mg/spray nicotinene

Absorption of nicotiAbsorption of nicotine through the nasane through the nasal liningl lining

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Delivers a peak level to CNS in 5 Delivers a peak level to CNS in 5 minutesminutes

By far the By far the fastestfastest of all nicotine of all nicotine formulations (but still much slower formulations (but still much slower than cigarettes)than cigarettes)

May use the spray in each nostril up May use the spray in each nostril up to twice in any hourto twice in any hour

Do not use more than 64 sprays in Do not use more than 64 sprays in any period of 24 hours any period of 24 hours

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Side effectsSide effects Transient burning and stinging of nasal mucosaTransient burning and stinging of nasal mucosa Throat irritationThroat irritation CoughingCoughing Sneezing, rhinorrhoeaSneezing, rhinorrhoea LacrimationLacrimation NauseaNausea

Usually lasting only a few seconds, and dimiUsually lasting only a few seconds, and diminishing after about a weeknishing after about a week

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Available without prescription at Available without prescription at pharmacypharmacy

Requires strong will to quitRequires strong will to quit Must not smoke while using NRT ?Must not smoke while using NRT ? Does not “replace” tobacco, just a less Does not “replace” tobacco, just a less

harmful substitute to tobaccoharmful substitute to tobacco Aim at Aim at

Sufficient duration of therapySufficient duration of therapy Tapering down nicotine at regular time Tapering down nicotine at regular time

intervalsintervals

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Can anyone use NRT?Can anyone use NRT?

Caution in patients withCaution in patients with Cardiovascular (hypertension, arrhythmia, Cardiovascular (hypertension, arrhythmia,

severe or worsening angina, during immediate severe or worsening angina, during immediate post-myocardial infarction period)post-myocardial infarction period)

Peripheral vascular diseasesPeripheral vascular diseases Renal or hepatic insufficiencyRenal or hepatic insufficiency DiabetesDiabetes Peptic ulcerPeptic ulcer Thyroid disordersThyroid disorders Elderly, pregnancy and lactationElderly, pregnancy and lactation

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Pregnancy and NRTPregnancy and NRT Nicotine is classified as pregnancy Nicotine is classified as pregnancy

category D drug by the FDAcategory D drug by the FDA Pregnant smokers should always be Pregnant smokers should always be

advised to stop smoking completely advised to stop smoking completely without using NRTwithout using NRT

Despite potential risks, use of NRT during Despite potential risks, use of NRT during pregnancy is pregnancy is probablyprobably safer than smoking safer than smoking in selected patients who are unable to quit in selected patients who are unable to quit using non-pharmacological methods aloneusing non-pharmacological methods alone

Pregnant smokers should always seek Pregnant smokers should always seek medical consultation on smoking cessationmedical consultation on smoking cessation

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Key points for NRTKey points for NRT

A minimum of 6 weeks initial A minimum of 6 weeks initial treatment periodtreatment period

Highlight the importance of strong Highlight the importance of strong will and gradual reduction in dosagewill and gradual reduction in dosage

Differentiate the symptoms of Differentiate the symptoms of withdrawal from side effects of withdrawal from side effects of nicotine therapynicotine therapy

Cautions, contraindications and Cautions, contraindications and pregnancypregnancy

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Advice on NRTAdvice on NRT Advise them to pick a Quit Day, a not-too-distant Advise them to pick a Quit Day, a not-too-distant

date when they will give up smoking completely date when they will give up smoking completely and start using NRTand start using NRT

Suggest that they ask a friend to give up smoking Suggest that they ask a friend to give up smoking with them. Sharing a goal with someone else will with them. Sharing a goal with someone else will help them know they're not alonehelp them know they're not alone

Tell them to get rid of temptation by throwing out Tell them to get rid of temptation by throwing out any cigarettes or other smoking materials and by any cigarettes or other smoking materials and by avoiding smoky places like pubs. Suggest that they avoiding smoky places like pubs. Suggest that they ask smokers they know not to offer them cigarettesask smokers they know not to offer them cigarettes

Tell them to take it one day at a time. They should Tell them to take it one day at a time. They should see each smoke-free day as an achievementsee each smoke-free day as an achievement

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Advice on NRTAdvice on NRT Advise them to keep busy whenever they feel the urAdvise them to keep busy whenever they feel the ur

ge for a cigarette.ge for a cigarette. Remind them of the money they'll save when they gRemind them of the money they'll save when they g

ive up buying cigarettes. Suggest they put this moneive up buying cigarettes. Suggest they put this money aside in a pot labelled 'Cash not ash' until they havy aside in a pot labelled 'Cash not ash' until they have enough to reward themselves with a treate enough to reward themselves with a treat

Advise against replacing cigarettes with food - ex-sAdvise against replacing cigarettes with food - ex-smokers often put on weight when they've given up. mokers often put on weight when they've given up. If your customer does want to diet, suggest that theIf your customer does want to diet, suggest that they concentrate on giving up smoking first, for about y concentrate on giving up smoking first, for about a month say, and then think about dieting.a month say, and then think about dieting.

Reassure them that if at first they don't succeed theReassure them that if at first they don't succeed they can try again with NRT at a later date. Most succesy can try again with NRT at a later date. Most successful long-term ex-smokers had to try to stop several sful long-term ex-smokers had to try to stop several times.times.

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Non-nicotine replacement Non-nicotine replacement therapytherapy

FDA-approvedFDA-approved BupropionBupropion

Other non FDA-approved medicationsOther non FDA-approved medications ClonidineClonidine NortriptylineNortriptyline

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BupropionBupropion Bupropion (Zyban®)Bupropion (Zyban®) A medication originally developed and markA medication originally developed and mark

eted to treat depression under the name of eted to treat depression under the name of Wellbutrin®Wellbutrin®

The first non-nicotine medication shown to The first non-nicotine medication shown to be effective for smoking cessation and indicbe effective for smoking cessation and indication approved by the U.S. Food and Drug Aation approved by the U.S. Food and Drug Administration (FDA)dministration (FDA)

Available in Hong Kong upon a prescriptionAvailable in Hong Kong upon a prescription

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BupropionBupropion Mechanism of actionMechanism of action

Dopaminergic-noradrenergic reuptake inhiDopaminergic-noradrenergic reuptake inhibitorbitor

Inhibit weakly the neuronal uptake of dopaInhibit weakly the neuronal uptake of dopamine, noradrenline and serotonin but does mine, noradrenline and serotonin but does not inhibit monoamine oxidasenot inhibit monoamine oxidase

Its mechanism in enhancing the ability of pIts mechanism in enhancing the ability of patients to abstain from smoking is unknownatients to abstain from smoking is unknown

Product availableProduct available 150 mg sustained release tablet150 mg sustained release tablet

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BupropionBupropion DosageDosage

Treatment should begin 1 week before Treatment should begin 1 week before patient stops smokingpatient stops smoking

150 mg in the morning for 3 days, then 150 mg in the morning for 3 days, then increase to 150 mg twice daily for 7-12 increase to 150 mg twice daily for 7-12 weeksweeks

Maximum daily dose 300 mgMaximum daily dose 300 mg Can be used alone or with nicotine Can be used alone or with nicotine

replacement therapyreplacement therapy

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BupropionBupropion Side effectsSide effects

dry mouthdry mouth difficulty sleepingdifficulty sleeping headacheheadache decreased appetitedecreased appetite dizzinessdizziness sweatingsweating nauseanausea increased or irregular heart beatincreased or irregular heart beat agitation / anxietyagitation / anxiety

These side effects usually lessen with These side effects usually lessen with continued use of the medicationcontinued use of the medication

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BupropionBupropion Contraindications and warningContraindications and warning

Seizures (or taking medication that might increase the likelSeizures (or taking medication that might increase the likelihood of having a seizure)ihood of having a seizure)

Epilepsy (or a family history of epilepsy)Epilepsy (or a family history of epilepsy) Significant head traumaSignificant head trauma StrokeStroke Brain tumourBrain tumour Brain surgeryBrain surgery Anorexia or bulimiaAnorexia or bulimia Taking monoamine oxidase inhibitor (MAOI) within the prTaking monoamine oxidase inhibitor (MAOI) within the pr

evious 14 daysevious 14 days Patients undergoing abrupt discontinuation of alcohol or sPatients undergoing abrupt discontinuation of alcohol or s

edatives (including benzodiazepines)edatives (including benzodiazepines)

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BupropionBupropion Points to notePoints to note

Patients should be made aware that ZybanPatients should be made aware that Zyban® contains the same active ingredient as W® contains the same active ingredient as Wellbutrin®ellbutrin®

Significant drug interactions (CYP450 2D6)Significant drug interactions (CYP450 2D6) Enzyme inducing anticonvulsants e.g. phenytEnzyme inducing anticonvulsants e.g. phenyt

oin, carbamazepine, phenobarbitone may decoin, carbamazepine, phenobarbitone may decrease bupropion levelsrease bupropion levels

Possible drug interactions, e.g.Possible drug interactions, e.g. Fluoxetine may decrease bupropion levelsFluoxetine may decrease bupropion levels Bupropion may increase levels of imipramineBupropion may increase levels of imipramine

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Clinical efficacy of first line Clinical efficacy of first line FDA approved agentsFDA approved agents

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Success Rate and Evidence Success Rate and Evidence RatingRating

Single therapiesSingle therapies Evidence Evidence ratingrating

Quit rate at 6 Quit rate at 6 months (%)months (%)

Brief physician adviceBrief physician advice AA 2-102-10

Telephone counselingTelephone counseling AA 5-195-19

Self-help materialsSelf-help materials BB 7-277-27

Nicotine patchNicotine patch AA 8-218-21

Nicotine sprayNicotine spray AA 3030

Nicotine inhalerNicotine inhaler AA 2323

Nicotine lozengeNicotine lozenge AA 2424

Nicotine gum in Nicotine gum in highly dependent highly dependent smokerssmokers

AA 2424

Bupropion SRBupropion SR AA 21-3021-30

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Success Rate and Evidence Success Rate and Evidence RatingRating

Combination Combination therapiestherapies

Evidence Evidence ratingrating

Quit rate at 6 Quit rate at 6 months (%)months (%)

Nicotine patch plus Nicotine patch plus nicotine gumnicotine gum

BB 2828

Nicotine patch plus Nicotine patch plus nicotine spraynicotine spray

BB 37 (at three 37 (at three months)months)

Nicotine patch plus Nicotine patch plus nicotine inhalernicotine inhaler

BB 2525

Niotine patch plus buprNiotine patch plus bupropionopion

BB 3535

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Second line Second line pharmacotherapypharmacotherapy

Clonidine (Catapress®)Clonidine (Catapress®) Non-FDA approvedNon-FDA approved Centrally acting alpha2-adrenergic agonist Centrally acting alpha2-adrenergic agonist

that reduces sympathetic outflow from CNthat reduces sympathetic outflow from CNSS

Oral 0.1 mg twice daily or transdermal 0.1 Oral 0.1 mg twice daily or transdermal 0.1 mg dailymg daily

Side effects include dry mouth, sedation, Side effects include dry mouth, sedation, dizziness, constipationdizziness, constipation

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Second line Second line pharmacotherapypharmacotherapy

Nortriptyline (Pamelor®)Nortriptyline (Pamelor®) Non-FDA approvedNon-FDA approved Tricyclic antidepressantTricyclic antidepressant Initiated 10 days before quit dateInitiated 10 days before quit date Oral 25 mg daily, increasing gradually to target dose Oral 25 mg daily, increasing gradually to target dose

75 – 100 mg daily75 – 100 mg daily Side effects include sedation, dry mouth, blurred visSide effects include sedation, dry mouth, blurred vis

ion, urinary retention, light-headedness, tremorion, urinary retention, light-headedness, tremor Caution in patients with cardiovascular diseases becCaution in patients with cardiovascular diseases bec

ause of risk arrhythmias and postural hypotensionause of risk arrhythmias and postural hypotension

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Nicotine Nicotine withdrawal withdrawal

symptoms and symptoms and managementmanagement

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Nicotine withdrawal Nicotine withdrawal symptomssymptoms

CravingsCravings An intense desire to smoke as the body An intense desire to smoke as the body

is missing the nicotine fixis missing the nicotine fix Craving will lesson over a few weeksCraving will lesson over a few weeks Try NRT and or these tips:Try NRT and or these tips:

Take a few long, low, deep breathsTake a few long, low, deep breaths Drink a glass of waterDrink a glass of water

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Coughing, dry mouthCoughing, dry mouth The lungs are clearing out the tarThe lungs are clearing out the tar Usually be worse at the start and Usually be worse at the start and

improve quite quicklyimprove quite quickly Warm drinks can ease the coughWarm drinks can ease the cough A sign that lung functions are A sign that lung functions are

recoveringrecovering

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HungerHunger May feel extremely hungry due toMay feel extremely hungry due to

Changes in metabolismChanges in metabolism Food tastes better after quitting smokingFood tastes better after quitting smoking

Put together a “survival kit” of fruits Put together a “survival kit” of fruits and vegetablesand vegetables

Carry chewing gum and drink lots of Carry chewing gum and drink lots of waterwater

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Bowel changesBowel changes May suffer from constipationMay suffer from constipation Will soon settle downWill soon settle down Drink plenty of waterDrink plenty of water If constipated, try to incorporate more fibIf constipated, try to incorporate more fib

re into the diet by eating more cereals, frure into the diet by eating more cereals, fruits and vegetablesits and vegetables

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Trouble sleepingTrouble sleeping Nicotine leaving the body can disturb Nicotine leaving the body can disturb

sleep patternssleep patterns Normal sleeping patterns will return in Normal sleeping patterns will return in

two or three weekstwo or three weeks Get more physical exercise and fresh airGet more physical exercise and fresh air Decrease consumption on tea, coffee Decrease consumption on tea, coffee

and other stimulating drinksand other stimulating drinks

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DizzinessDizziness Happens when more oxygen starts Happens when more oxygen starts

getting through to the CNS when the getting through to the CNS when the effect of carbon monoxide waneseffect of carbon monoxide wanes

Any dizziness will be gone after a few Any dizziness will be gone after a few daysdays

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Mood swings, poor concentration, Mood swings, poor concentration, irritabilityirritability Signs of nicotine withdrawal as the Signs of nicotine withdrawal as the

body is missing the stimulating effects body is missing the stimulating effects of smokingof smoking

Coping mechanisms that workCoping mechanisms that work Warn your family and friends, and ask Warn your family and friends, and ask

for supportfor support

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Role of healthcare Role of healthcare professionals in professionals in

smoking cessationsmoking cessation

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The Five A’s Model for The Five A’s Model for Facilitating Smoking Facilitating Smoking

CessationCessationAskAsk about tobacco about tobacco use during every use during every visitvisit

Include questions about tobacco use Include questions about tobacco use when assessing the patient’s vital signswhen assessing the patient’s vital signs

AdviseAdvise all smokers all smokers to quitto quit

Advice should be clear, strong and Advice should be clear, strong and personalizedpersonalized

AssessAssess the the patient’s patient’s willingness to quitwillingness to quit

Ask how motivated patient is to quit Ask how motivated patient is to quit smoking, then determine appropriate smoking, then determine appropriate stepstep

AssistAssist the patient the patient in his or her in his or her attempt to quitattempt to quit

Help the patient make a quit plan, Help the patient make a quit plan, provide basic information about smoking provide basic information about smoking and cessation, recommend and cessation, recommend pharmacotherapy and self-help materialpharmacotherapy and self-help material

ArrangeArrange follow-up follow-up contactcontact

First follow-up should occur within the First follow-up should occur within the first week and second within the first first week and second within the first month; can be by telephone, e-mail, or in month; can be by telephone, e-mail, or in personperson

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What we can do to help What we can do to help smokerssmokers

Advise smokers to quitAdvise smokers to quit Assess the patient’s condition and suiAssess the patient’s condition and sui

tability for smoking cessation aidstability for smoking cessation aids Recommend suitable dosage form of nRecommend suitable dosage form of n

icotine replacement therapy based on iicotine replacement therapy based on individual smoking habits and patternsndividual smoking habits and patterns

Provide detailed counselling on correcProvide detailed counselling on correct use of productst use of products

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What we can do to help What we can do to help smokerssmokers

Draft a plan of gradual tapering and Draft a plan of gradual tapering and duration of nicotine replacement duration of nicotine replacement therapytherapy

Monitor progressMonitor progress Suggest non-drug measuresSuggest non-drug measures Provide emotional supportProvide emotional support Arrange follow-upsArrange follow-ups

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Assessing level of care in Assessing level of care in smoking cessationsmoking cessation

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Assessing level of care in Assessing level of care in smoking cessationsmoking cessation

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People who successfully People who successfully stop smoking…stop smoking…

Really want to stopReally want to stop Understand why they smoked in the pastUnderstand why they smoked in the past Put time and effort into planning the attemptPut time and effort into planning the attempt Know what to expect when they stop smokingKnow what to expect when they stop smoking Have support and encouragementHave support and encouragement Take one day at a timeTake one day at a time Plan ahead to avoid temptationPlan ahead to avoid temptation See themselves as non-smokers See themselves as non-smokers

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Make the first step to Make the first step to quitquit

Set a quit date, get support from Set a quit date, get support from your family and friendsyour family and friends

Dispose of all cigarettes, ashtrays Dispose of all cigarettes, ashtrays and lightersand lighters

Stay away from smoking situationsStay away from smoking situations Seek information from health Seek information from health

professionalsprofessionals

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Most people start smoking Most people start smoking again because…again because…

They thought they could get away with They thought they could get away with having ‘just one’.having ‘just one’.

They hadn’t thought about their smoking They hadn’t thought about their smoking triggers, and got caught out.triggers, and got caught out.

They didn’t do enough planning and They didn’t do enough planning and preparation.preparation.

They didn’t work out other ways of They didn’t work out other ways of handling stress.handling stress.

They hit a bad patch or a pressurized day.They hit a bad patch or a pressurized day. They put on weight.They put on weight. They thought of themselves as They thought of themselves as ex-ex-

smokerssmokers, not , not non-smokersnon-smokers..

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Sample of calculation onSample of calculation oncost of smoking (UK)cost of smoking (UK)

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My smoking diaryMy smoking diary

Filling in a diary sheet will help you Filling in a diary sheet will help you think about your smoking patternsthink about your smoking patterns

Try to do it over the course of a few Try to do it over the course of a few daysdays

Understand when and why you smokeUnderstand when and why you smoke Plan what you can do at those times Plan what you can do at those times

instead of smoking will help you get instead of smoking will help you get through the first few days without through the first few days without cigarettescigarettes

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My smoking diaryMy smoking diary

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The “quit date” plannerThe “quit date” planner

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Investigating your smoking Investigating your smoking habitshabits

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How to get through those How to get through those tricky timestricky times

Start a new projectStart a new project Take a few slow, deep breathsTake a few slow, deep breaths Go for a quick stroll (to walk in a relaxed Go for a quick stroll (to walk in a relaxed

and slow manner) or even just into and slow manner) or even just into another roomanother room

Drink a glass of waterDrink a glass of water Talk to a friend about how you’re feelingTalk to a friend about how you’re feeling Refer to the list of reasons you have for Refer to the list of reasons you have for

stoppingstopping

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Not ready?Not ready? Remember why you want to be a non-smoker. Remember why you want to be a non-smoker. Try coTry co

pying your reasons for quitting on to a card and carpying your reasons for quitting on to a card and carry it with youry it with you, so you can read them if you get tempte, so you can read them if you get tempted.d.

Check through your ideas on handling the first week, Check through your ideas on handling the first week, and practise some of those new habits before your quiand practise some of those new habits before your quit date.t date.

Make sure you’re fully prepared, and ready to manaMake sure you’re fully prepared, and ready to manage without smoking.ge without smoking.

Lots of people fail because they rush into quitting befLots of people fail because they rush into quitting before they’re really ready.ore they’re really ready.

If you’ve tried giving up before, think about what haIf you’ve tried giving up before, think about what happened and how you felt.ppened and how you felt.

You can use your past experiences to help you cope bYou can use your past experiences to help you cope better this time.etter this time.

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5 Ds to tackle craving5 Ds to tackle craving

DeclareDeclare that you have quitted that you have quitted DelayDelay in getting a cigarette for a few in getting a cigarette for a few

minutes by minutes by deep breathingdeep breathing and and drinkingdrinking plenty of water plenty of water

DistractDistract yourself from thinking about yourself from thinking about smoking by doing something else smoking by doing something else like making a phone call or keeping like making a phone call or keeping yourself busyyourself busy

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If you’ve just had a If you’ve just had a cigarettecigarette

Make the decision to stop again immediatelyMake the decision to stop again immediately Throw away any remaining cigarettesThrow away any remaining cigarettes Call a friend or the Smoking HelplineCall a friend or the Smoking Helpline Go outside, or into a different room – get out Go outside, or into a different room – get out

of the situation that made you want to smokeof the situation that made you want to smoke Remember why you wanted to stop smoking Remember why you wanted to stop smoking

in the first placein the first place Try to handle the ‘situation’ without another Try to handle the ‘situation’ without another

cigarettecigarette Keep telling yourself, ‘I can choose not to Keep telling yourself, ‘I can choose not to

smoke’smoke’

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To sum up…To sum up…

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Thinking about giving upThinking about giving up- Ten top tips- Ten top tips

Contact your local Stop Smoking Contact your local Stop Smoking Service Service for practical help and advice from for practical help and advice from trained specialiststrained specialists

Plan ahead Plan ahead to help you cope with to help you cope with stressful situations.stressful situations.

Pick a quit date Pick a quit date that will be stress-free, that will be stress-free, and stick to it.and stick to it.

Take it Take it one day at a timeone day at a time, and , and congratulate yourself every day.congratulate yourself every day.

Pair up with someone else who wants to Pair up with someone else who wants to stop so you can stop so you can support each othersupport each other

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Thinking about giving upThinking about giving up- Ten top tips- Ten top tips

Use Use Nicotine Replacement Therapy (NRT) Nicotine Replacement Therapy (NRT) or bupropion (Zyban) or bupropion (Zyban) to help you manage tto help you manage the cravingshe cravings

At first, At first, avoid situations avoid situations where you might bwhere you might be e tempted tempted to smoketo smoke

Keep track of the Keep track of the money you’re saving money you’re saving – a– and treat yourself!nd treat yourself!

There’s There’s no such thing no such thing as having ‘just oneas having ‘just one’ cigarette’ cigarette

Think positive – you CAN do it!Think positive – you CAN do it!

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Stay positive. Keep Stay positive. Keep telling yourself, “I telling yourself, “I don’t smoke” and don’t smoke” and most importantly, most importantly, be very, very proud be very, very proud

of yourself!of yourself!

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Where smokers Where smokers can get help fromcan get help from

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Department of HealthDepartment of Health

Regularly conducts smoking cessation actRegularly conducts smoking cessation activities in various service units including civities in various service units including chest clinics, elderly health centres, etc.hest clinics, elderly health centres, etc.

Introduction of nicotine replacement of tIntroduction of nicotine replacement of therapy in herapy in the Education and Training Cethe Education and Training Centre in Family Medicine ntre in Family Medicine (Ngau Tau Kok)(Ngau Tau Kok)

DH smoking cessation hotline 2961 8883 DH smoking cessation hotline 2961 8883

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Hospital AuthorityHospital Authority

Hospital Authority Smoking CounselliHospital Authority Smoking Counselling and Cessation Centresng and Cessation Centres

Established in some hospitals / GOPCs frEstablished in some hospitals / GOPCs from different clusters om different clusters

Detailed counselling and nicotine replacDetailed counselling and nicotine replacement therapy trials provided by pharmement therapy trials provided by pharmacists and/or nursesacists and/or nurses

Breath carbon monoxide monitoringBreath carbon monoxide monitoring HA smoking cessation hotline 2300 7272 HA smoking cessation hotline 2300 7272

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Web resources from Web resources from organizationsorganizations- Hong Kong- Hong Kong

Tobacco Control Office, Department of Tobacco Control Office, Department of HealthHealth http://http://www.tobaccocontrol.gov.hkwww.tobaccocontrol.gov.hk/chi//chi/

Hong Kong Council On Smoking & HeHong Kong Council On Smoking & Health (COSH)alth (COSH) http://www.smokefree.hk/http://www.smokefree.hk/

Action on Smoking or HealthAction on Smoking or Health http://www.ash.org.hk/http://www.ash.org.hk/

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Web resources from Web resources from organizationsorganizations

- Overseas- Overseas Giving Up Smoking (UK)Giving Up Smoking (UK)

http://www.givingupsmoking.co.uk/http://www.givingupsmoking.co.uk/ Action of Smoking and Health (US)Action of Smoking and Health (US)

http://www.ash.org/http://www.ash.org/ American Lung AssociationAmerican Lung Association

http://www.lungusa.orghttp://www.lungusa.org Tobacco Free Initiative (TFI)Tobacco Free Initiative (TFI)

http://http://www.who.intwww.who.int/tobacco/en//tobacco/en/

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Thank youThank you

Documents

1 1. Tobacco Addiction and Nicotine Dependence 2. Nicotine Replacement Therapy and Treatment Approaches