8 months ago

2017 HCHB_digital

Smoking Cessation Almost

Smoking Cessation Almost 5000 New Zealanders die annually from smoking-related illnesses, such as heart disease, lung cancer and stroke. The lifespan of people who smoke is shortened, on average, by about 15 years, and children exposed to passive cigarette smoke (second-hand smoke) have a higher incidence of croup, pneumonia, bronchiolitis and asthma. Smoking also contributes to socioeconomic and ethnic inequalities in health. Maori are over-represented in smoking statistics. Research has shown almost 38% of Maori people aged 15 to 64 years smoke cigarettes, compared with just 15% of New Zealanders of European ethnicity. The New Zealand Government is committed to the goal of New Zealand becoming auahi kore (smoke-free) by 2025. Promotion of the auahi kore message ( throughout community and whanau groups aims to change attitudes towards smoking, encouraging Maori to either stop smoking or not to start. There is never a bad time to quit smoking. Within one year of stopping the risk of a heart attack or stroke significantly decreases, reaching that of a non-smoker within three to five years. The risk of lung cancer can also be reversed, but this may take 10–15 years. Once someone has started smoking, quitting can be challenging because smoking is so addictive. Initial assessment If you suspect a customer smokes, tactfully enquire as to their smoking status. Pharmacy staff are in an ideal position to deliver personalised, empathic smoking cessation advice, since there is good evidence that even brief advice from health professionals has a significant effect on smoking cessation rates. Success is increased when repeated interventions are delivered from several different sources over a long period of time. This may be as little as saying the words “If you ever want to stop smoking, we can help” to a customer who you know smokes. Smokers cycle through the stages of contemplation, quitting and relapse an average of 14 times before achieving permanent success. A free online smoking cessation training course for health professionals (Helping people to stop smoking e-learning) is available at The most important variable determining how smokers will respond to any intervention is TREATMENT OPTIONS Category Examples Comments Nicotine replacement therapy (NRT) Natural / herbal products / supplements [GENERAL SALE] eg, Habitrol Gum*, Habitrol Patches*, Habitrol Lozenges*, Nicorette CoolDrops Lozenge*, Nicorette Gum*, Nicorette 16hr InvisiPatch Patch*, Nicorette QuickMist* [PHARMACY ONLY MEDICINE] Nicorette Inhalator* L-tryptophan, Quit Smoke NRT offers relief against nicotine withdrawal symptoms, including cravings, irritability, excitability, anxiety, headaches, nausea, dizziness, lethargy, loss of concentration, insomnia, gastric disturbance and respiratory problems. NRT is the preferred method for smoking cessation, as recommended by the New Zealand Ministry of Health. Ensure correct strength. Under-dosing leads to nicotine craving and loss of confidence. Guidelines recommend staying on the same starting dose for at least eight weeks to allow time to create new habits and routines. Do not exceed stated doses. Keep out of reach of children and pets; poisoning has occurred from improperly discarded patches. Fold sticky ends of the patch together, wrap and place in bin. Patches may cause skin reactions. Always reapply on a new part of the skin. Use surgical tape over the patch to hold in place if the patch does not stick well. Patches may be worn while showering, exercising, or swimming. Remove patches overnight if they disturb sleep. May help with smoking cessation. Products with an asterisk have a detailed listing in the Smoking Cessation section of OTC Products, starting on page 260. A part of your everyday. New Zealand’s premier pharmacy website keeping you up to date between issues. Page 138 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Advice for smokers ready to quit •• Set a quit date, preferably within two weeks. •• Contact a local smoking cessation provider. •• Inform friends, family, and co-workers and ask for support to quit •• If the urge to smoke is strong then Delay (acting on the urge to smoke), Deep breathe, Drink water, and Do something else. •• Remove cigarettes from home, car and workplace and avoid smoking in these places for two weeks before quitting. •• Anticipate challenges, particularly during the first few weeks, including nicotine withdrawal. •• Focus on the benefits and rewards of quitting. •• Totally stopping is essential – not even a single puff. •• Drinking alcohol is strongly associated with starting smoking again. their readiness to change (ie, they have to want to stop). Smoking cessation advice is based around the mnemonic ABC. • Ask customers about their smoking status. • Give specific Brief advice about stopping smoking to all smokers, eg, “making a quit attempt will make a big difference to your health”. • Strongly encourage every person who smokes to use Cessation support and offer to help them access it. Enquire about a customer's progress or problems when they buy or collect their smoking cessation products and encourage continued abstinence. Treatment There are many effective treatments (some prescription only) that can produce long-term abstinence, but evidence has shown the success rate is improved fivefold when treatment is combined with personalised counselling and behaviour modification. The Quit Group ( or 0800 778 778) offers free smoking cessation advice and generously subsidised Nicotine Replacement Therapy (NRT). NRT is also subsidised on a prescription and through many other qualified smoking cessation providers. Some research suggests only 3%–7% of people stop smoking by going “cold turkey” alone. Hypnosis, acupuncture, and prescription medicines (eg, bupropion, nortriptyline, varenicline) are also options for smoking cessation. Electronic cigarettes mimic the look and feel of conventional cigarettes; however, evidence does not currently support their use as an aid to stopping smoking. Advice for customers • Giving up smoking may take a number of attempts but this is normal. • Planning a quit attempt, rather than just deciding to stop suddenly, has a higher chance of success. »» Make a chart to identify why and when you smoke (your smoking triggers). A key factor in quitting is changing your routines and habits. »» Register with a smoking cessation provider (eg, and discuss coping with cravings before you quit. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Is the person pregnant or breastfeeding or underweight? • Is the person elderly or do they have diabetes or heart disease? • Does the person experience skin sensitivity reactions often? • Is the person reluctant to totally abstain from smoking? • Does the person have an irregular smoking habit? • Has the person had a reaction to nicotine products in the past? » » Review previous quit attempts – what helped, what did not help and any reasons for relapse. Trying a different type of treatment may help. » » Apply for subsidised nicotine replacement therapies – an eight-week supply of nicotine patches costs around $5 compared with over $200 if bought. • Make your home and car smokefree and get rid of ashtrays. Wash all your smoky clothes and wash down furnishings. • Brush your teeth with fresh minty toothpaste and book into a dentist to have your teeth cleaned. • Carry a water bottle with you and practise saying "I am a non-smoker" or "I don't smoke". • The correct way to use nicotine gum is the “chew and park” method. » » Bite down slowly on a piece of gum six to 10 times, enough to soften it and release the nicotine, which may tingle or impart a spicy taste. » » Park the gum under the tongue or between the cheek and the gum, allowing the nicotine to be absorbed through the lining of the mouth into the bloodstream. » » Avoid over-chewing the gum or drinking while chewing the gum as this can wash nicotine into the stomach, causing side effects such as heartburn, abdominal pain or hiccups. » » An occasional bite will expose a fresh surface of gum and release more nicotine. » » Repeat the process around five or six times in 30 minutes if needed, until the gum loses its effectiveness. » » Wrap up the gum and dispose of in a rubbish bin. • If using lozenges, follow the same process as for the gum, except the lozenge should be sucked, not bitten. Page 139

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