Transcript Slide 1

Healthy Air for Kids Campaign
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Helping parents quit
smoking for the health of
their children.
Healthy Air for Kids Campaign
2006 Surgeon General Report
“The scientific evidence is now
indisputable: Secondhand
smoke is a serious health
hazard that can lead to
disease and premature
death in children.”
--Surgeon General Richard Carmona,
Surgeon General’s Report
June 27, 2006
Healthy Air for Kids Campaign
Why Treat?
According to the Surgeon General:
There are 4,000 chemicals in
cigarette smoke.

There is no safe amount of
secondhand smoke.

Breathing it for even a short time
can have immediate adverse
effects.

Healthy Air for Kids Campaign
Why Treat?

About 60 percent of children in Wisconsin
suffer from second-hand smoke exposure.
--Surgeon General Report, 2006

In Wisconsin, 54 percent of middle school
children are exposed to secondhand
smoke.
--Burden of Asthma in Wisconsin, 2004
Healthy Air for Kids Campaign
Why Treat?
As a result, these kids
develop pneumonia, ear
infections, bronchitis,
asthma, colic, reduced
pulmonary function and
SIDS.
Healthy Air for Kids Campaign
Why Treat?
Parents want your help.
• 85% of parents who smoke want pediatricians to counsel
them about quitting and prescribe tobacco cessation
medications.
• Parents say, “It shows you care.”
• Only 8% of parents who smoke are currently offered
medication or counseling
Source: Pediatrics, 2005
• “Smoking cessation interventions during physician visits
were associated with increased patient satisfaction with their
care among those who smoke.”
Mayo Clinic Proc. 2001;76:138-143
Healthy Air for Kids Campaign
Why Treat?
“In fact, when we don’t
ask parents about
smoking, they say,
‘What’s up?’ It’s like we
don’t care. If I don’t
ask parents about
smoking, I’m really
missing the boat.”
-- John Meurer, Chief of General Pediatrics,
Medical College of Wisconsin,
Wisconsin Pediatrician of the Year
Healthy Air for Kids Campaign
Why Treat?
You can have a huge impact with a brief
intervention.
– In a few minutes, you can help your
patients live in a smoke-free environment
and decrease the chances the children will
ever light up.
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“Minimal interventions lasting less than 3
minutes increase overall tobacco
abstinence rates.”
Source: U.S. Public Health Service Clinical Practice Guideline:
Treating Tobacco Use and Dependence
Healthy Air for Kids Campaign
Why Treat?
–
We’ll show you how to do it in a way that is:
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Brief.
Safe.
Effective.
Healthy Air for Kids Campaign
Three Tools
A quick reference guide to show you
and your staff how to do a brief,
effective intervention.
Healthy Air for Kids Campaign
Three Tools
A laminated tobacco
treatment chart to post on
your office wall for quick
reference.
1) 5 A’s for treatment
2) Medications chart
Healthy Air for Kids Campaign
Three Tools
A note pad of tear sheets so
you can walk your
patients through their
individualized plan to quit.
Healthy Air for Kids Campaign
Posters & Brochures
We have developed posters & brochures for your waiting rooms.
Healthy Air for Kids Campaign
How to Treat
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Help your patient’s parent(s) quit
smoking by following the “5 A’s”:
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Ask every parent at every patient visit.
Advise all tobacco users to quit.
Assess the parent’s willingness to quit.
Assist with counseling and medication.
Arrange follow-up care.
Healthy Air for Kids Campaign
How to Treat: ASK.
Ask the parents, “Do you smoke?”
“Clinicians should routinely
ask about secondhand
smoke exposure,
particularly when a child has
had an illness caused by
secondhand smoke.”
Former Surgeon General Richard Carmona,
Surgeon General’s Report, June 27, 2006
Healthy Air for Kids Campaign
How to Treat: ASK.
CHILD VITAL SIGNS
Blood Pressure: _______________________________________________
Pulse: ________________ Weight: ________________________________
Temperature: _________________________________________________
Respiratory Rate: ______________________________________________
Parent Smokes:
YES
no
(circle one)
IF YES > continue with counseling
Child Exposed to Secondhand Smoke:
YES
no
(circle one)
IF YES > urge smoke-free environments at all times
Healthy Air for Kids Campaign
How to Treat: ADVISE.
Urge parents to quit smoking in a clear,
strong, personalized manner.
Connect it to the child’s symptoms.
Secondhand
Smoke
Frequent Colds
Pneumonia
Ear Infections
Bronchitis
Asthma
Research shows this is most effective.
Healthy Air for Kids Campaign
How to Treat: ADVISE.
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“Second-hand smoke is
making Tommy’s asthma
worse… it could even be
the cause.”
–
“I strongly advise you to
quit, which will help him get
better.”
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“It’s not easy, but you can
do it. We can help.”
Healthy Air for Kids Campaign
How to Treat: ADVISE.
Document it. Advice to quit should be noted
in the child patient’s medical record.
Healthy Air for Kids Campaign
How to Treat: ASSESS.
Ask the parent if he/she is willing to try to quit.
“Are you ready to quit within the
next 30 days?”
• If yes, move on to ASSIST.
• If no, ask the parent to continue
to seriously think about quitting.
Healthy Air for Kids Campaign
How to Treat: ASSESS.
Strongly urge the parent not to smoke
around the child.
•
“We know that if you smoke, it’s more likely Sally will
light up later in her life.”
•
“There is no safe amount of second-hand smoke for
Jaden.”
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“It’s especially dangerous in your home and car.”
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“Chemicals from smoke linger even after you put out
your cigarette and the smoke disappears.”
Healthy Air for Kids Campaign
How to Treat: ASSIST.
For parents willing to make a quit attempt: provide
counseling and recommend medication.
This combination gives the parent the best chance to
successfully quit.
Brief Intervention. Advise the parent to:
• Review smoking history. This includes past quit attempts, amount
smoked, current medications, etc.
• Set a quit date, ideally within 2 weeks.
• Completely abstain. “Not a single puff,” starting on the quit date, to
prevent relapse.
• Avoid alcohol. It’s strongly linked to smoking relapse.
• Get support from family or peers.
• Avoid other smokers.
• Discuss challenges, particularly in the first few weeks, including
nicotine withdrawal.
Healthy Air for Kids Campaign
How to Treat: ASSIST.
Offer medication.
• You can prescribe medication or
recommend OTC medication.
• Seven different FDA-approved
cessation medications have been
clinically proven to increase the
chances of quitting – up to three
times better than placebo.
Healthy Air for Kids Campaign
How to Treat: ASSIST.
Prescription medication.
Medicaid and BadgerCare cover the following prescription
medications:
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Nicotine patch (when written as “legend nicotine patch”)
Nicotine inhaler
Nicotine nasal spray
Bupropion SR (generic or Zyban)
Varenicline (marketed as Chantix)
Healthy Air for Kids Campaign
How to Treat: ASSIST.
Recommend OTC medication.
• Nicotine patch
• Nicotine gum
• Nicotine lozenge
Healthy Air for Kids Campaign
How to Treat: ASSIST.
Nicotine Replacement Therapy (NRT)
• Nicotine is the active ingredient
• No evidence of increased cardiovascular risk with NRT
• Supplied as a steady dose (patch) or self-administered (gum,
inhaler, nasal spray)
• Self-administered products should be used on a scheduled
basis initially, then tapered to ad-lib use and eventual
discontinued
Healthy Air for Kids Campaign
How to Treat: ASSIST.
Nicotine Replacement Therapy (NRT)
Contraindications:
• Immediate myocardial infarction (< 2
weeks)
• Serious arrhythmia
• Serious or worsening angina pectoris
• Accelerated hypertension
Use and Cost:
• Varies by product and amount used
(see UW-CTRI Medications Chart for details)
Healthy Air for Kids Campaign
Nicotine gum
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2 mg vs 4 mg
Chew and park
Absorbed in a basic environment
Use enough pieces each day (6-16)
OTC
Healthy Air for Kids Campaign
Nicotine patch
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Available as both prescription and OTC
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A new patch is applied each morning
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Rotating placement site can reduce irritation
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Typical Dosing:
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4 weeks of 21 mg/day, then
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2 weeks of 14 mg/day, then
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2 weeks of 7 mg/day
Healthy Air for Kids Campaign
Nicotine lozenge
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2 or 4mg
Use enough
Benefits
OTC
Use enough (6-16 lozenges/day)
Healthy Air for Kids Campaign
Nicotine inhaler
• Prescription only
• May irritate mouth/throat at first (but
improves with use)
• Don’t drink acidic beverages during use
• 6-16 cartridges/day
• Inhale 80 times/cartridge
• May save partially-used cartridge for next
day
• Use up to 6 months; taper at end
Healthy Air for Kids Campaign
Bupropion SR
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One of two non-nicotine medications
approved by the FDA as an aid to quitting
smoking
Available by prescription only
Shown to be particularly effective for women
and patients diagnosed with depression
Mechanism of action: blocks neural reuptake
of dopamine and/or norepinephrine
Healthy Air for Kids Campaign
Bupropion SR
Contraindications
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Seizure disorder
MAO inhibitor within previous 2 weeks
History of anorexia nervosa or bulimia
Current use of Wellbutrin or Zyban
Side effects
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Insomnia
Dry mouth
Healthy Air for Kids Campaign
Bupropion SR
Dosing:
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Start 1-2 weeks before quit date
150 mg orally once daily x 3 day
150 mg orally twice daily x 7-12 weeks
No taper necessary at end of treatment
Maintenance:
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Efficacious as maintenance medication for 6 months
Healthy Air for Kids Campaign
Varenicline
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This new Pfizer medication was approved by the FDA in May
2006
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Like Bupropion, Chantix is available by prescription only
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Unique: Varenicline is neither a nicotine replacement therapy
nor does it actively reduce dopamine reuptake.
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Varenicline acts on nicotine receptors with two types of action: It
blocks some of the rewarding effects of nicotine (acts as an
antagonist) and at the same time stimulates the receptors in a
way that reduces withdrawal (acts as an agonist).
Healthy Air for Kids Campaign
Varenicline
Dosing & Maintenance
Start varenicline one week before the quit date for maximum
effectiveness
 Recommended treatment is 12 weeks:
– Days 1-3………..1 pill (0.5 mg) per day
– Days 4-7………..1 pill (0.5 mg) twice a day (am & pm)
– Day 8-end………1 pill (1 mg) twice a day (am & pm)
 An additional course of 12 weeks for maintenance can be
considered
Healthy Air for Kids Campaign
Varenicline
Contraindications
Use with caution and consider dose reduction in patients:
⇒ With significant renal impairment.
⇒ Undergoing dialysis.
Side effects
⇒ Primary side effect is nausea
⇒Suggested solution is to reduce dosage
Healthy Air for Kids Campaign
How to Treat: Coverage.
More than 70 percent of Wisconsin residents
with private insurance are covered for at
least one quit smoking medication.
Medicaid, BadgerCare and SeniorCare also cover tobacco
dependence treatments.
Healthy Air for Kids Campaign
How to Treat: REFER.
Refer parents to the:
• It’s free, confidential, and non-judgmental.
• Callers are 4 times more likely to quit than those who try to quit
cold turkey.
• Services are available in virtually any language.
Healthy Air for Kids Campaign
“Time is always short. I tell my patients: ‘Call the Wisconsin
Tobacco Quit Line. They’re sharp. They can help you.’”
-- Dr. Pierce Sherrill, Aurora Healthcare
“The Quit Line was very
helpful for me. I needed
someone who was on my
side... and they were.”
--Gloria Taylor
Healthy Air for Kids Campaign
How to Treat: ARRANGE.
Other referral options:
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A cessation program
in your clinic or
system.
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A local community
program. For a list of
programs in your
county, visit:
http://www.ctri.wisc.edu/resources.html
Healthy Air for Kids Campaign
How to Treat: ARRANGE.
Arrange for follow-up counseling.
• If the parent has quit, congratulate him or her on a
tremendous accomplishment!
• If the parent has relapsed, reassess the situation and
encourage another quit attempt.
• Like diabetes or hypertension, tobacco dependence is a chronic
disease and should be treated as such over time.
• Continue to encourage the parent to quit, focusing on maintaining
a positive outlook.
• You can follow up or refer to the Quit Line.
Healthy Air for Kids Campaign
Resources.
CME credit.
FREE online CME for
tobacco cessation
treatment is available for:
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Physicians
Nurses
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Pharmacists
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Visit www.medscape.com/viewprogram/3607
Healthy Air for Kids Campaign
How to Treat: Fax to Quit Program
How it works:
1.
The patient signs a
consent form.
2.
Your office faxes the form
to the Quit Line.
3.
The Quit Line calls the
patient at a time
requested by the patient.
4.
The Quit Line faxes back
a report to your office.
FREE to you and your patient!
Healthy Air for Kids Campaign
www. CTRI . WISC . EDU
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News
Research results
Treatment tools
Latest best practices
Healthy Air for Kids Campaign
Make a Difference.
Abby Kreul, right, 9 years old:
“It’s better now that
Mom and Dad have
quit because I don’t
get sick as much.”
Healthy Air for Kids Campaign
www. CTRI . WISC . EDU
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