Transcript Smoking Cessation in a Patient With Comorbidities

Smoking Cessation In A
Patient With Multiple
Comorbidities
Douglas E. Jorenby, Ph.D.
14 July 2004
PCC
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Support Disclosures
• State of WI, National Institutes of
Health, Robert Wood Johnson
Foundation, Pfizer, Nabi
Biopharmaceutical,
GlaxoSmithKline, Sanofi
Synthelabo, Knoll Pharmaceutical,
McNeil Consumer Health, Lederle
Laboratories, Elan Pharma, Ciba
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Objectives
• Understand the elements of
effective smoking cessation
• Understand how selected
comorbidities interact with
treatment options
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Evidence-Based Medicine
The Public Health Service
Clinical Practice Guideline
Treating Tobacco Use and
Dependence was
published in June, 2000
and offers effective
treatments for tobacco
dependence.
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Evidence-Based Medicine
• Reviewed 6,000 articles
published 1975-99
• Meta-analyses
• Recommendations for
clinicians and health care
systems
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
How do we treat tobacco
users who are willing to quit?
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
The 5 A’s
For Patients Willing To Quit
• ASK about tobacco use.
• ADVISE to quit.
• ASSESS willingness to make a
quit attempt.
• ASSIST in quit attempt.
• ARRANGE for follow-up.
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Patient Presentation
• 57 year old WF
• Retired
• Living alone
• Some college
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Smoking History
• Currently smoking 40 cpd
• No other tobacco use
• 40 year smoking history
• One previous quit attempt of 9
months
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Medical History
• Status-post breast cancer
• Osteoporosis
• Hospitalized for pneumonia in
previous 6 months
• Bipolar disorder
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Lung Function
• Reported shortness of breath
upon exertion
• FEV1 = 50% predicted
• FEV1/FVC = 0.55
• CO = 21 ppm
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Current Medications
• Olanzapine 15 mg
• Lamotrigene 200 mg
• Hydroxyzine 100 mg
• Gabapentin 600 mg
• Trazodone 150 mg
• Triazolam 0.25 mg
• Alendronate Sodium
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Pharmacotherapy
• The US PHS Guideline
recommends pharmacotherapy
except in the case of specific
contraindications
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Needs / Complications
• Disproportionately higher rates
among people with psychiatric
diagnoses
• Potential medication
interactions
• Post-cessation effectiveness
changes
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
SCPC Medication Plan
• Nicotine patch 21 mg x 6
weeks
• Nicotine Inhaler up to 8
cartridges per day
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Additional Medication
• Patient’s attending psychiatrist
approved concurrent bupropion
at a dose of 150 mg twice daily
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Counseling & Support
• Problem-solving counseling
• Extra-treatment social support
• Intra-treatment social support
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Use The WI Tobacco QL
• Available at no cost to all WI
residents
• 91.6% overall satisfaction
• 88.8% found helpful in quit
attempt
• 92.8% would recommend to a
friend
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
Intensive Social Support
• Twice weekly facilitated
support group
• Open-ended access
• On-going problem solving
• Opportunities to increase selfefficacy
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School
On The Horizon?
• New pharmacotherapies in the
pipeline
• Empirically-targeted
interventions
The Center for Tobacco Research and Intervention
The University of Wisconsin Medical School