Most smokers want to quit and have it with limited success already tried. Among the effective smoking cessation measures include counseling and drug treatment, for example, varenicline, bupropion or nicotine substitutes.

About 70% of US smokers say they want to quit and have already tried at least once. One of the difficulties here are the withdrawal symptoms.

Most smokers want to quit and have it with limited success already tried. Among the effective smoking cessation measures include counseling and drug treatment, for example, varenicline, bupropion or nicotine substitutes. About 70% of US smokers say they want to quit and have already tried at least once. One of the difficulties here are the withdrawal symptoms. Withdrawal Withdrawal symptoms can be so strong that even with accurate knowledge of the health risks, many smokers are not ready to stop. Often leads to severe withdrawal symptoms when smoking stop smoking. Primarily, this includes a craving for a cigarette, but also anxiety, depression (mostly mild, but sometimes severe forms), difficulty concentrating, irritability, restlessness, insomnia, hunger, headache and indigestion. These symptoms are at their worst in the first week (and also most relapses happen). However, within 2 weeks, most subside, but some symptoms remain for several months. Weight gain is common; mostly it is a gain of 4-5 kg. This weight gain is another reason for recidivism. Temporary cough and ulcers may develop after weaning. Prognosis About 20 million smokers in the US each year try to quit smoking (nearly half of all smokers), usually by cold turkey or other non-evidence-based approaches, resulting in a relapse within days, weeks or months , Many go through several periods of abstinence with relapse and remission. The long-term success rate in tests on your own is about 5%. In contrast, the success rates are for one year with up to 20-30% in smokers who received an evidence-based advice and recommended medications. Most smokers under 18 believe that they will no longer smoke in five years, and report 40 to 50%, they would have tried already in the previous year, to give up smoking. However, longitudinal studies in the US show that 73% of those who smoke in high school every day, smoking and 5-6 years later still daily. Cessation measures Evidence-based counseling and drug treatment are both effective treatments for tobacco dependence, but the combination of counseling and medication is more effective than any of these measures alone. (See also information about smoking cessation by the US Preventive Services Task Force. [Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions]) Smoking has many characteristics of a chronic disease. In practice, it has proved itself the most to deal similarly with smokers as with the chronically ill, especially if they do not want to quit or have never thought about it. One should be guided by the following principles: continuous recording and monitoring of smoking status adjustment verschiedenener evidence-based measures (or combinations thereof) to the needs of individual patients because of their previous experience and treatment preferences encouraging temporary abstinence and reducing consumption in patients would not make it to immediately stop smoking, with the emphasis that abstinence is the ultimate goal, although a reduction of smoking may increase the motivation completely to stop (especially when combined with a nicotine replacement therapy), smokers should be remembered that the reduction in the number of cigarettes smoked can not improve their health because smoking then pull harder on each cigarette and inhale more smoke and therefore more toxins. Evidence-based advice to the advisory measures include: to ask With each visit to the doctor if the patient smokes and then to document the answer. to say smokers in clear, understandable sentences that they should stop smoking. With a smoker who wants to quit to agree to start a trial within the next 30 days. A smoker who wants to quit, offer a brief counseling and drug treatment to arrange another appointment, preferably within the first week after the start of the smoking withdrawal. With patients who want to stop smoking, a date is agreed (as possible within 2 weeks), the physician should emphasize that total abstinence is better than a restriction of nicotine consumption. Looking back on previous experience can find out what has helped in previous quit attempts or not to schedule in advance, which animated the need to smoke or the cessation could be difficult. If relapses z. B. associated with alcohol consumption, you should bring a more restrictive use of alcohol or abstinence from this week. Many find it difficult to stop when they live with other smokers, one could therefore encourage their partners or roommates, shared quit smoking. In general, smokers should learn how they can get for cessation attempts of social support in the family or among friends, but they should also know that the doctor holds in its hands and gives them any help there. In addition to the brief advice from the physician of the smoker and counseling programs can help. These usually use cognitive-behavioral techniques and are offered by various commercial and voluntary bodies. The success rates are higher than in the self-help programs here. All states in the US have telephone counseling centers that offer advice and support (and sometimes a nicotine replacement therapy) to help smokers who want to quit. The toll-free number in the US is: 1-800-QUIT-NOW (1-800-784-8669). This phone consultations appear to be as effective as smoking cessation Einzelberatungen.Medikamente to the effective and safe drugs for smoking cessation include varenicline, bupropion SR and nicotine substitutes (in the form of chewing gum, lozenges, patches, inhalers and nasal spray medication for smoking cessation). The mechanism of action of bupropion results in an increased release of norepinephrine and dopamine in the brain. Varenicline acts on nicotinic acetylcholine receptor (on the ?-4?-2 subunit), where it acts as a partial agonist and have nicotine-like effects, while it inhibits the partial antagonist, the effect of nicotine. There is evidence that varenicline is the most effective single agent for smoking cessation. Research results suggest that the combination of various nicotine replacement products is more effective than individual products. For example, a combination of a nicotine patch with a short-term acting nicotine preparation can (z. B., sweet gum, nasal spray, inhaler) may be more effective than monotherapy. When used in combination, helping the plaster to constant nicotine levels, and the use of chewing gum, candies, inhalers or nasal spray allows the patient to quickly increase the nicotine content when he felt a very strong desire. Some smokers are afraid that they could remain dependent for smoking cessation nicotine after using nicotine products, but this occurs rarely. When choosing the agent, the physician must be guided by his own knowledge and preferences of the smoker, taking into account previous experience (good or bad) and contraindications. Despite proven efficacy access only <25% of patients who are trying to quit smoking, to such aid back. Possible reasons are low cost reimbursement from the health, safety concerns from doctors about the side effects of centrally acting drugs (severe neuropsychiatric events including depression, suicidal thoughts and suicide attempts) and security, when smoked the same time during nicotine replacement therapy, and discouragement by unsuccessful attempts in the past , Among the investigated at the time of smoking cessation therapies include drugs cystine, bromocriptine and topiramate. The vaccine therapy was examined and found to be ineffective. Medications for smoking cessation drug dosage permanent side effects Comments bupropion sustained release 150 mg every morning for 3 days (start of treatment 1-2 wk. From smoke-stop), then 150 mg two times daily beginning 7-12 wk. (Can be continued up to 6 months) insomnia dry mouth may serious neuropsychiatric symptoms * (z. B. changes in behavior, agitation, depressed mood, suicidal thoughts and behavior) prescription Contraindicated in a history of seizures, eating disorders or taking MAO inhibitors in the last 2 weeks. Nicotine gum is smoked, if> 30 minutes after waking up: 2 mg is smoked, when <30 minutes after waking up: 4 mg for both Dosierstärken: 1 pc. every 1-2 h 1 piece within the first 1-6 weeks. every 2-4 h in the 7th-9th Week 1 pcs. every 4-8 hours for the 10th-12th Week Up to 6 months soreness in the mouth dyspepsia Prescription Slow chewing is recommended so that the nicotine too quickly passes from the oral mucosa into the blood and irritation of the esophagus and stomach is avoided nicotine lozenges is smoked, if> 30 minutes after waking up: 2 is smoked If mg <30 min after waking: 4 mg for both Dosierstärken. 1 tablet every 1-2 h in 1.-6. Week 1 Tbl. Every 2-4 h from the 7th to 9th. Week 1 Tbl. Every 4-8 h from the 10th-12th. Week Up to 6 months nausea insomnia Prescription nicotine inhaler 6-16 cartridges a day for the first 6-12 weeks, then reduce 3-6 months Local irritation of mouth and throat prescription nicotine nasal spray 8-40 over the next 6-12 weeks doses per day (1 dose = 1 spray in each nostril) 14 weeks nose and sore throat prescription reaches maximum Blood levels rapidly (in 10 min) than other nicotine replacement products nicotine patch 21 mg daily for 6 weeks, then 14 mg daily for 2 weeks, then 7 mg daily for 2 weeks. If> 10 cigarettes were smoked per day: 21 mg as the starting dose when smoked <10 cigarettes per day: 14 mg as the starting dose 10 weeks Local skin reactions insomnia-the-counter and prescription drugs may auftretene skin reactions can be avoided by the pavement at different locations on the skin is applied. Varenicline 0.5 mg p.o. once daily for 3 days, then 0.5 mg two times a day for 4 days, then 1 mg 2 times a day for 12-24 weeks † Most frequently. nausea and insomnia Potential severe neuropsychiatric symptoms * (for example, changes in behavior, agitation , depressed mood, suicidal thoughts and behavior) prescription * It was reported neuropsychiatric symptoms, but clinical trials have confirmed no causal connection; such an association may be related to the symptoms of nicotine withdrawal. † The longer duration of treatment may increase the likelihood of long-term abstinence in patients who stopped smoking after 12 weeks of use of varenicline. MAO = monoamine oxidase drug safety When seizures in history, eating disorders and up to 2 weeks after treatment with MAOIs Bupropion is contraindicated. Whether bupropion and varenicline increased the suicide risk is unclear. Varenicline and bupropion increase the risk of serious neuropsychiatric effects and accidents. In 2009, the FDA issued a warning on the packaging for both drugs about these possible side effects. However, most experts varenicline recommended for most smokers, because the risks of smoking are significantly higher than the potential risks of taking the drug. However, varenicline should be avoided in smokers with suicidal risk, unstable psychiatric disorders and possibly depression. Nicotine replacement therapy should be performed with caution in certain cardiovascular risks (2 weeks after myocardial infarction, in severe arrhythmias or angina pectoris). Most data however indicate that the use is safe. Nicotine gums are contraindicated in temporomandibular joint arthrosis and nicotine patches with very sensitive skin. Because of security concerns, insufficient data on the efficacy, or for both reasons drugs are not recommended in the following cases: If you are pregnant For light smokers (<10 cigarettes per day) in adolescents (<18 years) For users of chewing tobacco smoking cessation in children's consulting approach for children is similar to adults, but the usual medicines are not recommended for smokers under 18 years. (See also the CDC Guidelines for Youth Tobacco Cessation.) Children should be tested for smoking and risk factors from the age of 10 years. For parents, the Council is important not to smoke at home and clearly the children to express their expectation that they stay Non smoking. To treat nicotine dependent children a cognitive behavioral therapy, which makes them the use of tobacco aware motivates them to quit or preparing acts and showing them strategies on how to remain abstinent after more suitable. Alternative methods for quitting smoking such as hypnosis and acupuncture could not be confirmed to be effective in tests and may therefore not recommended for routine use werden.Entwöhnung of chewing, pipe and cigar tobacco An advice to stop consuming for Kautabaknutzer, as offered for cigarette smokers, has proven to be effective. However, the drug did not show that they can be effective for Kautabaknutzer. The success of drug withdrawal treatments for pipe and cigar smoking is not well documented. The success of weaning may also depend on whether the way yet cigarettes are smoked or whether the smoke is inhaled. Summary About half of all smokers try to quit each year, but few succeed this. increase Evidence-based methods of smoking after one year of treatment, the success rate of about 5% to 20-30%. The use of evidence-based consulting methods, including medical counseling and referral to special programs makes sense. Drug treatment may be considered (eg. As varenicline or in combination with various nicotine replacement products). More information Centers for Disease Control and Prevention - Youth Tobacco Cessation: A Guide for Making Informed Decisions US Preventive Services Task Force - Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions


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