1. Nicotine Replacement Therapy: Administration and Overview Barbara Hart, MPA and Claudia Lechuga, MS Bronx BREATHES T: (718)430-2601 E: bhart@aecom.yu.edu / clechuga@aecom.yu.edu www.bronxbreathes.org June 15, 2009

2. Smoker Assessment History of usage Previous quit attempts – Withdrawal/abstinence symptoms Motivational level for quit attempt Current social environment – Stressors – Triggers – Biological/medical assessment – Family and friend support/sabotage

3. Previous Quit Attempts Dates Age Method used to quit – Medications or counseling used (if any) Duration of that method Problems and successes experienced Reason for relapse Withdrawal/Abstinence Symptoms

4. Current Quit Attempt Motivational Level – Confidence Main reason for considering/wanting to stop Concerns about quitting – Weight gain concerns

5. Use of NRT Reasons for using NRT Doubles the success rate Treats nicotine withdrawal – Helps patient feel more comfortable Safe – Patient receiving same drug (nicotine) in a less addictive form over a relatively short period Reasons for NOT using NRT Medical conditions requiring caution/physician input – i.e. recent MI, pregnancy, current arrythmia Age – Under 18s require physician/parental input Specific issues – Allergy to patches – Personal aversion to medication Questionable efficacy – i.e. those smoking less than 10pd

6. Tobacco Cessation Medications Nicotine Replacement Patch * Gum * Lozenge * Oral Inhaler ^ Nasal Spray ^ Non-nicotine medication Bupropion ^ – (Zyban/Wellburtrin) Varenicline ^ – (Chantix) * Available OTC ^ prescription only

7. Nicotine Delivery Comparison

8. Medication Overview

9. Use and Efficacy of combination therapy Multiple patch therapy (42 vs 21mg) – 20% increased abstinence – No significant increased sleep disturbances – (Dale 1995; Jorenby 1995) Patch + Gum – Kornitzer 1995; Puska 1995 Early better rates – 7% increase at 6 months Not sustained at 1 year No increase in adverse events – 2008 OHS Guidelines Meta-analysis Path + Gum/Spray OR = 1.9 – Compared to patch alone (OR=1) – Fiore 2008 Abstinence rates – Nicotine Patch = 23.4% – Nicotine Gum = 19.0% – Long term Patch + Gum = 36.5%

10. Important Points about NRT Nicotine is the addictive part of tobacco smoke but NOT the most dangerous part People do NOT generally become addicted to medication People DON’T use enough medication or stop TOO EARLY – Medications are SAFE and EFFECTIVE – Plan on minimum of 2 months of medication Combinations – Work better than single medications Use Long acting + Short acting

11. NRT Kits Available Moderate Smokers Smoke 10-20 per day Includes: – Novartis Step 1 28 count 21 mg patches Heavy Smokers Smoke 20+ per day Includes : – Nicorelief Gum 110 pieces of 4mg gum – Novartis Step 1 28 count of 21mg patches

12. NRT Enrollment Forms  Necessary for each course distributed  Full information required  Fax or email back to Bronx BREATHES

13. NRT Enrollment Forms (cont’d 1)