1. Department of Family Medicine
Smoking Cessation Counselling
By: Lucie Desjardins Bscn R.N
Certified Smoking Cessation Counsellor from CAMH

2. Fast Facts on Tobacco Use in Canada
Tobacco kills 1 in 5 Canadians or 45,000 peoples every year
Economic impact of smoking is estimated at 17 billions every year
Tobacco related disease for at least 500,000 hospital day each year
17.5 % of Canadian age 15 and over are current smokers
Department of Family Medicine

3. Why Should Health Professionals Get Involved?
Tobacco is the first cause of preventable death in Canada
Successful intervention exist 1 pack a day at $10/pack = $3,600/year
Lung cancer treatment = $19,000/yr per person
Smoking cessation counselling session is way cheaper and is one of the most cost – effective intervention a clinician can perform after immunization
Smoking tobacco should be treated as a chronic disease, the same as we do for hypertension and diabetes
Department of Family Medicine

4. Involving health care professionals
Multiple quit attempts may be necessary
Past failure does not prevent future success
Optimal intervention is minutes for estimated abstinence
Rate of 26.5% (1 in 4)
Department of Family Medicine

5. What Are Tobacco And Nicotine?
Tobacco is a plant that contains nicotine
Nicotine is one of the major addictive component in tobacco
More than 60 carcinogens are in cigarette smoke
To name a few:
Arsenic – a deadly poison used in insecticides
Formaldehyde – used to preserve dead body
Cadmium – highly poisonous metal used in battery
Shellac – wood varnish
Ammonia – cleaning agent
Department of Family Medicine

6. Tobacco and Nicotine - Background
Tar – toxic chemical found in cigarette is a contributing factors
causing C.O.P.D. and respiratory problem
In solid form, tar is brown, tacky substance that is left behind
on the end of cigarette filter. It stains a smoker's teeth and
fingers brown and coats everything it touches with brownish–yellow film, imagine that settling into the delicate pink tissue of lungs!!!
Department of Family Medicine

7. Department of Family Medicine
Carbon Monoxide (co)
Toxic gas that is produced when there is combustion of any product
including tobacco
When inhaled (Co) compete with O2 in the blood stream to form COHB( carbonxyhaemoglobine)
This starves the body tissue of O2, CO can remain in the bloodstream for up to 24 hrs. It takes 8 hrs to see a decreased level
A normal level of CO in blood stream is below 6 ppm
A smoker can have up to 50 ppm
Department of Family Medicine

8. Department of Family Medicine
Carbon Monoxide
It is hard to believe but cigarette users inhale 4 times the amount of CO found in car exhaust
There is a tool that calculates the level of CO. It is called PICO (piCO+smokerlyzer (Breath Carbon Monoxide (CO) Monitor). The patient takes a deep breath and keeps the air in their lungs for seconds then need to blow in the device. This give me the measurement of COHB% AND PPM OF CO in the blood. If you do the test, you can explain to the client their level and this can become a good source of motivation as the level will decrease once they cut down on their cigarette intake and will return to normal once an individual quits smoking
When the level of CO decreases, the client has more energy, skin coloration in the face gets more pink than grey
Department of Family Medicine

9. What Your Carbon Monoxide Levels?
Non-smoker levels
20 ppm Loss of oxygen to vital organs
35 ppm Legal limit for 8 hr workplace exposure
50 ppm Air pollution emergency
60 ppm Headaches, nausea, nervous system slows down, difficulty thinking clearly, vision difficulties
Department of Family Medicine

10. VIDEO – Quitting Smoking is a Journey
Department of Family Medicine

11. Algorithm for tailoring pharmacotherapy
Department of Family Medicine

12. Medications for quitting smoking
Department of Family Medicine

13. Costs of Smoking vs Pharmacotherapy
Note: Dispensing fees vary between pharmacies and costs may slightly differ between chains
Department of Family Medicine

14. Fagerstrom test for nicotine dependence
Department of Family Medicine

15. Bruyère questionnaire for smokers
Department of Family Medicine

16. Counselling session for smoking cessation
Department of Family Medicine

17. Counselling session for smoking cessation - 2
Department of Family Medicine