Why Quit? Potential Lifetime Health Benefits of Quitting Smoking1-2Why Quit? Potential Lifetime Health Benefits of Quitting Smoking1-2

1. CDC. Surgeon General Report 2004: American Cancer Society. Guide to Quitting Smoking. 2. US Department of Health & Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. 1990.

Lung function may start to improve with decreased cough, sinus

congestion, fatigue, and shortness of breath

3 m

on

ths

Lung cancer risk is 30-50% that of continuing smokersC

es

sa

tio

n

CHD: excess risk is reduced by 50% among ex-smokers

Cardiovascular heart disease (CHD) risk is similar to never smokers

Stroke risk returns to the level of people who have never smoked at 5-15 years post-cessation

1 ye

ar

5 ye

ars

10 y

ears

15 y

ears

PathogenesisPathogenesis

Managing tobacco use: the neglectedcardiovascular disease risk factorNancy A. Rigotti1*and Carole Clair

Managing tobacco use: the neglectedcardiovascular disease risk factorNancy A. Rigotti1*and Carole Clair

Risk and BenefitsRisk and Benefits

Ingredient Rating Ingredient Rating Ingredient Rating

In-person support Abrupt stop (vs gradual) Deep breathing

NRT (supported) Identity change Exercise

Champix Avoiding smokers Isometric exercise

Zyban Avoiding alcohol Mental exercises

Cytisine Changing routine Healthy snacks

Quitline Keep busy Go to bed early

Internet One day at a time Get rid of cigs

SMS support Tell others Smartphone app

Book or booklet Quit together

E-cigs Count savings

Glucose

6 Strong evidence Moderate evidence Some evidence

Current Methods 2013Current Methods 2013

The Cycle of Nicotine AddictionThe Cycle of Nicotine Addiction

Nicotine binding causes an increase in dopamine release 1

Dopamine gives feelings of pleasure and calmness 2

The dopamine decrease between cigarettes leads to withdrawal symptoms of irritability and stress 3,4

A smoker craves nicotine to release more dopamine to restore pleasure and calmness 2,3

DopamineDopamine

NicotineNicotine

1. Foulds J. Int J Clin Pract 2006;60:571-576.2. Fagerstrom K. Drugs 2002;62(Suppl2):1-9.3. Jarvis MJ. BMJ 2004; 328:277-279.4. Rigotti NA. N Engl J Med 2002;346:506-512.

Withdrawal Symptoms from Stopping SmokingWithdrawal Symptoms from Stopping Smoking

0 1 2 3 4 5 6 7 8 9 10

Duration (weeks)or more

Jarvis MJ. BMJ 2004;328:277-279.

Incidence

Increased appetite

Restlessness

Depression

Irritability/aggression

Craving for nicotine

Poor concentration

Sleep disturbance

Lightheadedness

70%

60%

60%

50%

70%

60%

25%

10%

11

When the desire is stronger than abstinence and cigarettes are close .... You will be tempted to start!

Urge to

smoke

Time

Resolve Strength of urge

0,0

0,5

1,0

1,5

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

Anxiety/Tension

Irritability/Anger

Excessive Hunger

Select Withdrawal Symptoms Over TimeSelect Withdrawal Symptoms Over Time

N = 40. Mean adjusted withdrawal scores are from an analysis of covariance with baseline cigarettes per day and baseline scores on the items shown as covariates. Gross et al. Psychopharmacology. 1989;98:334-341.

Impatience

0,0

0,5

1,0

1,5

1 2 3 4 5 6 7 8 9 10

Placebo Nicotine Gum

Mea

n A

dju

sted

Wit

hd

raw

al S

core

Mea

n A

dju

sted

Wit

hd

raw

al S

core

Postcessation Weeks

0.0

0.5

1.0

1.5

0,0

0,5

1,0

1,5

1 2 3 4 5 6 7 8 9 10

Postcessation Weeks

Postcessation WeeksPostcessation Weeks

Withdrawal Syndrome: a Combination of Physical and Psychological Conditions, Making Smoking Hard to

Treat1,2

Withdrawal Syndrome: a Combination of Physical and Psychological Conditions, Making Smoking Hard to

Treat1,2

Restlessness or impatience

Increased appetite or weight gain

Withdrawal Syndrome

Anxiety

Dysphoric or depressed mood

Irritability, frustration, or anger

Difficulty concentrating

Insomnia/sleep disturbance

1. Diagnostic and Statistical Manual of Mental Disorders, IV-TR. Washington, DC: APA; 2006.2. West RW et al. Fast Facts: Smoking Cessation. 1st ed. Oxford, United Kingdom. Health Press Limited, 2004.

About Vaping

Executive Agency for Health and Consumers Specific Request EAHC/2011/Health/11 for under EAHC/2010/Health/01 Lot 2 Economic analysis of the EU market of tobacco, nicotine and related products Revised Final Report 20 September 2013

Truth About Vaping

Executive Agency for Health and Consumers Specific Request EAHC/2011/Health/11 for under EAHC/2010/Health/01 Lot 2 Economic analysis of the EU market of tobacco, nicotine and related products Revised Final Report 20 September 2013

People who quit smoking after a heart attack or cardiac surgery reduce their risk of death by 36%

Cochrane Database of Systematic Reviews 2003;4:CD003041

Slide courtesy of Andrew Pipe, CM, MD, LLD(Hon), DSc(Hon)

Over the long term, even in a higher risk population of patients with stable CVD, the benefits of smoking cessation likely outweigh potential short-term harms of varenicline.

However, this increase in risk may be important in choosing between medical therapies for smoking cessation in patients at increased risk of cardiovascular events.

A (shock) Well Informed E Cig Media Report

Публикуван на 28.04.2014 г.BBC Breakfast from 28th April 2104

20

How to stop smoking cigarettes: these lines must be separated!

Жел

ание за

пушене

Време

Resolve Strength of urge

22Proven as the most effective medicament in the world for the last 50 years!

Medical specialist claims 2012-2015Medical specialist claims 2012-2015

Product promotional campaign in pharmacy stores

New Key opinion leader in BulgariaNew Key opinion leader in Bulgaria

Product promotional campaign at Workplaces

Free flu vaccination

Head manager

Health promotional campaign at Sopharmacy 31-05 2015

No smoking cessation

No smoking cessation

consultation

consultation

SMOKING CESSATION CAMPAINSMOKING CESSATION CAMPAIN

200 NICOTINE 200 NICOTINE ADDICTED MEDICSADDICTED MEDICS

Prof. Kosta Kostov Prof. Kosta Kostov Head of pulmonary department at Head of pulmonary department at

Military Hospital in SofiaMilitary Hospital in Sofia

NEW PRODUCT STRATEGY

We can be the next Dunhill ….

TABEX IS NOT SEXY FOR CONSUMERs

ANTI GENERIC STRATEGY

NEW PROPOSAL

NEW PROPOSAL

Smoking cessation market in Bulgaria in sales unitsSmoking cessation market in Bulgaria in sales units