E-Cigarettes Dan Vape Pengganti Rokok

E-Cigarettes Dan Vape Pengganti
Rokok ?
Dr Salmah Noordin
Pakar Perubatan Keluarga
Hulu langat
• Memahami isu tentang rokok
• Memahami isu tentang vape
• Mengetahui kajian tentang penggunaan vape
untuk berhenti merokok
• Memahami prinsip terapi gantian
Kenapa perlu ganti ?
Pokok tembakau
Adakah kita boleh menjadi ketagih
kepada tembakau?
• Nikotin- sejenis alkaloid yang terdapat dalam
tembakau dan bertanggungjawab
menyebabkan ketagihan
Ketagihan Nikotin
• Bertindak di otak- ‘ reward pathway’
• Reseptor Nikotine acetylcholine di ransang
dan merembeskan dopamine
• Merokok menyebabkan pengeluaran
dopamine dengan cepat
200
% of Basal DA Output
NAc shell
150
100
Empty
50
Box Feeding
200
150
100
15
10
5
0
0
0
60
120
Time (min)
180
ScrScr
BasFemale 1 Present
Sample 1 2 3 4 5 6 7 8
Number
Scr
Scr
Female 2 Present
9 10 11 12 13 14 15 16 17
Mounts
Intromissions
Ejaculations
Source: Di Chiara et al.
Source: Fiorino and Phillips
Copulation Frequency
DA Concentration (% Baseline)
Natural Rewards Elevate Dopamine
Levels
FOOD
SEX
Accumbens
1100
1000
900
800
700
600
500
400
300
200
100
0
AMPHETAMINE
DA
DOPAC
HVA
250
1
2
3
4
Time After Amphetamine
% of Basal Release
400
0
Accumbens
Caudate
150
100
0
0
1
2
3 hr
Time After Nicotine
COCAINE
DA
DOPAC
HVA
200
100
0
5 hr
NICOTINE
200
Accumbens
300
% of Basal Release
% of Basal Release
% of Basal Release
Effects of Drugs on Dopamine Levels
250
0
1
2
3
4
Time After Cocaine
Accumbens
5 hr
MORPHINE
Dose (mg/kg)
0.5
1.0
2.5
10
200
150
100
0
0
Source: Di Chiara and Imperato
1
2
3
4
Time After Morphine
5hr
Nicotine addiction cycle
Nicotine use for pleasure,
enhance performance, mood
regulation
Nicotine use to self-medicate
withdrawal symptoms
Tolerance and physical
dependence
Nicotine abstinence produces
withdrawals symptoms
Kenapa terus merokok ?
• Host: Addiction, genetic, family, mental
illness
• Agen: mudah di perolihi
• Persekitaran : Occupation, Peer, Culture
Host
Environment
Agent
Selain ketagihan…
• 4000 7000 bahan kimia
• 40 adalah penyebab kanser
• 500 racun
Apa kita perlu tahu tentang E cig dan
Vape
Apa itu E Cig dan Vape ?
E-cig
Electronic vaping
device
Personal vaporiser1
Electronic nicotine
delivery system (ENDS)
Vaporette1
Vaping pen1
E-hookah1
E-liquid or E-juice
Propylene glycol (~66%) 2
Glycerin (~24%) 2
Nicotine (0-34mg/ml3; up to
87mg/ml4)
Flavouring (~0.1%) 2
Majority used liquid with
nicotine ≤20mg/ml5
1.
2.
3.
4.
5.
“CIG-A-LIKEs”
(disposable or prefilled cartridges)
“TANKs”
(refillable)
Orellana-Barrios et al. Electronic cigarettes – a narrative review for clinicians. The American Journal of Medicine 2015;128:674-681
Pellegrino et al. Electronic cigarettes: an evaluation of exposure to chemicals and fine particulate. Ann Ig 2012;24:279-288
Goniewicz et al. Nicotine content of electronic cigarettes, its release in vapour and its consistency across batches: regulatory implications. Addiction 2014;109:500-507
Kirschner et al. Nicotine content of liquid for electronic cigarettes. Clin Toxicol 2013;51:684
Tackett et al. Biochemically verified smoking cessation and vaping beliefs among vape store customers. Addiction 2015;110:868-874
16
VARIOUS TYPES OF E-CIG… STILL
EVOLVING!!
• >nicotine in vapour produced by
EC vs1st gen EC1
3rd
gen
• 3rd gen EC- higher battery output voltage
or sub-ohm vaping1
• Various concentration of
1. Pisinger
C, Døssing M. Preventive Medicine 2014;69: 248formaldehyde
260
Modified ecigarettes
17
E-juices: >7700 flavours1
Most
preferre
d: Fruity
&
candy/n
uts eliquids2
1. Zhu et al. Four hundred and sixty brands of e-cigarettes and counting: implication for product regulation. Tob Control 2014;23(Suppl 3):iii3-9
2. Tackett et al. Biochemically verified smoking cessation and vaping beliefs among vape store customers. Addiction 2015;110:868-874
18
AWARENESS OF E-CIG IN MALAYSIA
Based on International Tobacco Control
(ITC) Project1
Netherland (2013)
19%
Australia (2013)
66%
Malaysia (2011)
62%
Korea (2010)
79%
Canada (2010)
40%
USA (2010)
73%
UK (2010)
54%
0
10
20
30
40
50
60
70
80
90
Awareness
1. Gravely et al. Int J Environ Res Public Health 2014;11:11691-11704
19
INCREASE POPULARITY OF VAPING
Prevalence of cigarette smoking & e-cigarette use
among adults in UK (based on Smoking Toolkit Study)1
1. McNeill et al. E-cigarettes: an evidence update – A report commissioned by Public
Health England. 2015. Retrieved from: www.gov.uk/phe
20
PREVALENCE OF E-CIG USE IN
Based on International Tobacco Control
MALAYSIA
(ITC) Project1
3%
Netherland (2013)
19%
7%
Australia (2013)
20%
14%
Malaysia (2011)
7%
Korea (2010)
1%
Canada (2010)
12%
4%
6
USA (2010)
15%
4%
UK (2010)
0
19%
5
10%
10
Current e-cig use
1. Gravely et al. Int J Environ Res Public Health 2014;11:11691-11704
15
20
25
Ever-tried e-cig
21
Kenapa Vape?
Alasan untuk ‘Vaping’
Sebab utama yang sering di beri:
• Untuk berhenti merokok
• Untuk mengurangkan kemudharatan dan
risiko kesihatan ( berbanding dengan rokok
• Untuk mengelak relaps kepada merokok
• Untuk mengurangkan ketagihan, gian dan
kesan tarikan ( withdrawal symptoms)
1.
2.
3.
4.
5.
6.
McNeill et al. E-cigarettes: an evidence update. A report commissioned by Public Health England. Public Health England 2015. Retrieved from: www.gov.uk/phe
Etter & Bullen. A longitudinal study of electronic cigarette users. Addictive Behaviour 2014;39:491-494
Czoli et al. Electronic cigarettes in Canada: Prevalence of use and perceptions among youth and young adults. Can J Public Health 2014;105(2):e97-e102
Farsalinos et al. Characteristics, perceived side effects and benefits of electronic cigarette use: A worldwide survey of more than 19,000 consumers. Int J Environ Res
Public Health 2014;11:4356-4373
Harrell et al. Expectancies for cigarettes, E-Cigarettes, and nicotine replacement therapies among E-cigarette users (“Vapers”). Nicotine & Tobacco Research 2014;
Goniewicz et al. Patterns of electronic cigarette use and user beliefs about their safety and Eenefits: a prospective 6-months pilot study. BMC Public Health
2011;11:786-798
Sebab lain untuk ‘vaping’
•
•
•
•
•
•
•
Lebih murah
Lebih bebas merokok di tempat awam
Lebih diterima masyarakat
Lebih memuaskan
Rasa lebih sedap
Diguna secara rekreasi ( for fun)
Ingin tahu ( terutamanya remaja yang merokok
dan yg tidak merokok)
• Prngruh rakan sebaya
• Teknologi ‘vaping’
1.
2.
3.
4.
5.
6.
7.
McNeill et al. E-cigarettes: an evidence update. A report commissioned by Public Health England. Public Health England 2015. Retrieved from: www.gov.uk/phe
Etter. Electronic cigarettes: a survey of users. BMC Public Health 2010;10:231-7
Etter & Bullen. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction Research Report 2011;106:2017-28
Czoli et al. Electronic cigarettes in Canada: Prevalence of use and perceptions among youth and young adults. Can J Public Health 2014;105(2):e97-e102
Harrell et al. Expectancies for cigarettes, E-Cigarettes, and nicotine replacement therapies among E-cigarette users (“Vapers”). Nicotine & Tobacco Research 2014;
Tackett et al. Biochemically verified smoking cessation and vaping beliefs among vape store customers. Addiction 2015;110:868-874
Shiplo et al. E-cigarette use in Canada: prevalence and patterns of use in a regulated market. BMJ Open 2015;5:e007971
Benarkah ianya selamat ?
• ‘Vape’ masih tidak selamat walaupun ianya
mengandungi kurang bahan toksik dan
karsinogen
– Propylene glycol dn glycerine -> formal dehyde bila
dipanaskan ( bahan awet mayat)
– Kabus/asap yang terhasil boleh menyebabkan iritasi tekak
dan mata, batuk, sakit kepala, pening dan susah bernapas
– Bahan toksik dan karsinogen yang di uji dalam EC hanyalah
untuk apa yang di ketahui ada dalam rokok. Lain lain
bahan yang terkandung dan terbentuk bila dipanaskan
tidak dikaji
– ‘liquid nicotine’ sangat toksik jika di telan
Boleh kah berlaku ketagihan dengan
menggunakan vape’ ?
• Di dapati jus yang di katakan tidak
mengandungi nikotine tetap mengandungi
nikotine dalam kandungan yang sedikit dan
nikotine penyebab ketagihan
• Terdapat ‘vape’ yang di kesan mengandungi
dadah ganja dan dadah lain
• Tabiat memganag vape dan membawanya ke
mulut utk hisap pun bukan tabiat yang mudah
di buang
Second hand ‘vapping’ tetap ujud
• Wap / kabus yang dihasilkan masih
mengandungi nikotin dan bahan toksik yang
lain
Mempunyai kesan negatif kepada
kanak kanak dan remaja
Mempunyai kesan negatif kepada
kanak kanak dan remaja
• Menjadi satu ‘trend’
• Selalu ingin mencuba-> tidak merokok kepada
perokok
• Menjadi penagih dadah tanpa di sedari
dengan jus yang mempunyai campuran dadah
‘Vaping’ boleh menjadi satu hazard
• Peralatan yang d gunakan boleh meletup dan
menyebabkan kecederaan
• Menyebabkan toksik dan kematian jika di
minum terutama oleh kanak kanak
• Loya, muntah, sakit perut, berpeluh, jantung
laju, tremor, sakit kepala, pening -> lemah
otot, lumpuh, susah bernafas, koma dan mati
Nicotine
Biological effects1
Irritation & burning sensation in mouth & throat
Increased salivation, nausea, abdominal pain, vomiting, diarrhea
Vasoconstriction, increased heart rate, increased myocardial
contractility
Acute toxicity1
Tremors, prostration, cyanosis, dyspnoea, convulsion, coma
Respiratory failure: 30-60mg (adults) & 10mg (children)
Meta analysis on
NRT use2
No increase risks of serious adverse events
Long term NRT use3 No increase risks of cancer
NRT use in
pregnancy4
Category D medication
Significantly reduce risks of preterm delivery & low birth weight
(compared to smokers)
Increase risk for birth defect (but the analysis was not adjusted
for other known associated factors)
Animal studies5
Accelerates atherosclerosis, reduces sperm quality, promotes
growth of cancer cells, proliferation of endothelial cells
1. Mishra et al. Harmful effects of nicotine. Indian J Med Pediatr Oncol 2015; 36(1): 24-31
2. Moore et al. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systemic review and meta nalysis. BMJ 2009;338:b1024
3. Murray et al. Does nicotine replacement therapy cause cancer? Evidence from Lung Health Study. Nicotine Tob Res 2009; 11(9): 1076-1082
4. Forinash et al. Nicotine replacement therapy effect on pregnancy outcomes. Ann Pharmacother 2010; 44(11): 1817-1821
5. Pisinger & Døssing. A systemic review of health effects on electronic cigarettes. Preventive Medicine 2014; 69:248-260
36
Harmful contents in E-Cig liquid & ‘vapour’1-3
Chemical compounds
1.
2.
3.
Toxic effects
Carbonyls / Aldehydes
Formaldehyde
Acetyldehyde
Acrolein
Acetone
O-Methyl benzyldehyde
Cytotoxic,
carcinogenic, irritant,
pulmonary
emphysema,
dermatitis
Tobacco-specific
nitrosamines
N-nitrosonornicotine (NNN)
Carcinogenic
4-(N-nitrosomethylamino)-1-(3-pyridyl)-1-butanone
(NNK)
Metals
Cadmium
Nickel
Lead
Chromium
Polycyclic aromatic
hydrocarbons
Benzo(a)pyrene
Benzo(a)anthracene
Carcinogenic
Volatile organic
compounds
Toluene; p,m-Xylene
Irritant, neurotoxic
Drugs
Amino-tadanafil, Rimonabant, coumarin
Tin
Silver
Aluminium
Mercury
Arsenic
Carcinogenic,
nephrogenic,
neurotoxic,
haematotoxic
Pisinger & Døssing. A systemic review of health effects on electronic cigarettes. Preventive Medicine 2014; 69:248-260
Cheng T. Chemical evaluation of electronic cigarettes. Tob Control 2014;23:ii11-ii17
Farsalinos & Polosa. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systemic review. Ther Adv Drug Saf 2014;5(2):67-86
37
Bolehkah E cig dan vape di guna untuk
berhenti merokok?
Findings of the Reviews 1-3
• Most studies: main chemicals →low concentration or
traces (<<CC)
• Some studies: Certain metals were not detected at all1,2
• Some studies: comparable levels (formaldehyde [1
study]; lead & chromium [1 study]) with CC1
• One study: nickel up to 100x higher than CC & silicate
beads5
– >4000 chemicals in CC → completely absent in E-Cig3
– Most toxicants & carcinogens: Reduced by >90%4
1. Pisinger & Døssing. A systemic review of health effects on electronic cigarettes. Preventive Medicine 2014; 69:248-260
2. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control 2014;23:ii11-ii17
3. Farsalinos & Polosa. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systemic review. Ther Adv Drug Saf
2014;5(2):67-86
4. Lauterbach &Laugesen. Comparison of toxicant levels in mainstream aerosols generated by Ruyan®electronic nicotine delivery systems (ENDS)39
and
conventional cigarette products. Toxicologist 2012;126(1)
9 to 450 times LESS than
conventional cigarettes1
1. Lukasz et al. Levels of selected carcinogens and toxicants in vapor from electronic cigarettes. Tob Control
2014;23(2):133-139
40
>970 times MORE nitrosamines in
conventional cigarettes1
1. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control 2014;23:ii11-ii17
41
Toxic emission scores: Comparison
between CC and E-Cig1
Data from Laugesen (2009)2
1. Farsalinos & Polosa. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systemic
review. Ther Adv Drug Saf 2014;5(2):67-86
2. Laugesen M. RuyonE-cigarette Bench-top tests. Society for Research on Nicotine and Tobacco (SNRT) Dublin, Poster 5-11. Available
42
at: http://www.healthnz.co.nz/DublinEcigBenchtopHandout.pdf
Reviews on chemical contents in E-Cig1-3
• Reviewed ~40 studies:
– Analytical methods were varied2
– Authors in 34% of the studies → conflict of
interest1
– Focus on specific chemical known from studies on
conventional cigarettes (CC) 3
• Levels in liquids & vapour: vary considerably &
inconsistent
1. Pisinger & Døssing. A systemic review of health effects on electronic cigarettes. Preventive Medicine 2014; 69:248-260
2. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control 2014;23:ii11-ii17
3. Farsalinos & Polosa. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systemic review. Ther Adv Drug Saf
2014;5(2):67-86
43
E-Cig helps to reduce cigarette consumption
Studies
Study design
Sample size
Capponetto et
al (2013a)1
RCT: Nicotine
EC vs Placebo
EC
Bullen et al
(2013) 2
Polosa et al
(2013) 3
Brose et al
(2015) 4
≥50% reduction
Pvalue
Nicotine EC
Comparison
300 smokers
At 1 year :
14.5%
At 1 year:
12.0%
0.55
RCT: Nicotine
EC vs NRT
Patch
657 smokers
At 6 months:
57.0%
At 6 months:
41%
0.000
2
Prospective
cohort study
40
Unmotivated
to quit
smokers
Prospective
cohort study
General
population –
unmotivated
to quit
At 6 months: 27.5%
Daily E-Cig
users
None E-Cig
users
At 1 year:
13.9%
At 1 year: 5.7%
-
0.022
E-Cig users had 1.31x the chance to reduce their cigarette consumption by at least half
compared to Non-Users5
1.
Caponnetto et al. Efficacy and safety of an eLectronic cigarette (ECLAT) as tobacco Cigarettes Substitute: A prospective 12-month randomized control design study. PLoS ONE 2013;8(6):e66317
2.
3.
4.
5.
Bullen et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 2013; 382(9905):1629-37
Polosa et al. Effectiveness and toletability of electronic cigarette in real-life: a 24-month prospective observational study. Intern Emerg Med 2013;9:537-46
Brose et al. Is the use of electronic cigarettes while smoking associated with smoking cessation attempts, cessation and reduced cigarette consumption? A survey with 1-year follow-up. Addiction 2015;110:1160-1168
McRobbie et al. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systemic Reviews 2014; Issue 12: Art No CD010216
44
E-Cig helps to quit smoking
Nicotine EC
Comparison
Pvalu
e
At 3 months:
14.0%
At 3 months:
4.0%
0.00
8
At 1 year: 11.0%
At 1 year: 4.0%
0.04
At 6 months:
7.3%
At 6 months:
5.8%
0.46
1.26
0.24
0.62
Smoking cessation
Studies
Study design
Sample size
Capponetto et
al (2013a)1
RCT: Nicotine
EC vs Placebo
EC
300 smokers
Bullen et al
(2013)2
RCT: Nicotine
EC vs NRT Patch
657 smokers
Polosa et al
(2013)3
Prospective
cohort study
40 Unmotivated
to quit smokers
At 6 months: 12.5%
Etter & Bullen
(2014)4
Prospective
online study
367 vapers
At 1 year: 46%
Brose et al
(2015)5
Prospective
cohort online
study
1759 General
population
Daily E-Cig
users
None E-Cig users
At 1 year: 8.1%
At 1 year: 12.9%
RR /
OR
-
E-Cig users had 2.26x the chance to stop smoking for at least 6 months compared to
Non-Users6
1.
2.
3.
4.
5.
6.
Caponnetto et al. Efficacy and safety of an eLectronic cigarette (ECLAT) as tobacco Cigarettes Substitute: A prospective 12-month randomized control design study. PLoS ONE 2013;8(6):e66317
Bullen et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 2013; 382(9905):1629-37
Polosa et al. Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study. Intern Emerg Med 2013;9:537-46
Etter & Bullen. A longitudinal study of electronic cigarette users. Addictive Behaviors 2014; 39:491-494
Brose et al. Is the use of electronic cigarettes while smoking associated with smoking cessation attempts, cessation and reduced cigarette consumption? A survey with 1-year follow-up. Addiction45
2015;110:1160-1168
McRobbie et al. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systemic Reviews 2014; Issue 12: Art No CD010216
Predictors for smoking cessation among vapers
• Intention to quit1,2
– Motivated to quit in the next 3 months
(Contemplation stage) 2
•
•
•
•
•
•
Lower consumption of cigarettes1
Experience weaker urges to smoke2
Tank users (particularly daily users)2,3
Use non-tobacco & non-menthol flavour juices3
Longer duration of E-Cig use3
Higher incomes2
1. Grana et al. A Longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Internal Medicine 2014;174(5):812-813
2. Hitchman et al. Associations between e-cigarette type, frequency of use, and quitting smoking: Findings from a longitudinal online panel survey in
Great Britain. Nicotine & Tobacco Research 2015; 17(10):1187-1194
46
3. Tackett et al. Biochemically verified smoking cessation and vaping beliefs among vape store customers. Addiction 2015;110: 868-874
‘Dual users’
• Menggunakan kedua dua vape dan menghisap
rokok
• Indicates: nicotine addiction is still significant
& experimenting with e-cig
PREVALENCE OF DUAL USERS
1.
2.
3.
4.
5.
Studies
Methodology
Prevalence
Goniewicz et al
(2013)
Online survey in Poland;
179 E-Cig users
- 66% E-Cig only users
- 25% dual users (<5cig/day)
Etter & Bullen
(2014)
Online survey;
477 E-Cig users (after 1 month),
367 E-Cig users (after 1 year)
- 72% E-Cig only users
- 28% dual users
Farsalinos et al
(2014)
Online survey; 19,353 E-Cig
users
- 81% E-Cig only users
- 19% dual users (68.5% daily
smokers)
Harrel et al (2014) Online survey; 1,434 E-Cig users
- 79% E-cig only users
- 21% dual users
ASH Smoke free
GB
- 40% E-Cig only users
- 60% dual users
Cross-sectional yearly
(population) online survey (GB)
~12,000 adults
Goniewicz et al. Patterns of electronic cigarette use and user beliefs about their safety and Eenefits: a prospective 6-months pilot study. BMC Public Health 2011;11:786-798
Etter & Bullen. A longitudinal study of electronic cigarette users. Addictive Behaviour 2014;39:491-494
Farsalinos et al. Characteristics, perceived side effects and benefits of electronic cigarette use: A worldwide survey of more than 19,000 consumers. Int J Environ Res Public Health
2014;11:4356-4373
Harrell et al. Expectancies for cigarettes, E-Cigarettes, and nicotine replacement therapies among E-cigarette users (“Vapers”). Nicotine & Tobacco Research 2014;
McNeill et al. E-cigarettes: an evidence update. A report commissioned by Public Health England. Public Health England 2015. Retrieved from: www.gov.uk/phe
48
PERBEZAAN
ROKOK BIASA
ROKOK ELEKTRONIK
Mengandungi tembakau yang dicarik
dan digulung
Mengandungi cecair nikotin yang
tulen dengan kepekatan sebanyak
4mg/1ml (sumber analisa dari Pusat
Racun Negara)
Kandungan emisi bagi kandungan
nikotin adalah di kawal di bawah
Peraturan-Peraturan Kawalan Hasil
Tembakau 2004
Mengandungi lebih 4000 bahan kimia
merbahaya
Kandungan emisi tidak di kawal dan
belum ada kajian dibuat setakat ini
untuk melihat tahap emisi tersebut
Mengandungi bahan-bahan
karsinogenik yang lain seperti
Formaldehyde dan Logam Berat
(Heavy Metals) yang boleh
menyebabkan kanser
PERBEZAAN
ROKOK BIASA
Kesan sampingan jangka panjang
terutama kanser telah terbukti
Sukar untuk diubah suai berikutan
kandungan dalam bentuk pepejal
Risiko keracunan kepada kanak-kanak
adalah rendah disebabkan bentuk
fizikal
ROKOK ELEKTRONIK
Kesan sampingan jangka panjang
terutama kanser masih belum dapat
dibuktikan dan masih perlu kajian
lanjut
Mudah untuk diubahsuai berikutan
kandungan dalam bentuk cecair dan
kebarangkalian penggunaan dadah
sintetik adalah tinggi
Risiko keracunan kanak-kanak adalah
tinggi disebabkan berbentuk cecair ,
berwarna menarik serta bau yang
harum
Rumusan
• Penggunaan EC semakin meningkat
• EC mengandungi kurang bahan toksik dan karsinogen berbanding
rokok
• Kesan samping akut yang kurang berbanding rokok
• Kesan jangka panjang bahan kimia dalam vape terhadap badan
masih tidak di ketahui
• Kebanyakan mengguna vape untuk mengurangkan kemudharatan
dan ada yang mengguna vape kerana ingin tahu
• Ramai di kalangan yang pernah guna vape tidak terus
menggunakannya
• Mungkin boleh digunakan untuk mengurangkan pengambilan rokok
dan berhenti merokok
• Terdapat kerisauan jika vape di salah guna untuk pengambilan ganja
dan dadah lain, keracunan dan liquid vape dan tidak di kawal
Prinsip asas dalam berhenti merokok
• Tetapkan tarikh untuk berhenti..
• Kurang kan penggunaan rokok ke kosong pada
tarikh ‘ quit day’
• Gunakan salah satu NRT/farmakoterapi untuk
2-3 bulan
NRT
•
•
•
•
•
Di preskrip oleh pengamal perubatan
Penggunaannya di pantau
Datang dalam pelbagai dos
Tidak datang dalam pakej yang menarik
Ada dos dan tempoh yang di tentukan
Pengganti rokok..
• Vape untuk ganti rokok dalam usaha berhenti
merokok?
– NRT
• Vape untuk ganti rokok sebagai alternatif
kepada merokok ?
– Harm Reduction
Fikirkan..
• Jika seorang perokok tegar telah berusaha
untuk berhenti merokok menggunakan vape
datang berjumpa doktor…
– Adakah doktor patut menyuruh beliau berhenti
vape dan kembali menghisap rokok ?
Fikirkan…
• Adakah perokok beralih kepada vape untuk
berhenti merokok kerana KBM kita gagal ?
Fikirkan …
• Adakah kanser akibat bahan kimia dalam vape
lebih kurang bahaya dari pada kanser akibat
dari bahan kimia dalam rokok ?
Kesimpulan
• Lebih banyak kajian perlu dijalankan terhadap
penggunaan vape dari aspek kesan sampingan
dan kesesuaian untuk di gunakan sebagai
pengganti rokok dalam usha berhenti merokok
• Perlu ada pengawalan
SAY NO TO SMOKING, VAPING
AND USING TOBACCO PRODUCT
Health is the greatest wealth
Thank You
Counselling for vapers
Dr Hizlinda Tohid
Department of Family Medicine
Aims of the counselling
• To make them realise that:
– “Total abstinence from smoking or any tobacco
product is the best”
– “Vaping is still NOT SAFE even though the harm is
lesser than smoking cigarettes”
• To empower motivation and self-efficacy:
– “I want to stop smoking & vaping“
– “I can do this”
EXPLORE
ADVICE
ASSIST
Explore to determine….
• Gaps in knowledge & misconception
– Ideas about smoking & vaping
• Risks if the patient continues smoking cigarettes
– Individual health risks
– Health risks to family members
• Likelihood for the patient to stop smoking in near future
– Readiness to quit smoking
– Nicotine dependence
– Barriers
• Ability to quit smoking
– Confidence
– Self-efficacy
WHO’s BRIEF INTERVENTION
5A
Approach
Relevance; Risks; Rewards;
Roadblocks; Repetition
WHO. Strengthening health systems for treating tobacco dependence in primary care. Part
III: Training for primary care providers: Brief tobacco interventions. 2013
5A’s approach
ASK
ADVICE
ASSESS
ASSIST
• Smoking
status
• Advice
all
smokers
to quit
(clear,
strong &
personal
ised)
• Readine
ss to
quit
smoking
• Nicotine
depend
ence
• Advice
on
specific
strategie
s
• Develop
quit
plan
• Provide
self-help
material
s
• Prescrib
e
medicati
on
AAR or 3A’s
approach
ASK
ADVICE
REFER/
ACT
ASK
ARRAN
GE
FOLLOW
-UP
• WHO –
one
week
after the
quit
attempt
• Refer to
quit
smoking
clinic
ABC approach: New
Zealand
BRIEF
ADVICE
CESSATION
SUPPORT
5R’s approach
RELAVANCE
RISKS
REWARDS
Perceived harmful to continue
smoking?
Misperception?
APPRECIATION
OFwith
RISKS
& risks?
Unable to relate
the
BENEFITS
ROADBLOCKS
REPETITION
What has he tried
before?
What went wrong?
DIFFICULTIES
TO
What were the
QUIT
barriers?
Explore about E-Cig use
Type of E-Cig
Identify those > likely to quit smoking (e.g. tank users)
Duration
Identify those > likely to quit smoking (e.g. longer
duration of use)
Frequency
Indicates nicotine addiction
Situations
Suggest reasons for vaping & seriousness to quit
smoking
Total
substitution
Indicates: use to reduce harm or help quitting
Dual usage
Indicates: nicotine addiction is still significant &
experimenting with e-cig
> Likely to discontinue vaping
Explore perception about vaping
Reasons for
vaping
Identify those > likely to quit smoking
Benefits of
vaping
Positive perception of vaping
Satisfaction with Most discontinued vaping because it could not satisfy
vaping
them similarly like smoking
Withdrawal
symptoms
Indicates nicotine obtained from vaping is inadequate to
meet nicotine obtained from smoking
Improvement of Positive experience of vaping increases chance for total
symptoms
substitution
Worsening of
symptoms
Negative experience of vaping decreases chance for total
substitution
What advice would you give?
Misconcept
ion & Gaps
in
knowledge
High risks if
continue
smoking
Unlikely to
stop
smoking in
near future
• Provide accurate information
• Correct misconception
• Clear advice: “Quit smoking is the best thing you can
do for your health”
• Clear advice: “Vaping is still NOT SAFE even though the
harm is lesser than smoking cigarettes”
• Convince patients to use effective smoking cessation
interventions
• State aim of interventions: Stop the use of any tobacco
products altogether
• Many barriers: Discuss possible strategies (problem
solving skills)
• Nicotine dependence: Offer pharmacotherapy
• Poor self-efficacy: Behavioural therapy
• Not ready: Guide on proper vaping, aiming for
smoking abstinence
McNeill et al. E-cigarettes: an evidence update. A report commissioned by Public Health England. 2015. Retrieved from: www.gov.uk/phe
WHO. Electronic nicotine delivery system. 2014. Document FCTC/COP/6/10
How to assist?
• Provide pamphlets on smoking cessation
• Reassess & repeat counselling during every follow-ups
• Refer to quit smoking clinics:
– KKM: Quit smoking clinic at Klinik Kesihatan
– UKM: Quit smoking clinic at Pusat Perubatan
Primer PPUKM
Quit smoking clinic by the pharmacists