Ain Shams University

Faculty of Medicine
Community, Environmental and
Occupational medicine Department

2009

Assessment of Health improvement after

sustained smoking cessation among
Cessation Clinic patients

Under supervision of:

Prof. Dr. Mahmoud Radwan

Prof. Dr. Moustafa el Houseiny
Dr. Lamiaa Saeed
Dr. Ayat Farouk

Presented by:

269- Amin Mohamed Amin

270- Antony Ihab Fouad
279- Awab Ali Moussa
 Introduction

Tobacco use is one of the main risk factors for a number of chronic diseases, including
cancer, lung diseases, and cardiovascular diseases. Substantial harm to the individual accrues
from the smoking habit [1].
Cigarette smoking is the single biggest avoidable cause of death and disability in developing
countries.
Worldwide there are an estimated 1.2 billion smokers [2] Smoking is responsible for the death
of 1 in 10 adults worldwide, about 5 million unnecessary deaths each year. Avoidance of
tobacco use is the best strategy.

For current smokers, there are substantial benefits from smoking cessation, including
reductions in the risks of lung cancer, COPD, and heart disease [3]. A prospective study of >
34,000 male British doctors has shown that prolonged cigarette smoking triples mortality
rates, but that cessation at age 30 years avoids almost all of this increased risk [4].
Smoking cessation for current smokers is an imperative in any health-care setting, including
hospital-based care.
Chronic obstructive pulmonary disease (COPD), usually caused by tobacco smoking, is one
of the leading causes of morbidity and mortality. Smoking cessation at an early stage of the
disease usually stops further progression.

Accurate studies on the prevalence of smoking in Egypt are very rare. However, according to
the EGYPTIAN SMOKING PREVENTION  RESEARCH INSTITUTE (ESPRI) [5], 39
Billion Cigarettes are made in Egypt annually, besides there are 13 million smokers in Egypt
consuming 60 billion Cigarettes annually. Another study done by WORLD HEALTH
ORGANIZATION (WHO) in 2005 stated that prevalence of tobacco use among adults
(= > 15 years) of both sexes in Egypt is 15.1% [6].

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Two main approaches to tobacco addiction have been used in Spain: primary prevention to
limit the number of new smokers and secondary prevention to increase the number of ex-
smokers.
Seventy percent of smokers want to quit, but most find it very difficult to do so without
assistance.
Smokers currently have many resources available for help in quitting. In order to increase the
number of ex-smokers, several organizations have agreed on common treatment guidelines
for use at primary care centers and specialized treatment units.

Nicotine replacement therapy (NRT) and bupropion have proven to be effective in treating
tobacco addiction at all levels of care.
The aim of nicotine replacement therapy (NRT) is temporarily to replace much of the
nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms,
thus easing the transition from cigarette smoking to complete abstinence [7] .
However, the abstinence rate achieved is unsatisfactory. A number of studies have been
carried out to identify ways to improve treatment protocols to increase abstinence rates. Some
authors agree that successful smoking cessation therapy is correlated with the smoker's stage
of readiness in the change process as well as degree of motivation prior to treatment [8].
To date, no pretreatment factor has been identified that is able to successfully predict
medium- and long term abstention. Only abstinence at 1 week of treatment has proven to
predict success at 1 year [9].

Objectives of the study:

1. Identify the factors that affect smoking cessation.

2. Assess changes of respiratory function tests, complete blood picture and lipid profile
following smoking cessation trials.

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Subjects and Methods:
A Cross-sectional study will be carried out in public and occupational health department Ain
Shams University. The study will be done on two steps. First step will be performed on
smokers who attend to the Smoking Cessation Clinic (SCC) themselves seeking help to quit,
either by their family physician at their primary health care center, or they may enroll on their
own initiative. The second step will be performed after two years on smokers who joined the
first step and were able to quit smoking; this step will determine smoking cessation rates as
well as changes in Spirometric functions, and routine laboratory investigations including:
complete blood picture and lipid profile.

The following variables will be studied: smoking habits, smoking social context, medical
problems, sex, age, educational level, age at which smoking began, age at which it became a
regular habit and the time elapsed between the two moments.

Information will be obtained about factors known to be important in influencing uptake of

smoking: smoking among family members, parental attitude to smoking, smoking behavior
of friends and availability of smoking at work place [10], all subjects will be subjected to
complete the Fagerstrom test for nicotine dependence (FTND) [11] number of cigarettes per
day, number of years smoking, presence of concomitant disease, previous attempts to quit
smoking, current reasons for smoking cessation and concentration of expired air carbon
monoxide (CO). An initial medical history and presence of chronic diseases will be taken
from each smoker.

Data Management:

Data entry and analysis will be done by “SPSS”

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References
1. Edwards, R , The problem of tobacco smoking. BMJ 2004

2. World Health Organization (WHO), 2005

3. World Health Organization (WHO), 2004

4. Doll, R, Peto, R, Boreham, J, Mortality in relation to smoking: 50 years’

observations on male British doctors. BMJ 2004

5. Egyptian Smoking Prevention Research Institute (ESPRI), 2002

6. World Health Organization (WHO), 2007

7. Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for
smoking cessation. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.:
CD000146. DOI: 10.1002/14651858.CD000146.pub

8. Richmond RL, Kehoe LA, Webster IW.Multivariate models for predicting

abstention following intervention to stop smoking by general practitioners.
Addiction 1993; 88:1127-35.

9. Stapleton JA, Russell MA, Feyerabend C, Wiseman SM, Gustavsson G, Sawe U, et

al. Dose effects and predictors of outcome in a randomized trial of transdermal
nicotine patches in general practice. Addiction 1995; 90:31-42.

10. Winstanley, M, Woodward, S, Walker, N, Tobacco in Australia: facts and issues 2nd
ed. 1995 Victorian Smoking and Health Program. Carlton South, Victoria, Australia.

11. Kozlowski LT, Porter CQ, Orleans CT, Pope MA, Heatherton T. Predicting smoking
cessation with self-reported measures of nicotine dependence: FTQ, FTND, and
HSI. Drug Alcohol Depend 1994;34: 211-6