32: Chronic Bronchitis and Smoking Cessation

32

Chronic Bronchitis and Smoking Cessation

CHRONIC BRONCHITIS

Chronic bronchitis is a disease state wherein the patient has had cough with expectoration for two to three months of the year, for at least two successive years. This patient will give a history of using bronchodilators, antibiotics during flare-ups, and oral or injectable corticosteroids during exacerbation of the chronic bronchitis.

Chronic Bronchitis Treatment

Chronic bronchitis management consists of quitting smoking, using bronchodilators, and using corticosteroids to control or attenuate a flare-up.

Chronic Bronchitis Suggested Dental Guidelines

The following are dental guidelines for chronic bronchitis:

1. Follow the suggested dental and AAA guidelines as outlined for asthma, focusing on the specific bronchodilators used by the patient.
2. Follow “the rule of twos” if steroids were used for two weeks or longer within the past two years.

SMOKING CESSATION

Smoking Cessation treatment helps smokers overcome their nicotine addiction by providing tools, information, and support for people who want to quit smoking. Further outlined are smoking cessation facts, local and national smoking cessation efforts, the 5A cessation-counseling model, and smoking cessation prescription medications.

Smoking Cessation Facts

  • According to analysis from the Centers for Disease Control and Prevention (CDC), tobacco use causes more deaths each year the world over compared with deaths resulting from human immunodeficiency virus (HIV), illicit drug or alcohol use, motor vehicle accidents, suicides, and murders combined.
  • Most smokers have a difficult time quitting because they are addicted to nicotine. A smoker will often give a history of making several attempts to quit before achieving long-term success.
  • Young adults are better served with e-health, Internet cessation interventions, because young adults are least likely to use cessation counseling and medications.
  • The provider must show genuine interest in helping the patient to quit and must periodically remember to discuss cessation progress with the patient.
  • Counseling and medication are each effective in increasing the incidence of smoking cessation, but when they are used together they are even more effective.
  • FDA analysis recently concluded that menthol cigarette use results in lower rates of smoking cessation compared with nonmenthol cigarette use.
  • The FDA also issued a warning against e-cigarettes (electronic cigarettes), stating that they “may contain ingredients that are known to be toxic to humans, and may contain other ingredients that may not be safe.” Electronic cigarettes are handheld nicotine-delivery devices that use a rechargeable battery-operated heating element to vaporize nicotine that comes in a replaceable cartridge.

Local and National Smoking Cessation Efforts

  • There is a site (www.cdc.gov/tobacco/quit_smoking/) that provides resources such as quit tips, quit plans, and educational materials that support efforts to quit smoking.
  • < ?tight?>All states now have a cessation quit-line that can be accessed through a national toll-free number (1-800-QUIT NOW). Providers should refer their patients to the quit-lines so the patients can have access to all steps in the recommended 5A cessation-counseling model. Quit-lines are an effective cessation tool with diverse populations.

The recommended 5A cessation-counseling model:

1. 1. Ask about tobacco use.
2. Advise the patient to quit.
3. Assess willingness of the patient to quit.
4. Assist in the quit attempt.
5. Arrange for a follow-up.
  • State health departments are offering nicotine patches for smoking cessation.
  • Many establishments are now implementing tobacco-free campus policies in health-care settings and workplaces.
  • Medicaid and Medicare now cover smoking cessation counseling for all members.
  • National initiatives have been implemented in the United States to quit smoking and more will be implemented soon. The 2010 Patient Protection and Affordable Care Act requires state Medicaid programs to provide cessation coverage to pregnant Medicaid enrollees at no cost. Per legislation effective January 1, 2014, state Medicaid programs will not be allowed to exclude from Medicaid drug coverage FDA-approved smoking-cessation medications, including the OTC medications. The legislation has already required private health plans to offer cessation coverage at no cost, and health plans are now providing coverage for smoking cessation treatments.
  • Under the Centers for Medicare and Medicaid Services electronic health record (EHR) incentive program, participating providers and hospitals must identify a patient’s smoking status, and health-care providers also must implement clinical quality measures on tobacco use assessment and intervention.
  • The Million Hearts initiative of the US Department of Health and Human Services is another initiative that has made smoking prevention and cessation in communities and health-care systems a priority.

Smoking Risks

  • Smoking causes an increased risk of stroke, is responsible for 85% of all lung cancers and cases of chronic obstructive lung disease (COPD), and increases the risk of a number of other cancers and medical disorders. The risk for heart disease is cut by half one year after quitting, and the risk of developing lung cancer also decreases by almost 50% ten years after smoking cessation.
  • Secondhand smoke also increases the risk of cancers, heart disease, and lung disease. Secondhand smoke or smoking while pregnant can lead to children with low birth weight, sudden infant death syndrome (SIDS), and serious childhood respiratory diseases, including childhood asthma.

Smoking Cessation Benefits

  • The patient feels less fatigued and the extreme shortness of breath previously experienced while exercising disappears once the patient quits smoking.
  • With quitting, the levels of carbon monoxide in the blood decrease, the level of oxygen increases toward normal, and the chronic smoker’s cough starts to dissipate.
  • Smoking cessation causes a drop in blood pressure, the heart rate decreases, and there is a decrease in the risk for myocardial infarction.
  • Smokers with comorbidities who quit smoking recover better and live longer than those who continue to smoke.
  • Other benefits of quitting smoking include being able to taste and smell food better, having better breath, having younger-looking skin, and not smelling smoke in your surroundings./>
    Only gold members can continue reading. Log In or Register to continue

Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 32: Chronic Bronchitis and Smoking Cessation
Premium Wordpress Themes by UFO Themes