Smoking & The Eye

The whole lecture centered around the 'brief advice' that us, GPs etc should be giving to smokers. Evidence shows that brief advice given by GPs to all known smokers leads between one and three percent to stop smoking for at least six months. That doesn't sound like a lot but it's above those that would've quit anyway. Anyway doing this brings health gains in the population for a modest spend and will reduce hospital costs long term.

Smoking is still prevalent throughout the uk

• 26%+ in Scotland
• 25% in England
• 23% in Wales
• 26% in NI

It's 37% in the greater Glasgow area and 50% in some of the more deprived areas. There's 277 hospital beds in Glasgow taken up each day with px suffering from smoking related illnesses. Out of 1000 lifelong smokers, 1 will be murdered, 6 will die in road traffic accidents and 500 will die from a smoking related illness. Here ends the stat parade.

Cigarettes contain 4000 chemicals and 60 of them are known carcinogens. Nicotine is the addictive bit, Carbon Monoxide binds to haemoglobin and causes hypoxia/vascular problems and Tar is the thick sticky ming that causes pulmonary problems. Also you have arsenic, cyanide, ammonia, acetone, formaldehyde etc etc etc! Horrible. Cigarettes aren't allowed to be called light or mild these days because they aren't. Cutting down leads to compensation. So although 'cutting down' seems to do nowt it should still be applauded as the px clearly wants to quit and is making an effort.

How Smoking Affects the Eye

• AMD - risk is increased 2-3times. Smoking is the only proven cause of AMD that's actually avoidable. Out of 500k people in the uk with AMD 54000 have it because of smoking. This is the kind of info you need to give to px because apparently only 7% of people are aware of the link. Furthermore the yoof of today are more worried about losing their eyesight than they are getting cancer or some ting! 9/10 people said they would quit at the first sign of a problem with eyesight.
• Cataracts - smoking doubles the risk of nuclear cataract and the risk increases with the amount smoked
• DR - smoking accelerates development or worsens the existing condition
• Thyroid Eye Disease - people who have Graves disease and smoke have 4 times the risk of developing eye problems (puffy lids, bulging eyes, squint, gritty feeling, sometimes swelling behind eyeball pressing on ON and disrupting vision). The risk increases with the amount smoked.
• Optic Neuropathy - caused by reduced blood flow to the eyes. 16x increased risk of developing it w/smoking and developing it at a young age to boot. Like at 51 instead of 64. Not nice
• Smoking can cause a more serious glaucoma with earlier onset due to again the reduced blood flow to the eyes
• Children born to smoking mothers are prone to developing squinting, learning disability, smaller size

Other problems

• Aesthetics - premature ageing, bad breath, smelly, fatter round the middle, crap at sports, yellow fingers
• Stroke, gum disease/tooth loss, Cancer of lips, tongue, throat, larynx, oesophagus, narrowed arteries, heart attacks, coronary heart disease, chronic obstructive pulmonary disease, bronchitis, emphysema, chest infections, asthma, lung cancer, stomach ulcers, stomach cancer, kidney cancer, bladder cancer, pancreatic cancer, wrinkling of skin, osteoporosis, impotence, reduced fertility, testicular cancer, miscarriage, Sudden Infant Death Syndrome, gangrene, peripheral vascular disease.
• Quite a few
• Secondhand smoke also proven carcinogenic in 2002 - ask if anyone in household smokes

Health Effects Again

• Immediately you have eye irritation, headache, dizziness, sore throat, nausea, cough, reduced coronary blood flow
• Increases CHD risk 25-35%
• Increases lung cancer risk 20-30%
• Risk of acute stroke 82%!!!!!

Benefits of Quitting

• Start almost straight away - blood pressure goes back to normal after 20 minutes
• Better wound healing, less likely to have complications during surgery
• Halts progression of existing conditions eg COPD
• Mental/financial benefits
• MED/LONG TERM increases life expectancy if before the onset of serious disease, even if px has serious disease does better job of fighting it

Addiction

• The compulsive physiological and psychological need for a habit-forming substance
• Nicotine's actually more addictive than heroin and cocaine and has higher relapse rates
• It takes 7 seconds to reach the brain. You're looking at about 200 hits per day.
• In high levels nicotine is a potent nerve poison. It stimulates adrenal glands and thus produces adrenalin which increases heart rate, BP & breathing
• It also acts on ACh receptors establishing the 'reward pathway'. There's a rush of ACh and new receptors are developed. Dopamine is release and pleasure/enjoyment results
• Nicotine withdrawal involves urges to smoke, depression, sleep probs, GI upset, headache, restlessness, cravings, increased appetite, poor concentration, irritability & anxiety.

Brief Questioning Tactix

• Open questions to help them explore the issue
• How do you think you'd cope w/out a cigarette for a day? What would help you in that situation? What do you like about smoking? What don't you like?
• Have you ever thought about quitting? Have you tried before, how did that go?

Stuff that works

• Nicotine replacement therapy
• Zyban
• Health professional advice
• Individual counselling
• Behavioural support groups
• Pharmacist
• No smurking day
• Workplace tobacco policy
• Smokeline

Not proven to work

• Brand switching
• Cutting down
• Low tar
• Alternative therapies
• That Alan Carr book

In Glasgow

• Intensive smoking cessation groups citywide as well as one to one brief support at 200+ pharmacies, Breathe (for pregnant women) & Hospital Inpatient Service
• Intensive support is 1hr/week groups, weeks 1&2 info, week 3 =quit and 4-7 group support. Stops 16-20% of people after a year. Difficult cos it's a chronic relapsing condition. The group is relaxed/informal and can actually be fun
• Groups don't suit everyone so the pharmacy does trained 1 to 1 counselling ("Starting Fresh") 5-10 minutes once a week and NRT dispensed regularly for up to 12 weeks
• Groups have shown to be twice as effective as Starting Fresh
• Heavier smokers find it harder to quit. If smoking within one hour of wakening px needs intensive support.
• Breathe project launched in May 2004. 4 weeks support and NRT.