CTCS Tutorial #13 Case 2
On 15 September 2023, the 13th monthly tutorial session was conducted for Certified Tobacco Cessation Specialists. One of the two cases discussed a 38-year-old, chronic cigarette smoker, owner of a travel agency, referred for cessation by a pulmonologist. He had been smoking for the last 25 years, consuming around 40 cigarettes a day. He was married, had 2 children, and was accompanied by his mother to the cessation center. He gave a history of bronchial asthma for 3 years and diabetes, and blood pressure for 2 years, and was under medications for the same.
He had been consuming 40 cigarettes in a day, with maximum consumption during morning hours, around 6-7 cigarettes reportedly before using the washroom. Apart from this, he had increased frequency while driving, meeting friends, after meals, and under stress. He stated that a few times when he could not smoke for 2-3 days, he felt extreme anger, stress, and restlessness. He reported sweating, thirst, constipation, and increased appetite during this phase. Presently, he was quite motivated to quit smoking due to health issues.
He was explained the adverse effects of smoking and the benefits of quitting in the long run. A detailed treatment plan was made for him after counseling. He was guided for a Cold Turkey method of quitting smoking, replacing it using a 21-mg Nicotine patch to be used for three weeks and Nobacco gums (4 mg) to be used for severe craving episodes. He was allowed 2 puffs of smoking a day initially, which he stopped after 2 days. He complained of body cramps and worsening asthma in 2-3 days of withdrawal. He was supplemented with SleepNova, Lycoedge, Cbinan, ELC, and Mg tablets. He was suggested to use the Acapella device for breathing exercises, which helps in clearing mucous in the throat. Mucolytics and anti-asthmatic drugs were also modified accordingly by the consulting pulmonologist. He was kept on a nebulizer, steam inhalation, and a modified diet plan and showed considerable improvement in asthma over 2 weeks.
The Nicotine replacement patch would be reduced to a 14-mg dose after 3 weeks, further to a 7-mg dose in 2 weeks, continuing, in addition with 1mg BD Varnitrip, over 3 months duration. He would be regularly monitored by a cessation specialist and pulmonologist over this period and the treatment plan would be modified accordingly.
ICanCaRe Academy Tutorial for Certified Tobacco Cessation Specialists (CTCS) is a monthly program on the 15th, from 9-10 PM. We welcome our CTCS to present complex cases on tobacco cessation for discussion and finding solutions for successful quitting. Please contact Dr. Mariya, Dr Siddhi, or Dr. Monalee for tutorial cases.
ICanCaRe Academy encourages you to take part in our monthly session and learn in-depth details about practical tobacco cessation through cases discussed here.
To be a Certified Tobacco Cessation Specialists go to www.icancare.in/academy/ctcs
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Blog composed by – Dr. Siddhi Hathiwala, MDS (Public Health Dentistry), CTCS(GU) – ICanCaRe. Assoc. Prof. & HoD, HDCH, Jabalpur)
Expert – Dr. Pawan Gupta M.Ch. Cancer Surgeon and Master Trainer Tobacco Cessation