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Managementul pacientului cu BPOC
Lectia 1: Reducerea factorilor de risc
Obiectiv:

In aceasta lectie veti studia metode de informare, educare si asistare a pacientilor in
vederea reducerii factorilor de risc pentru patologia BPOC.
Formatori:

Sef lucrari Dr. Dragos Bumbacea - autor
Dr. Daciana Toma - referent
Dr. Razvan Miftode - referent
Prof. Dr. Miron Bogdan - coordonator cursuri BPOC

SUMAR
In aceasta lectie vor fi abordate urmatoarele subiecte:
Prevenirea fumatului
Renuntarea la fumat:
consiliere
strategii de asistare
tratament farmacologic
Reducerea factorilor de risc
profesional
Reducerea poluarii










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Prevenirea fumatului

Componentele fumului de tigara o seringa murdara





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Renuntarea la fumat
Cel mai eficient mod de a reduce riscul aparitiei BPOC
si de a incetini declinul functiei pulmonare
Reduce mortalitatea prin cancer pulmonar, boli
cardiovasculare si alte comorbiditati
Consilierea crete semnificativ procentul
renuntarii la fumat comparativ cu strategiile
auto-initiate. O scurta perioada (3 minute) de
consiliere conduce la o rata de renuntare la fumat
de 5-10%
De asemenea, pacientii care vor sa renunte la fumat au
la indemana diverse farmacoterapii eficiente

Fumatul in Romania:










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Renuntarea la fumat
Fumatul da dependenta si reprezinta o conditie ce
predispune la recaderi repetate
Tratamentul pentru renuntarea la fumat si pentru
dependenta de fumat trebuie privit ca tratament
specific de prima linie
Activitatile depuse pentru renuntarea la fumat ar
trebui sa reprezinte parte integranta din activitatile
sistemelor de sanatate





Spirala schimbarii







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Renuntarea la fumat:
Consilierea
Consilierea trebuie sustinuta de
intreg personalul medical si oferita
fiecarui pacient fumator
5-10% dintre fumatori renunta la
fumat in urma unei consilieri de
minim 3 minute oferita de medic
Exista o corelatie stransa intre
intensitatea consilierii pentru
dependenta de fumat si eficienta
acesteia


Strategii de asistare a pacientului care doreste sa
renunte la fumat










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Argumente pentru pacientii care nu sunt pregatiti sa
faca o incercare de renuntare la fumat


Renuntarea la fumat:
Date statistice
Dependenta de nicotina este la fel de puternica ca dependenta de cocaina sau
heroina
Desi mai mult de jumatate din fumatori doresc sa renunte la fumat, doar 3%
dintre ei reusesc sa renunte la fumat fara suport medical











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Renuntarea la fumat


Tratamentul farmacologic
Tratamentul farmacologic este recomandat mai ales atunci cand consilierea nu
este eficienta.
terapia de substituie cu nicotina
bupropionul
nortriptilina
vareniclina
Oportunitatea terapiei farmacologice trebuie cantarita cu atentie la:
Persoane cu contraindicatii medicale: boala coronariana netratata, ulcer
peptic netratat , infarct miocardic recent sau AVC pentru substituentii
nicotinici si istoric de epilepsie pentru bupropion
Fumatori a mai putin de 10 tigari /zi, femei insarcinate si adolescenti.










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Terapia de substitutie cu nicotina


Alte terapii
Alte terapii farmacologice folosite in renuntarea
la fumat sunt:
Bupropiona - Rata de renuntare la fumat
este 35% in cazul administrarii asociate
cu plasturi cu nicotina
Vareniclina - un agonist partial ai
receptorilor nicotinici - s-a dovedit
eficienta si sigura












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Bupropiona
Bupropiona clorhidrat este indicata in tratamentul dependentei de nicotina ca
suport al renuntarii la fumat
Tratamentul trebuie urmat minim 7 saptamani
Pacientul fixeaza data la care va intrerupe fumatul (intre ziua 8-14)


Vareniclina
Indicatie: tratament farmacologic care sustine renuntarea la fumat
Doza uzuala recomandata pentru adulti incepand cu Ziua 1 este:






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Beneficiile renuntarii la fumat


Reducerea expunerii la factori de risc ocupationali
Program de monitorizare stricta a gradului
de expunere la noxe la locul de munca
Programe de educatie privind riscul
expunerii la particule la locul de munca
Accent pe preventia primara care este
principala modalitate de reducere si
eliminare a expunerii la substantele toxice
la locul de munca.
Preventia secundara este importanta pentru
detectie precoce si supraveghere
Masuri de reducere a poluarii locuintelor
rezultate din arderea combustibililor biologici
utilizati pentu gatit sau incalzit in camere
putin ventilate.








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Reducerea poluarii

Harta mondiala a poluarii FOTO: NASA
Sfatuirea pacientilor sa fie atenti la nivelele de poluare anuntate de autoritati si sa
evite exercitiile fizice in aer liber sau deplasarile in aceea perioada.









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Concluzii
Statutul de fumator trebuie investigat de rutina la fiecare prezentare la medic a
pacientilor
Renuntarea la fumat prezinta beneficii substantiale pentru sanatate si nu numai
Exista la dispozitia noastra multiple interventii capabile sa ajute pacientii sa
renunte la fumat
Aceste interventii trebuie oferite tuturor fumatorilor

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