Plácido GascóC.S. IturramaSociedad Vasco Navarra de Prevención del Tabaquismo/ Euskadi Eta Nafarroako Tabakismoari Aurregitekoelkartea

Sanguesa, 29 de Mayo de 2012

Sanguesa, 29 de Mayo de 2012

¿ Por qué fuman las personas ?

¿ Por qué fuman las personas ?

Me relaja

Me concentro mejorMe produce placer

acto creativo

Inicio de…..

Me calma los nervios

Saboreo mejor mi café

Me hace com

pañía +

Me es

timul

a po

r las

mañ

anas

Por las noches me relaja

Lo necesito para funcionar por las mañanas

Me ayuda después de comer

Nicotina

Dopamina Placer, suprime el apetito

Norepinefrina Estimula, suprime el apetito

Acetilcolina Estimula

Intensifica el conocimiento cognitivo

Vasopresina Mejora la memoria

Serotonina Cambia el humor, suprime el apetito

Beta-endorfina Reduce la ansiedad y la tensión

Benowitz, 1999.

Mecanismo de acción de la nicotina

DD

D

DDD D

DD

DDD D

DD

DDD

DD

D

DDD

ReceptorNicotínico

El fumador necesita mantener un nivel de nicotina en sangre entre 15-18 ng/ml

para evitar los sintomas de abstinencia

DD

D

DD D

DD

D

DDD

DD

D

DDD

DD

D

DDD

DD

D

DDD

DD

D

DDD

DD

D

DDD

DD

D

DDD

DD

D

DDD

Concentración de nicotina en plasmaConcentración de nicotina en plasma

0

5

10

15

20

25

30

35

40

45

00/01 /1 9 00 1 0/01 /1 9 00 2 0/01 /1 9 00 3 0/01 /1 9 00 09 /02 /1 9 00 1 9 /02 /1 9 00 2 9 /02 /1 9 00 1 0/03 /1 9 00 2 0/03 /1 9 00 3 0/03 /1 9 00 09 /04 /1 9 00 1 9 /04 /1 9 00 2 9 /04 /1 9 00 09 /05 /1 9 00 1 9 /05 /1 9 00 2 9 /05 /1 9 00 08 /06 /1 9 00

Pla

sma

nico

tine

(mcg

/L)

Cigarette

0 30 60 90 120 150 60Tiempo (minutes)

Sensación de falta de nicotina

Estímulo reforzador negativo (ER-)

Estímulo reforzador positivo (ER+)

Síndrome de Abstinencia de Nicotina

• Deseo vehemente de fumar

• Irritabilidad

• Frustración o enojo

• Insomnio

• Disminución del pulso

• Aumento del apetito o aumento de peso

• Ansiedad

• Dificultad para concentrarse

Receptores hambrientos de nicotina

Fuen

te: J

. Hen

ning

field

Ni todos los fumadores son iguales, ni los Ni todos los fumadores son iguales, ni los efectos son los mismosefectos son los mismos

Nicotina Fumar

Cravings(Deseo intenso de Fumar)

British American Tobacco

Plácido GascóMédico

J.R.Reynolds ( Camel y Winston)

• Decadienal; gamma-Decalactone; delta-Decalactone; Decanal; Decanoic acid; Decanoic acid, ester with; 1,2,3 - propanetriol octanoate (coconut oil); Dextrin; Dextrose; Diacetyl; Diethyl malonate; Diethyl sebacate; 2,3-Diethylpyrazine; 2,3-Diethylpyrazine; Dill oil; meta-Dimethoxybenzene; para-Dimethoxybenzene; 2,6-Dimethoxyphenol; 3,4-Dimethyl-1,2-cyclopentadione; 3,7-Dimethyl-1,3,6-octatriene; 4,5-Dimethyl-3-hydroxy-2; 5-dihydrofuran-2-one; 4,5-Dimethyl-3-hydroxy-2; 5-dihydrofuran-2-one; 3,7-Dimethyl-6-octenoic acid; 2,4-Dimethylacetophenone; alpha,para-Dimethylbenzyl alcohol; alpha,alpha-Dimethylphenethyl ; butyrate; 2,3-Dimethylpyrazine; 2,5-Dimethylpyrazine; 2,6-Dimethylpyrazine; Dimethyltetrahydrobenzofuranone; gamma-Dodecalactone; delta-Dodecalactone; Dimethyltetrahydrobenzofuranone; gamma-Dodecalactone; delta-Dodecalactone; Ethyl 2-methylbutyrate; Ethyl acetate; Ethyl alcohol, including Specially Denatured Alcohol (SDA) No. 4; Ethyl benzoate; Ethyl butyrate; Ethyl cinnamate; Ethyl decanoate; Ethyl heptanoate; Ethyl hexanoate; Ethyl isovalerate; Ethyl lactate; Ethyl laurate; Ethyl levulinate; Ethyl maltol; Ethyl methyl phenylglycidate; Ethyl myristate; Ethyl nonanoate; Ethyl octadecanoate; Ethyl octanoate; Ethyl oleate; Ethyl palmitate; Ethyl phenylacetate; Ethyl propionate; Ethyl valerate; Ethyl vanillin; Ethyl vanillin glucoside; 2-Ethyl-1-hexanol; 3-Ethyl-2-hydroxy-2- cyclopenten-1-one; 2-Ethyl-3,(5 or 6)- dimethylpyrazine; 5-Ethyl-3-hydroxy-4-methyl -2(5H)-furanone; 2-Ethyl-3-methylpyrazine; 4-Ethylbenzaldehyde; 4-Ethylguaiacol; para-Ethylphenol; 3-Ethylpyridine; Eucalyptus oil; Farnesol; cid; cis-3-Hexenyl formate; Hexyl acetate; Hexyl alcohol; Hexyl phenylacetate; High Fructose Corn Syrup; Honey; Hydrolyzed soy protein; 4-Hydroxy-2,5-dimethyl; -3(2H)-furanone; 4-Hydroxy-3-pentenoic; acid lactone; 4-Hydroxybutanoic acid; lactone; Hydroxycitronellal; 6-Hydroxydihydrotheaspirane; 4-(para-Hydroxyphenyl)-2-butanone; Hydroxypropyl celluloseFenchone; Fenugreek, extract, resin, and absolute; Fig juice concentrate and extract; Food starch modified; Fructose; Furfuryl mercaptan; 4-(2-Furyl)-3-buten-2-one; Galbanum oil and resinoid; Geraniol; Geranium rose oil; Geranyl acetate; Geranyl butyrate; Geranyl formate; Geranyl phenylacetate; Ginger oil and oleoresin; Glucose; l-Glutamic acid; Glycerol; Graphite; Guaiac wood oil; Guar gum; 2,4-Heptadienal; gamma-Heptalactone; Heptanoic acid; 3-Hepten-2-one; 4-Heptenal; Heptyl acetate; omega-6-Hexadecenlactone; gamma-Hexalactone; Hexanal; Hexanoic acid; 2-Hexen-1-ol; 3-Hexen-1-ol; cis-3-Hexen-1-yl acetate; Hexen-2-al; trans-2-Hexenoic acid; 3-Hexenoic a

• Immortelle absolute and extract; Invert sugar; alpha-Ionone; beta-Ionone; Isoamyl acetate; Isoamyl benzoate; Isoamyl butyrate; Isoamyl cinnamate; Isoamyl formate; Isoamyl hexanoate; Isoamyl isovalerate; Isoamyl phenylacetate; Isobornyl propionate; Isobutyl acetate; Isobutyl alcohol; Isobutyl cinnamate; Isobutyl phenylacetate; 2-Isobutyl-3-methoxypyrazine; alpha-Isobutylphenethyl alcohol; Isobutyraldehyde; Isobutyric acid; 2-Isopropylphenol; Isovaleric acid; Jasmine absolute; Kola nut extract; Labdanum oils, absolute; Lactic acid; Lauric acid; Lauric aldehyde; Lavandin oil Lemon oil, terpenes and terpeneless; Lemongrass oil; Levulinic acid; Licorice root, fluid extract ; and powder; Lime oil and lime oil terpeneless; Linalool; Linalool oxide; Linalyl acetate; Lovage oil and extract; l-Lysine; Mace powder and oil; Malic acid; Malt and malt extract; Maltodextrin; Maltol; Mandarin and tangerine oil; Maple syrup and concentrate; Maté leaf, absolute, extract and oil; para-Mentha-8-thiol-3-one; Menthol and l-Menthol; Menthone; Menthyl acetate; Menthyl isovalerate; Methoprene; 2-,5-, or 6-Methoxy -3-methylpyrazine; 2-Methoxy-4-vinylphenol; para-Methoxybenzaldehyde; 1-(para-Methoxyphenyl) -1-penten-3-one; 1-(para-Methoxyphenyl) -2-propanone; Methoxypyrazine; Methyl 2-furoate; Methyl 2-octynoate; Methyl 2-pyrrolyl ketone; Methyl anisate; Methyl anthranilate; Methyl benzoate; Methyl cinnamate; Methyl dihydrojasmonate; Methyl ester of rosin, partially hydrogenated; Methyl isovalerate; Methyl linoleate (48%) methyl linolenate (52%) mixture; Methyl phenylacetate; Methyl salicylate; Methyl sulfide; 5-Methyl-2-phenyl-2-hexenal; 6-Methyl-3,5-heptadien-2-one ; 1-Methyl-3-methoxy-4-isopropylbenzene; Methyl-3-methylthiopropionate; Methyl-3-methylthiopropionate; 2-Methyl-4-phenylbutyraldehyde

• Methyl-5-hepten-2-one; 4-Methyl-5-thiazoleethanol; 4-Methylacetophenone; para-Methyl-anisole; Methyl-alpha-ionone; alpha-Methylbenzyl acetate; 3-Methylbutyraldehyde; 2-Methylbutyric acid; alpha-Methylcinnamaldehyde; Methylcyclopentenolone; Methylcyclopentenolone; 2-Methylheptanoic acid; 2-Methylhexanoic acid; 3-Methylpentanoic acid; 2-Methylpyrazine; 5-Methylquinoxaline; (Methylthio)methylpyrazine (mixture of isomers); 3-(Methylthio)propionaldehyde; Methyl-trans-2-butenoic acid; 2-Methylvaleric acid; Mimosa absolute; Molasses, blackstrap, sugarcane and extract; Mountain maple solid extract; Myristic acid; Myrrh oil and absolute; Nerol; Neroli bigarade oil; Nerolidol; Nona-2-trans,6-cis-dienal; 2,6-Nonadien-1-ol; gamma-Nonalactone; gamma-Nonalactone; Nonanoic acid; 2-Nonanone; trans-2-Nonen-1-ol; Nonyl alcohol; Nutmeg powder and oil; Oak moss absolute; 9,12-Octadecadienoic acid (48%) and 9,12,15-octadecatrienoic acid (52%)(mixture); gamma-Octalactone; delta-Octalactone; Octanal; Octanoic acid; 2-Octanone; 1-Octen-3-ol; 1-Octen-3-yl acetate; 2-Octenal; Octyl isobutyrate; Oleic acid; Olibanum oil; Opoponax oil; Orange leaf absolute; Orange oil and extract (sweet orange oils, sweet orange oils; terpeneless, sour/ bitter orange oils, orange oils terpenes); Origanum oil; Orris concrete oil and root extract; Palmarosa oil; Palmitic acid; Parsley seed oil; Parsley seed oil; Pectin omega-Pentadecalactone 2,3-Pentanedione; 2-Pentanone; Pepper oil, black; Peppermint oil and peppermint oil terpeneless; Petitgrain absolute, oil, mandarin oil and terpeneless; alpha-Phellandrene; 2-Phenethyl acetate; 2-Phenethyl acetate; Phenethyl butyrate; Phenethyl cinnamate; Phenethyl isobutyrate; Phenethyl isovalerate; Phenethyl phenylacetate; 3-Phenyl-1-propanol; 2-Phenyl-2-butenal; 4-Phenyl-3-buten-2-one; Phenylacetaldehyde; Phenylacetic acid; l-Phenylalanine; 3-Phenylpropionaldehyde; 3-Phenylpropionic acid; 3-Phenylpropyl acetate; Phosphoric acid; Phosphoric acid; Pine oil, scotch; alpha-Pinene; beta-Pinene; d-Piperitone; Piperonal; Pipsissewa leaf extract; Plum juice, concentrate and extract; Potassium carbonate anhydrous; Potassium sorbate; l-Proline; Propenylguaethol; Propionic acid; Propyl acetate; Propyl para-hydroxybenzoate; Propylene glycol; 3-Propylidenephthalide; Prune juice and concentrate; Pyridine; Pyroligneous acid and extract; Pyruvic acid; oil.

• Acetanisole; Acetic acid; Acetoin; Acetophenone; Acetylpyrazine; 2-Acetylpyridine; 3-Acetylpyridine; 2-Acetylthiazole; Aconitic acid; dl-Alanine, l-Alanine; Alfalfa extract and powder; Allspice extract, oleoresin, and oil; Allyl hexanoate; Ambergris tincture; Ammonium alginate; Ammonium hydroxide; Ammonium phosphate dibasicv Amyl alcohol; Amyl butyrate; Amyl formatev Amyl octanoate; alpha-Amylcinnamaldehyde; Amyris oil; trans-Anethole; Angelica root extract and oil; Anise oil; Anisyl acetate; Anisyl alcohol; Anisyl formate; Apple juice concentrate and extract; Apricot extract; l-Arginine; Ascorbic acid; l-Aspartic acid; Balsam peru and oil; Bay oil (west indian and sweet oil); Beeswax white and absolute; Beet juice concentrate; Benzaldehyde; Benzaldehyde glyceryl acetal; Benzoic acid; Benzoin, resin and absolute; Benzophenone; Benzyl alcohol; Benzyl benzoate; Benzyl butyrate; Benzyl cinnamate; Benzyl saliclatev Bergamot oil; Bisabolene; Bois de rose (Peruvian) oil; Borneol; Bornyl acetate; Bornyl isovalerate; Buchu leaf oil; Buchu leaf oil; 1,3-Butanediol; 4-(2-Butenylidene)-3,5, 5-trimethyl-2-cyclohexen-1-one; Butter, butter esters and butter oil; Butyl acetate; Butyl alcohol; Butyl butyrate; Butyl butyryl lactate; n-Butyl isovalerate; Butyl phenylacetate; 3-Butylidenephthalide; Butyric acid; Caffeine; Calcium carbonate; Camphene; Cananga oil; Caramel and caramel color; Caraway oil; Carbon; Carbon dioxide; Cardamom oleoresin, oil, extract; seed oil, and powder; Carob bean and extract; beta-Carotene; Carrot oil; Carvacrol; 4-Carvomenthenol; l-Carvone; Caryophyllene acetate; beta-Caryophyllene; beta-Caryophyllene oxide; Cascarilla oil and bark extract; Cassia bark, buds, oil; and extract; Cassie absolute; Castoreum extract, tincture; and absolute; Cedar leaf oil; Cedarwood oil terpenes; Celery seed extract, solid; oil, and oleoresin; Cellulose fiber; Cellulose fiber; Chicory extract; Chocolate; 1,8-Cineolev Cinnamaldehyde; Cinnamaldehyde; Cinnamic acid; Cinnamon leaf oil, bark oil; and extract; Cinnamyl acetate; Cinnamyl alcohol; Cinnamyl cinnamate; Cinnamyl isovalerate; Citral; Citric acid; Citronella oil; dl-Citronellol; Citronellyl isobutyrate; Citronellyl phenylacetate; Civet absolute; Clary sage oil and extract; Cocoa, cocoa shells, extract, distillate, powder, alkalized, absolute and tincture; Coffee and coffee solid extract; Cognac white and green oil; Copaiba balsam oil and; copaiba oil; Coriander extract, oil, and seed; Corn silk; Corn starch; Corn syrup; Costus root oil; Cuminaldehyde; para-Cymene; para-Cymene; Dandelion root solid extract; Davana oil;

• Raisin juice concentrate and extract; l-Rhamnose; Rhodinol; Rose absolute and oil; Rosemary oil and extract; Rum and rum extract; Rum ether; Sage, sage oil, and sage oleoresin; Salicylaldehyde; Sandalwood oil, yellow; Sclareolide; Sodium benzoate; Sodium bicarbonate; Sodium carbonate; Sodium citrate; Sodium propionate; Sorbic acid; d-Sorbitol; Spearmint oil; Storax and styrax, extract, gum, and oil; Sucrose; Sucrose octaacetate; Tannic acid; l-Tartaric acid, dl-Tartaric acid; Tea extract; Terpinolene; Terpinyl acetate; 5,6,7,8-Tetrahydroquinoxaline; 1,5,5,9-Tetramethyl-13- oxatricyclo (8.3.0.0(4,9)) tridecane; 2,3,5,6-Tetramethylpyrazine; Thyme oil, white and red; Thymol; Tocopherols (mixed); Tolu balsam gum and extract; Tolualdehydes (ortho,meta,para); para-Tolyl 3-methylbutyrate; para-Tolyl acetate; para-Tolyl isobutyrate; para-Tolyl phenylacetate; Triacetin; 2-Tridecanone; Triethyl citrate; 3,5,5-Trimethyl-1,2 -cyclohexanedione; 3,5,5-Trimethyl-1-hexanol; 4-(2,6,6-Trimethylcyclohex -1-enyl)but-2-en-4-one; 2,6,6-Trimethylcyclohex-2 -ene-1,4-dione; 4-(2,6,6-Trimethylcyclohexa -1,3-dienyl); but-2-en-4-one; 2,2,6-Trimethylcyclohexanone; 2,3,5-Trimethylpyrazine; gamma-Undecalactone; delta-Undecalactone; 2-Undecanone; Urea; Valeraldehyde; Valerian root extract, oil and powder; gamma-Valerolactone; l-Valine; Vanilla extract, absolute and oleresin; Vanillin; Veratraldehyde; Vetiver oil; Violet leaf absolute; Walnut hull extract; Water; Wheat extract; Wine and wine sherry; Ylang ylang

•Lung cancer in men

•Chronic obstructive pulmonary disease

2004

•Peptic ulcer disease

•Lung cancer in women

•Coronary heart disease

•Laryngeal cancer

•Bladder cancer

•Abdominal aortic aneurysm

•Acute myeloid leukemia

•Cataracts•Cervical cancer•Kidney cancer•Pancreatic cancer

•Pneumonia•Periodontitis•Stomach cancer

•Esophageal cancer

•Oral cancer

•Stroke

1964

•Lung cancer in men

•Chronic obstructive pulmonary disease

1967

•Lung cancer in men

•Chronic obstructive pulmonary disease

•Peptic ulcer disease

•Lung cancer in women

1979

•Lung cancer in men

•Chronic obstructive pulmonary disease

•Peptic ulcer disease

•Lung cancer in women

•Coronary heart disease

1980

•Lung cancer in men

•Chronic obstructive pulmonary disease

•Peptic ulcer disease

•Lung cancer in women

•Coronary heart disease

•Laryngeal cancer

1982

•Lung cancer in men

•Chronic obstructive pulmonary disease

•Peptic ulcer disease

•Lung cancer in women

•Coronary heart disease

•Laryngeal cancer

•Esophageal cancer

•Oral cancer

1989

•Lung cancer in men

•Chronic obstructive pulmonary disease

•Peptic ulcer disease

•Lung cancer in women

•Coronary heart disease

•Laryngeal cancer

•Esophageal cancer

•Oral cancer

•Stroke

1990

•Lung cancer in men

•Chronic obstructive pulmonary disease

•Peptic ulcer disease

•Lung cancer in women

•Coronary heart disease

•Laryngeal cancer

•Esophageal cancer

•Oral cancer

•Stroke

•Bladder cancer

The Mounting Evidence of the Toll of Tobacco on Life and Health

Más de 25 enfermedades Más de 25 enfermedades Más de 25 enfermedades Más de 25 enfermedades

• Cerebro– A.V.C.

• Boca y faringe– Cáncer

• Esófago y estómago– Cáncer– Úlcus

• Laringe y traquea– Cáncer– Inflamación (laringitis)

• Pulmones– Cáncer– Enfisema– Bronquitis crónica

• Corazón– Cardiopatía isquémica

• Páncreas– Cáncer

• Útero y ovário– Infertilidad– Aborto– Retardo crecimiento– Menopausia precoz– Cáncer de cervix

• Testículos– Disminución fertilidad– Impotencia

• Aparato Urinario– Cáncer de riñón– Cáncer de vejiga

• Arterias periféricas– Arteritis de EEII

• Huesos– Osteoporosis

• Piel y anejos– Color gris– Arrugas

(Cualquier especialidad médica)(Cualquier especialidad médica)

Engaño continuo a su cliente

1. Engaño en la calidad

2. Engaño en la cantidad

3. Engaño en cuanto a las consecuencias1. Adicción 2. Toxicidad

Uno de los negocios mas Uno de los negocios mas rentables del mundo rentables del mundo

Uno de los negocios más rentables del Uno de los negocios más rentables del mundo mundo

LA CALIDAD DE LOS

CIGARRILLOS

De esta forma utilizan los tallos y nervaduras, filamentos y polvillo del tabaco que hasta entonces se desechaba. De esta forma ganan un 30 % mas de producto

CigarrilloAño 1960

CigarrilloAño 2008

1.04 g 0,43 g

Tabaco Expandido

Tipo % Ventilación del Filtro

Máximo Sabor 12,7

Suave 27,3

Ultra Suave 53,4

¿Que nos indica esta información?

Premio a quien lo adivine

1994

Los fumadores del futuroLos fumadores del futuro(Los objetivos de la industria)(Los objetivos de la industria)

Sanguesa, 29 de Mayo de 2012

LAS 5 ETAPAS DEL FUMADOR (El continun del fumador)

18 30 40 50 60 70

I VIVIIIII

ADICCIÓNNO PERCIBIDA

SÍNTOMAS

SUBCLÍNICOS ENFERMEDAD

CLÍNICAINVALIDEZ MUERTE

LAS 5 ETAPAS DEL FUMADOR (El continun del fumador)

18 30 40 50 60 70

I VIVIIIII

ADICCIÓNNO PERCIBIDA

SÍNTOMAS

SUBCLÍNICOS ENFERMEDAD

CLÍNICA INVALIDEZ MUERTE

– Control de estres– Control emociones negativas– Mejora concentracion– Situaciones sociales– Control peso

– Control de estres– Control emociones negativas– Mejora concentracion– Situaciones sociales– Control peso

Ventajas Inconvenientes

– Cosecuencias saludCosecuencias salud

de otros

– Cosecuencias saludCosecuencias salud

de otros

Equilibrio Decisional

1º Querer dejarlo1º Querer dejarlo

2º Voluntad2º Voluntad

3º Sabercomo

3º Sabercomo

2º Motivación 2º Motivación

Tres requisitos para dejar de fumar

Para que una persona cambie de conducta debe reunir tres características

A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA 2000 Jun 28; 283(24): 3244-54

Pastillas

Hipnosis

Parches

¡¡ Saber como !!

¿ métodos ?

¿ Qué métodos hay para dejar de

fumar ?

La pregunta del millón

¿¿Cuál es el método más eficazpara dejar de fumar?

Método del avestruz

ASESORAMIENTO

MEDICACIÓN

Descenso del riesgo de mortalidad por càncer de pulmón después

de dejar el tabaco1.4

1.2

1.0

0.8

0.6

0.4

0.2

Años de abandono del tabaco

Font: Doll R & Peto R. BMJ, 1974 & 1994

Muertospor1.000

Fumadores

Exfumadores

Riesgo del no fumador

0 252015105

RP E UG

TN

SA

respuestas

&