Smokers, current

Step 4. Provide a Motivational Intervention for Smokers Currently Unwilling to Quit... 

However, when the disease occurs in smokers (current or former), the cUnical course seems to be more severe, and most patients develop chronic recurrent or the insidious form of the disease displaying a worse survival rate compared with nonsmokers (35). The reason is unknown, but it can be associated with changes in the lung T-ceU subsets and with increased local induction of free radicals (36,37). 

The most recent RDA has included a vitamin C recommendation of 100 mg/day for cigarette smokers. An increasing number of investigators have concluded that the current RDA for vitamin C may not be adequate for elderly individuals. Plasma vitamin C level is generally accepted as an indicator of vitamin C status. 

In general, for smokers with cardiac disease, the benefits of nicotine replacement therapy outweigh the potential risks. In a safety and efficacy study that included veterans with cardiac disease, smoking concurrently with the nicotine patch was not associated with an increase in adverse events (Joseph et al. 1996). Although bupropion SR is generally well tolerated by smokers, it has not been adequately studied in persons with cardiac disease, and definitive conclusions regarding its safety in this patient population cannot currently be made (Society for Research on Nicotine and Tobacco 2003). 

One other study deserves a mention. The Cancer Prevention Study 11 was a prospective investigation using a very large cohort of over one million adult Americans, in which the effects of commercial multivitamin supplements and vitamins A, C or E on mortality were studied, during a follow-up period of seven years. The results were complex in that the use of multivitamins plus vitamins A, C and/or E significantly reduced the risk of lung cancer in both former smokers and life-long non-smokers, but vitamins A, C and E apparently increased the risk in current smokers. 

Tobacco smoke contains chemicals that induce the cytochrome P-450 isoenzymes 1A1,1A2, and 2E1. Theophylline is metabolized by 1A2 and 2E1, and therefore smoking leads to increased clearance and subsequently decreased plasma levels of the drug.15 Because most patients with COPD are current or past smokers, it is important to assess current tobacco use and adjust the theophylline dose as required based on altered plasma theophylline levels if tobacco use changes. 

Assess the patient s symptoms and status (i.e., inpatient, outpatient, or intubated) to determine the type of pneumonia and comorbid conditions. Does the patient have moderate to severe asthma, COPD, or emphysema or is a current smoker ... 

Certain subgroups of the population may be more susceptible to the toxic effects of lead exposure. These include crawling and house-bound children (<6 years old), pregnant women (and the fetus), the elderly, smokers, alcoholics, and people with genetic diseases affecting heme synthesis, nutritional deficiencies, and neurological or kidney dysfunction. This is not an exhaustive list and reflects only current data available, further research may identify additional susceptible subgroups. 

Around half of American and British adults who used to smoke have now stopped. Furthermore, 80-85% of current smokers state that they would like to quit and wish they had never started. However, quitting can be difficult, with many smokers relapsing... 

Major risk factors include current smoker, low body weight (<127 lb in postmenopausal women), history of osteoporotic fracture in a first-degree relative, and personal history of low-trauma fracture as an adult. Other independent risk factors include age, high bone turnover, low body mass index (<19 kg/m2), rheumatoid arthritis, and glucocorticoid use. Decision tools may help identify individuals who should undergo BMD testing, such as the Osteoporosis Risk Assessment Instrument and the Simple Calculated Osteoporosis Risk Estimation. 

Galliant and Schubert (2007) 13 16 9 NR 15.1 Glu in hippocampus or ACC did not differ between groups. In current smokers, number of cigarettes per day, pack-years, age of smoking initiation did not correlate with Glu. 

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