Charla a poblacion general sobre porque hay que dejar de fumar.

1. S an g u e s a, 2 9 d e M ayo d e 2 01 2
P lác i d o G as c ó
C .S . I tu rram a
S o c i e d ad Vas c o N avarra d e P re ve n c i ón d e l T ab aq u i s m o /
E u s k ad i E ta N afarro ak o T ab ak i s m o ari Au rre g i te k o e lk arte a

2. S an g u e s a, 2 9 d e M ayo d e 2 01 2

6. ¿ Por qué fuman
las personas ?

7. Lo
n
Me calma
los nervios
ec
es
it op
ara
Me relaja
s fun
na cio
ña
na
rp act
Ma
or
las oc
la
s ma
ña rea
po
r Saboreo mejor mi café na
s ti v o
la
M
i Mu Po
st r
e
e la s
Me
ha
no
ch
ce
es
Inicio de….. m
co
er
e la
mp
ja
añ
Me ayuda después de comer
ía
Me concentro mejor
+
M e produce placer

8. Dopamina Placer, suprime el apetito
Norepinefrina Estimula, suprime el apetito
Acetilcolina Estimula
Intensifica el conocimiento cognitivo
Nicotina
Vasopresina Mejora la memoria
Serotonina Cambia el humor, suprime el apetito
Beta-endorfina Reduce la ansiedad y la tensión
Benowitz, 1999.

10. Mecanismo de acción de la nicotina
Receptor
Nicotínico
D D
D DD D D D D D D
D DDD DDD DDD
D D D

12. El fumador necesita mantener un nivel de nicotina en sangre entre 15-18 ng/ml
para evitar los sintomas de abstinencia
D D
DDD DD
D D DD D D
D D D
D DD DDD
D D
D D
D DD
D
D D
DDD
D
D D D D
DDD DDD
D
D D D
DDD
D

13. 45
Estímulo reforzador positivo nicotina en plasma
Concentración de (ER+)
40
35
30
Plasma nicotine (mcg/L)
25
Cigarette
20
15
10
Sensación de falta de nicotina
5
0 30 60 90 120 150 60
0 0 0/01 /1 9 0 0 1 0/01 /1 9 0 0 2 0/01 /1 9 00 3 0 /0 1 /1 9 00 09 /02 /1 9 00 1 9 /02 /1 9 00 2 9 /0 2 /1 9 00
Tiempo (minutes)
1 0/03 /1 9 00 2 0 /0 3 /1 9 00 3 0/0 3 /1 9 00 09 /04 /1 9 00 1 9 /0 4 /1 9 00 2 9 /04 /1 9 0 0 09 /05 /1 9 00 1 9 /0 5 /1 9 00 2 9 /0 5 /1 9 00 08 /06 /1 9 00
Estímulo reforzador negativo (ER-)

14. Síndrome de Abstinencia de Nicotina
Receptores hambrientos de nicotina
• Deseo vehemente de fumar
• Irritabilidad
• Frustración o enojo
Fuente: J. Henningfield
• Insomnio
• Disminución del pulso
• Aumento del apetito o aumento de peso
• Ansiedad
• Dificultad para concentrarse

15. Ni todos los fumadores son iguales, ni los efectos son los
mismos

16. Cravings
(Deseo intenso de Fumar)
Nicotina Fumar

18. British American Tobacco

20. Plácido Gascó
Médico

21. • 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-Dimethoxybenz ene; 2,6-Dimethoxyphenol; 3,4-Dimethyl-1,2-
• Acetanisole; Acetic acid; Acetoin; Acetophenone; Acetylpyrazine; 2-Acetylpyridine; 3-Acetylpyridine; 2- cyclopentadione; 3,7-Dimethyl-1,3,6-octatriene; 4,5-Dimethyl-3-hydroxy-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; 5-dihydrofuran-2-one; 4,5-Dimethyl-3-hydroxy-2; 5-dihydrofuran-2-one;
Ammonium phosphate dibasicv Amyl alcohol; Amyl butyrate; Amyl formatev Amyl octanoate; alpha- 3,7-Dimethyl-6-octenoic acid; 2,4-Dimethylacetophenone; alpha,para-
Amylcinnamaldehyde; Amyris oil; trans-Anethole; Angelica root extract and oil; Anise oil; Anisyl Dimethylbenzyl alcohol; alpha,alpha-Dimethylphenethyl ; butyrate; 2,3-
acetate; Anisyl alcohol; Anisyl formate; Apple juice concentrate and extract; Apricot extract; l-Arginine; Dimethylpyrazine; 2,5-Dimethylpyrazine; 2,6-Dimethylpyrazine;
Ascorbic acid; l-Aspartic acid; Balsam peru and oil; Bay oil (west indian and sweet oil); Beeswax white Dimethyltetrahydrobenzofuranone; gamma-Dodecalactone; delta-
and absolute; Beet juice concentrate; Benzaldehyde; Benzaldehyde glyceryl acetal; Benzoic acid; Benzoin,
resin and absolute; Benzophenone; Benzyl alcohol; Benzyl benzoate; Benzyl butyrate; Benzyl cinnamate; Dodecalactone; Dimethyltetrahydrobenzofuranone; gamma-Dodecalactone;
Benzyl saliclatev Bergamot oil; Bisabolene; Bois de rose (Peruvian) oil; Borneol; Bornyl acetate; Bornyl delta-Dodecalactone; Ethyl 2-methylbutyrate; Ethyl acetate; Ethyl alcohol,
isovalerate; Buchu leaf oil; Buchu leaf oil; 1,3-Butanediol; 4-(2-Butenylidene)-3,5, 5-trimethyl-2- including Specially Denatured Alcohol (SDA) No. 4; Ethyl benzoate; Ethyl
cyclohexen-1-one; Butter, butter esters and butter oil; Butyl acetate; Butyl alcohol; Butyl butyrate; butyrate; Ethyl cinnamate; Ethyl decanoate; Ethyl heptanoate; Ethyl
Butyl butyryl lactate; n-Butyl isovalerate; Butyl phenylacetate; 3-Butylidenephthalide; Butyric acid; hexanoate; Ethyl isovalerate; Ethyl lactate; Ethyl laurate; Ethyl levulinate;
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- Ethyl maltol; Ethyl methyl phenylglycidate; Ethyl myristate; Ethyl
Carotene; Carrot oil; Carvacrol; 4-Carvomenthenol; l-Carvone; Caryophyllene acetate; beta- nonanoate; Ethyl octadecanoate; Ethyl octanoate; Ethyl oleate; Ethyl
Caryophyllene; beta-Caryophyllene oxide; Cascarilla oil and bark extract; Cassia bark, buds, oil; and palmitate; Ethyl phenylacetate; Ethyl propionate; Ethyl valerate; Ethyl
extract; Cassie absolute; Castoreum extract, tincture; and absolute; Cedar leaf oil; Cedarwood oil vanillin; Ethyl vanillin glucoside; 2-Ethyl-1-hexanol; 3-Ethyl-2-hydroxy-2-
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; cyclopenten-1-one; 2-Ethyl-3,(5 or 6)- dimethylpyrazine; 5-Ethyl-3-
and extract; Cinnamyl acetate; Cinnamyl alcohol; Cinnamyl cinnamate; Cinnamyl isovalerate; Citral; hydroxy-4-methyl -2(5H)-furanone; 2-Ethyl-3-methylpyrazine; 4-
Citric acid; Citronella oil; dl-Citronellol; Citronellyl isobutyrate; Citronellyl phenylacetate; Civet Ethylbenzaldehyde; 4-Ethylguaiacol; para-Ethylphenol; 3-Ethylpyridine;
absolute; Clary sage oil and extract; Cocoa, cocoa shells, extract, distillate, powder, alkalized, absolute Eucalyptus oil; Farnesol; cid; cis-3-Hexenyl f ormate; Hexyl acetate; Hexyl
and tincture; Coffee and coffee solid extract; Cognac white and green oil; Copaiba balsam oil and; alcohol; Hexyl phenylacetate; High Fructose Corn Syrup; Honey; Hydrolyzed
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; 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-
• Immortelle absolute and extract; Invert sugar; alpha-Ionone; beta- Hydroxyphenyl)-2-butanone; Hydroxypropyl celluloseFenchone; Fenugreek,
Ionone; Isoamyl acetate; Isoamyl benzoate; Isoamyl butyrate; extract, resin, and absolute; Fig juice concentrate and extract; Food starch
Isoamyl cinnamate; Isoamyl formate; Isoamyl hexanoate; Isoamyl modified; Fructose; Furfuryl mercaptan; 4-(2-Furyl)-3-buten-2-one;
Galbanum oil and resinoid; Geraniol; Geranium rose oil; Geranyl acetate;
isovalerate; Isoamyl phenylacetate; Isobornyl propionate; Isobutyl Geranyl butyrate; Geranyl formate; Geranyl phe n yla ce t a t e ; Ginger oil and
acetate; Isobutyl alcohol; Isobutyl cinnamate; Isobutyl oleoresin; Glucose; l-Glutamic acid; Glycerol; Graphite; Guaiac wood oil; Guar
phenylacetate; 2-Isobutyl-3-methoxypyrazine; alpha- • gum; 2,4-Heptadienal; gamma-Heptalactone; Heptanoic acid; 3-Hepten-2-
Methyl-5-hepten-2-one; 4-Methyl-5-thiazoleethanol; 4-Methylacetophenone;
Isobutylphenethyl alcohol; Isobutyraldehyde; Isobutyric acid; 2- para-Methyl-anisole; Heptyl acetate; omega-6-Hexadecenlactone; acetate; 3-
one; 4-Heptenal; Methyl-alpha-ionone; alpha-Methylbenzyl gamma-
Isopropylphenol; Isovaleric acid; Jasmine absolute; Kola nut extract; Hexalactone; Hexanal; Hexanoic acid; 2-Hexen-1-ol; 3-Hexen-1-ol; cis-3-
Methylbutyraldehyde; 2-Methylbutyric acid; alpha-Methylcinnamaldehyde;
Labdanum oils, absolute; Lactic acid; Lauric acid; Lauric aldehyde; Methylcyclopentenolone; Hexen-2-al; trans-2-Hexenoic acid; 3-Hexenoic a 2-
Hexen-1-yl acetate; Methylcyclopentenolone; 2-Methylheptanoic acid;
Lavandin oil Lemon oil, terpenes and terpeneless; Lemongrass oil; Methylhexanoic acid; 3-Methylpentanoic acid; 2-Methylpyrazine; 5-
Methylquinoxaline; (Methylthio)methylpyrazine (mixture of isomers); 3-
Levulinic acid; Licorice root, fluid extract ; and powder; Lime oil and (Methylthio)propionaldehyde; Methyl-trans-2-butenoic acid; 2-Methylvaleric
lime oil terpeneless; Linalool; Linalool oxide; Linalyl acetate; Lovage acid; Mimosa absolute; Molasses, blackstrap, sugarcane and extract; Mountain
oil and extract; l-Lysine; Mace powder and oil; Malic acid; Malt and maple solid extract; Myristic acid; Myrrh oil and absolute; Nerol; Neroli
malt extract; Maltodextrin; Maltol; Mandarin and tangerine oil; bigarade oil; Nerolidol; Nona-2-trans,6-cis-dienal; 2,6-Nonadien-1-ol; gamma-
Maple syrup and concentrate; Maté leaf, absolute, extract and oil; Nonalactone; gamma-Nonalactone; Nonanoic acid; 2-Nonanone; trans-2-
para-Mentha-8-thiol-3-one ; Menthol and l-Menthol ; Menthone; 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);
Menthyl acetate; Menthyl isovalerate; Methoprene; 2-,5-, or 6- gamma-Octalactone; delta-Octalactone; Octanal; Octanoic acid; 2-Octanone; 1-
Methoxy -3-methylpyrazine; 2-Methoxy-4-vinylphenol; para- Octen-3-ol; 1-Octen-3-yl acetate; 2-Octenal; Octyl isobutyrate; Oleic acid;
Methoxybenzaldehyde; 1-(para-Methoxyphenyl) -1-penten-3-one; 1- Olibanum oil; Opoponax oil; Orange leaf absolute; Orange oil and extract (sweet
(para-Methoxyphenyl) -2-propanone; Methoxypyrazine; Methyl 2- orange oils, sweet orange oils; terpeneless, sour/ bitter orange oils, orange oils
furoate; Methyl 2-octynoate; Methyl 2-pyrrolyl ketone; Methyl terpenes); Origanum oil; Orris concrete oil and root extract; Palmarosa oil;
anisate; Methyl anthranilate; Methyl benzoate; Methyl cinnamate; Palmitic acid; Parsley seed oil; Parsley seed oil; Pectin omega-Pentadecalactone
2,3-Pentanedione; 2-Pentanone; Pepper oil, black; Peppermint oil and peppermint
Methyl dihydrojasmonate; Methyl ester of rosin, partially oil terpeneless; Petitgrain absolute, oil, mandarin oil and terpeneless; alpha-
hydrogenated; Methyl isovalerate; Methyl linoleate (48%) methyl Phellandrene; 2-Phenethyl acetate; 2-Phenethyl acetate; Phenethyl butyrate;
linolenate (52%) mixture; Methyl phenylacetate; Methyl salicylate; Phenethyl cinnamate; Phenethyl isobutyrate; Phenethyl isovalerate; Phenethyl
• Methyl sulfide;c5-Methyl-2-phenyl-2-hexenal; 6-Methyl-3,5- phenylacetate; 3-Phenyl-1-propanol; 2-Phenyl-2-butenal; 4-Phenyl-3-buten-2-
Raisin jui ce oncentrate and extract; l-Rhamnose; one; Phenylacetaldehyde; Phenylacetic acid; l-Phenylalanine; 3-
heptadien-2-one ; 1-Methyl-3-methoxy-4-isopropylbenzene; extract;
Rhodinol; Rose absolute and oil; Rosemary oil and
Methyl-3-methylthiopropionate; Methyl-3-methylthiopropionate; 2- Phenylpropionaldehyde; 3-Phenylpropionic acid; 3-Phenylpropyl acetate;
Rum and rum e xtrac t; Rum e ther; Sage, sage oi l, and sage
Methyl-4-phenylbutyraldehyde
Phosphoric acid; Phosphoric acid; Pine oil, scotch; alpha-Pinene; beta-Pinene; d-
oleoresin; Salicylaldehyde ; Sandalwood oil, ye llow; Piperitone; Piperonal; Pipsissewa leaf extract; Plum juice, concentrate and
extract; Potassium carbonate anhydrous; Potassium sorbate; l-Proline;
Sclareolide ; Sodium benzoate; Sodi um bicarbonate; Sodium Propenylguaethol; Propionic acid; Propyl acetate; Propyl para-hydroxybenzoate;
carbonate ; Sodium citrate; Sodium propionate; Sorbi c aci d; Propylene glycol; 3-Propylidenephthalide; Prune juice and concentrate; Pyridine;
d-Sorbitol; Spearmint oi l; Storax and styrax, e xtrac t, gum, Pyroligneous acid and extract; Pyruvic acid; oil.
and oil; Sucrose; Suc rose octaace tate ; Tannic ac id; l-
Tartaric acid, dl-Tartaric ac id; Te a extract; Terpi nolene;
Te rpinyl ac etate; 5,6, 7, 8-Tetrah ydroquinoxaline; 1,5,5,9-
Te trameth yl-13- oxatric yclo (8.3.0.0(4,9)) tridecane;
2, 3,5,6-Tetrame thylpyrazine; Thyme oil, whi te and red;
Th ymol; Toc oph erols (mixe d); Tolu balsam gum and
extract; Tolualdeh ydes (ortho,meta,para); para-Tolyl 3-
methylbutyrate; para-Tolyl ac etate; para-Tolyl
isobutyrate; para-Tolyl phenylac etate; Triacetin; 2-
Tride canone ; Trieth yl citrate ; 3,5,5-Trimeth yl-1,2
-cyclohe xane di one; 3,5,5-Tri me thyl-1-h exanol; 4-(2,6,6-
Trimeth ylcyclohex -1-e nyl)but-2-e n-4-one; 2,6,6-
Trimeth ylcyclohex-2 -ene-1,4-dione; 4-(2,6, 6-
Trimeth ylcyclohexa -1,3-dienyl); but-2-en-4-one ; 2,2,6-
Trimeth ylcyclohexanone; 2,3,5-Trimeth ylpyrazine; gamma-
Unde calactone; delta-Undecalactone; 2-Unde canone ; Urea;
Valeraldeh yde; Vale ri an root extrac t, oi l (and powder; Winston)
J.R.Reynolds Camel y
gamma-Valerolactone; l-Vali ne; Vanilla extract, absolute
and oleresin; Vanillin; Veratraldehyde; Ve tiver oil; Vi ole t
leaf absolute; Walnut h ull extract; Water; Whe at extract;

26. • Abdominal
aortic aneurysm
The Mounting Evidence of the Toll of Tobacco on Life and Health •Acute myeloid
leukemia
• Cataracts
• Cervical cancer
•Kidney cancer
• Pancreatic
cancer
• Pneumonia
•Periodontitis
• Stomach
cancer
• Bladder cancer • Bladder cancer
• Stroke • Stroke • Stroke
• Esophageal • Esophageal • Esophageal • Esophageal
cancer cancer cancer cancer
•Oral cancer •Oral cancer •Oral cancer •Oral cancer
• Laryngeal • Laryngeal • Laryngeal • Laryngeal • Laryngeal
cancer cancer cancer cancer cancer
• Coronary heart • Coronary heart • Coronary heart • Coronary heart • Coronary heart • Coronary heart
disease disease disease disease disease disease
• Peptic ulcer • Peptic ulcer • Peptic ulcer • Peptic ulcer • Peptic ulcer • Peptic ulcer • Peptic ulcer
disease disease disease disease disease disease disease
•Lung cancer in •Lung cancer in •Lung cancer in •Lung cancer in •Lung cancer in •Lung cancer in •Lung cancer in
women women women women women women women
• Lung cancer in • Lung cancer in • Lung cancer in • Lung cancer in • Lung cancer in • Lung cancer in • Lung cancer in • Lung cancer in
men men men men men men men men
•Chronic •Chronic •Chronic •Chronic •Chronic •Chronic •Chronic •Chronic
obstructive obstructive obstructive obstructive obstructive obstructive obstructive obstructive
pulmonary pulmonary pulmonary pulmonary pulmonary pulmonary pulmonary pulmonary
disease disease disease disease disease disease disease disease
1964 1967 1979 1980 1982 1989 1990 2004

27. Más de 25 enfermedades
(Cualquier especialidad médica)
• Cerebro • Útero y ovário
– A.V.C. – Infertilidad
• Boca y faringe – Aborto
– Cáncer – Retardo crecimiento
• Esófago y estómago – Menopausia precoz
– Cáncer – Cáncer de cervix
– Úlcus • Testículos
• Laringe y traquea – Disminución fertilidad
– Cáncer – Impotencia
– Inflamación (laringitis) • Aparato Urinario
• Pulmones – Cáncer de riñón
– Cáncer – Cáncer de vejiga
– Enfisema • Arterias periféricas
– Bronquitis crónica – Arteritis de EEII
• Corazón • Huesos
– Cardiopatía isquémica – Osteoporosis
• Páncreas • Piel y anejos
– Cáncer – Color gris
– Arrugas

28. Engaño continuo a su cliente
2. Engaño en la calidad
5. Engaño en la cantidad
8. Engaño en cuanto a las consecuencias
1. Adicción
2. Toxicidad

29. Uno de los negocios mas
rentables del mundo

30. Uno de los negocios más rentables del mundo

31. LA CALIDAD DE
LOS
CIGARRILLOS

32. 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

33. Tabaco Expandido
Cigarrillo
Año 1960
Cigarrillo
Año 2008
1.04 g 0,43 g

35. Tipo % Ventilación del Filtro
Máximo Sabor 12,7
Suave 27,3
Ultra Suave 53,4

37. ¿Que nos indica esta información?
Premio a quien lo adivine

38. 1994

40. Los fumadores del futuro
(Los objetivos de la industria)

41. S an g u e s a, 2 9 d e M ayo d e 2 01 2

43. LAS 5 ETAPAS DEL FUMADOR
(El continun del fumador)
I II III IV V
ADICCIÓN SÍNTOMAS ENFERMEDAD INVALIDEZ MU ERT
NO PERCIBIDA SUBCLÍNICOS CLÍNICA E
18 30 40 50 60 70

44. LAS 5 ETAPAS DEL FUMADOR
(El continun del fumador)
I II III IV V
ADICCIÓN SÍNTOMAS ENFERMEDAD
NO PERCIBIDA SUBCLÍNICOS CLÍNICA
INVALIDEZ MUERT
E
18 30 70
40 50 60

48. Equilibrio Decisional
– Cosecuencias salud
– Control de estres
– Control emociones negativas Cosecuencias salud
– Mejora concentracion de otros
– Situaciones sociales
– Control peso
s ien tes
Ventaja I n co n ven

50. Tres requisitos para dejar de fumar
3º Saber
como
2º Motivación
2º Voluntad
1º Querer dejarlo
Para que una persona cambie de conducta debe reunir tres características

51. ¡¡ Saber como !!
Pastillas
Parches
Hipnosis
¿ métodos ?
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

52. ¿ Qué métodos hay para
dejar de fumar ?

53. La pregunta del millón
¿¿Cuál es el método más eficaz
para dejar de fumar?

54. Método del avestruz

56. ASESORAMIENTO

57. MEDICACIÓN

61. Descenso del riesgo de mortalidad por
càncer de pulmón después
de dejar el tabaco
1.4
Fumadores
Font: Doll R & Peto R. BMJ, 1974 & 1994
1.2
1.0
Muertospor
1.000 0.8
0.6
0.4 Exfumadores
Riesgo del 0.2
no fumador
0 5 10 15 20 25
Años de abandono del tabaco

63. P R E G U
N
T
A
S
&
respuestas