Cigarette smoking is the most common form of tobacco use in the United States. Approximately 43.8 million (1 in every 5) adults smoke cigarettes.1 Tobacco use can lead to dependence and cause serious health problems. It is one the leading causes of preventable and premature death.2 More deaths are caused each year by tobacco use than by human immunodeficiency virus, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.3
Smoking
harms nearly every organ of the body, causes many diseases, and overall reduces
quality of health. Smokers are at
increased risk of developing coronary heart disease, stroke, cancer, and
chronic obstructive lung disease.3
Fortunately,
cessation of tobacco use can significantly reduce the risk of suffering from
smoking-related diseases. While tobacco dependence is a chronic condition that
may warrant repeated interventions, effective treatment and helpful resources do
exist.
Benefits of Quitting Smoking4
The
overall benefits of quitting smoking are numerous, ranging from short to long
term, as listed below.
20
minutes after quitting – heart rate and blood pressure drops
12 hours
after quitting – carbon monoxide levels in body becomes normal
2-3
months after quitting – circulation and lung function improves
1-9
months after quitting – coughing, shortness of breath decrease and risk of
infection is reduced because lung functioning improves
1 year
after quitting – risk of coronary heart disease is half that of an individual
who continues to smoke
5 - 10
years after quitting – cancer and stroke risk is significantly reduced
Ways to Quit Smoking
Quitting
smoking at any age is beneficial; however, quitting early is associated with
more benefits. Smoking is both a psychological habit and physical addiction,
thus in order to successfully quit smoking, both habits and addiction need to
be addressed.
First, a
quit date should be set and family, friends, co-workers should be informed
about the plan to provide social support. Next, smoking triggers should be
identified and strategies to avoid these triggers should be determined. For
example, if stress is a trigger, other strategies such as deep breathing
exercise or other calming activities should be identified. In addition, smoking
cessation may be accompanied by withdrawal symptoms such as irritability, anxiety,
insomnia, and dizziness. Withdrawal symptoms usually last 2-4 weeks. 5 D’s is a
recommended strategy to help fight cravings and consist of delaying need for
cigarettes, drinking water to keep the mouth occupied, distraction, deep
breathing for relaxation purposes, and discussion of feelings with friends or
local quit line. Staying motivated through the entire quitting process is
important and there are multiple resources available to stay on track, such as www.smokefree.gov
or a toll-free telephone quit line
(1-800-QUIT-NOW).
To help
address the physical addiction, nicotine replacement therapy is available in form
of patch, gum, inhaler, lozenge, and nasal spray. Two nicotine replacement
products, such as gum and patch, may be used in combination to increase
efficacy of therapy. In addition, two non-nicotine medications, bupropion
(Zyban) and varenicline (Chantix), are also approved for smoking cessation.
More information about the medications is provided below:
|
Drug
|
Mechanism of Action
|
Dosage
|
Adverse Effect
|
|
Gum
|
Nicotine
replacement
|
<25 2mg="" cigs:="" span="">
> 25 cigs: 4mg
1 gum
q1-2 hrs X 6 weeks, then 1 gum q2-4h X 3 weeks, then 1 gum q4-8hrs X 3 week
|
Upset
stomach, mouth soreness, hiccups, jaw ache
|
|
Patch
|
Nicotine
replacement
|
>10
cigs: 21mg X 6 week, 14mg X 2 week, 7mg X 2 week
<10 cigs: 14mg X 6 week, 7mg X 2
week
|
Local
skin reaction, insomnia, vivid dreams
|
|
Lozenges
|
Nicotine
replacement
|
1st
cig 30 mins after waking up: 2mg
1 cigs
within 30 mins of waking up: 4mg
1
lozenge every 1-2 hrs for 6 weeks, then 1 lozenge every 2-4 hrs for 3 weeks,
then 1 lozenge every 4-8 hrs for 3 weeks
|
Nausea,
sore throat, hiccups, heartburn
|
|
Inhaler
|
Nicotine
replacement
|
6-16
cartridges daily; taper frequency of use over last 6-12 weeks
|
Local
irritation of mouth/throat, coughing
|
|
Spray
|
Nicotine
replacement
|
1 spray
in each nostril; 1-2 doses per hour and increase as needed for symptom relief
|
Nasal
irritation, change of taste and peppery sensation in the nose
|
|
Bupropion
(sustained release)
|
Blocks
neural re-uptake of dopamine and/or norepinephrine
|
150 mg
QAM for 3 days, then 150mg BID; start 1-2 weeks before quit date
|
Insomnia,
dry mouth, loss of appetite
|
|
Varenicline
|
Blocks
nicotine binding to alpha-4-beta-2 nicotinic acetylcholine receptors
|
Days
1-3: 0.5 mg daily
Day
4-7: 0.5mg BID
Days 8
– end of treatment: 1 mg BID
|
Nausea,
sleep disturbances, vivid/strange dreams, headaches, impaired ability to
drive/operate machinery, depressed moods or change sin behavior
|
Smoking Attempts
6 out of
10 former smokers were not able to successfully quit on the first try, but were
able to quit smoking for good after multiple attempts. A quit attempt is
defined as not smoking for at least one day with the intent of not starting
again. Multiple quit attempts are normal and necessary steps along the way to
quitting for good.6
Truth about electronic cigarettes7
Electronic
cigarettes or “e-cigs”, pitched as the alternative to smoking tobacco, were
introduced into the U.S. market in 2007. E-cigarettes do not contain any
tobacco, but utilizes liquid nicotine, which is heated into vapor form that
resembles cigarette smoke and allows smokers to inhale and exhale. The nicotine
content contained in these products is variable. A few small studies have
demonstrated that e-cigarettes may be an effective alternative method in the
setting of smoking cessation; however, more data is needed to determine the
long-term safety of these products.
One Final Word
St.
Augustine once said “Habit, if not resisted, soon becomes necessity.”
Fortunately, the human nature has an incredible ability to initiate and adapt
to changes. Success is not defined by the number of attempts that are taken to
quit, but rather by achieving the ultimate endpoint – giving up smoking for
good. Numerous resources exist to help make smoking cessation a reality.
Written
by:
Shubha
Bhat
PGY2
Ambulatory Care Resident
UIC
College of Pharmacy
1.
American
Cancer Society. Questions about smoking, tobacco, and health. 13 Aug 2013.
Available: www.cancer.org. Accessed 25 Sept 2013.
2. U.S. Department of Health and
Human Services. Preventing tobacco use among youth and young adults: a report
of the Surgeon General. 2012. Available: http://www.surgeongeneral.gov.
Accessed 25 Sept 2013.
3.
Center
for Disease Control and Prevention. Health effects of cigarette smoking. 1 Aug
2013. Available: www.cdc.gov. Accessed 25 Sept 2013.
4.
American
Cancer Society. Guide to quitting smoking. 9 Sept 2013. Available:
www.cancer.org. Accessed 25 Sept 2013.
5.
Wan-Chih
T. Smoking cessation drug therapy: an update. Pharmacist’s Letter. 2011;27: 270111.
6.
American
Lung Association. Most smokers make multiple quit attempts before they quit
smoking for good. 30 Sept 2009. Available at: www.lung.org. Accessed 25 Sept
2013.
7.
Hajek,
P. Electronic cigarettes for smoking cessation. Lancet. 2013;13:1-2.
