Smoking Cessation: Stompin’ Out the Habit

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.