Ask the Docs
Smoking Cessation: How to Achieve Your Goal
By Heather Loguidice, ARNP
This time next month we will have already rung in the New Year. For many of us, the New Year is a time for resolutions. I know for myself, I need to eat less junk food and exercise more. For those who smoke, I hope your resolution will be to quit smoking.
The US Surgeon General has said, “Smoking cessation represents the single most important step that smokers can take to enhance the length and quality of their lives.” Smoking harms every organ of the body. In the United States, smoking is responsible for nearly 1 in 5 deaths. Smoking increases the risk for all kinds of cancer, including lung, mouth, nose, throat, bladder, kidney, pancreas, cervix, stomach, and leukemia. It destroys the lungs ability to function which leads to emphysema, chronic bronchitis, and pneumonia. Smoking causes blood vessels in your body to narrow causing an increase risk for stroke, heart attack, poor circulation in the extremities, blindness, and erectile dysfunction. As a matter of fact, smokers are twice as likely to die from a heart attack as non-smokers. According to the Centers for Disease Control, it is estimated that adult male smokers lose an average of 13.2 years of life and female smokers lose 14.5 years of life due to smoking. Smoking-related illnesses also ruin the quality of your life long before you die.
The good news is that no matter how old you are or how long you have smoked, quitting can help you live longer and be healthier. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who keep smoking. Ex-smokers also enjoy a higher quality of life and live longer than those who continue to smoke.
Many smokers try to quit smoking multiple times throughout their lives. Quitting smoking is extremely difficult due to the addictive effect of nicotine. Over time, a person becomes physically and emotionally dependent on nicotine.
For most people, the best way to quit will be using a combination of medicine, behavior modification, and emotional support. When smokers cut back or quit smoking, the lack of nicotine leads to withdrawal symptoms. These can include dizziness, depression, agitation/anxiety, trouble sleeping, headaches, increased appetite/weight gain, cough, chest tightness, and slower heart rate. The majority of smokers attempting to quit will return to smoking within 3 months after their stop date due to unpleasant withdrawal symptoms. Symptoms usually start within several hours after the last cigarette and peak around the third day of not smoking. Nicotine is typically out of the body by day 4. Withdrawal symptoms can last up to several weeks but become more tolerable the longer you remain smoke free.
Nicotine replacement therapy ( NRT) can help relieve some of the withdrawal symptoms. NRT provides nicotine without the other harmful chemicals found in tobacco. It is available in the form of gum, patches, sprays, inhalers, and lozenges. NRT only deals with the physical dependence. It is not meant to be the only thing you use to help you quit smoking. Studies have shown that by combining NRT with behavior modification, such as a stop smoking program, you can double your success of quitting.
Prescription drugs are also available to assist with smoking cessation. Bupropion, also known as Zyban or Wellbutrin, is a prescription anti-depressant that reduces symptoms of nicotine withdrawal. This drug acts on chemicals in the brain that are related to nicotine cravings. Bupropion works best if it is started 1-2 weeks before you quit smoking. The usual dose is one or two 150 mg tablets per day. This drug should not be taken if you have a history of seizures, heavy alcohol use, serious head injury, bipolar, or anorexia/bulimia. Bupropion can be used in combination with NRT if needed.
Varenicline, also known as Chantix, is a prescription medication that works by interfering with the brain’s nicotine receptors. It decreases nicotine’s pleasurable effects and it reduces the symptoms of nicotine withdrawal. Varenicline should be started a week before you stop smoking. Several studies have shown that varenicline can more than double the chances of quitting smoking successfully. Varenicline should not be used in persons with uncontrolled depression, bipolar or heavy alcohol use. Currently, varenicline is not recommended to use in conjunction with NRT.
The decision to quit smoking has to come from you. The first step in the process is wanting to quit. Next, set a quit date and choose a quit plan. Discuss with your healthcare provider the best method for you to deal with nicotine withdrawal. Finally, develop a maintenance plan with support from family, friends, and support groups.
Good luck in your journey to becoming a non-smoker and have a happy, healthy New Year. If you would like further information on smoking cessation, please call us at Family Medical and Wellness Center (561) 721-1953.
Heather Loguidice, ARNP, works closely with doctors Glover and Vizcaino and is certified in Family Practice. Her experience spans 14 years and she has worked in Fast-Track ER’s and a few large Family Practice offices. Her interests include Women’s Health and Pediatrics and she has a wide range of experience in all Family Practice related matters. Heather is a big Gator’s fan; she lives in Boynton Beach and enjoys spending her free time with her daughter.