Smoking Cessation

February 2, 2017

Cigarette smoking is a major public health problem globally. According to the WHO, smoking is the second most important cause of death worldwide and is currently responsible for 5 million death each year. More people in the United States are addicted to nicotine than to any other drug.3 Research suggests that nicotine may be as addictive as heroin, cocaine, or alcohol. Cigarette is packed with harmful and additive substances. Smoking is responsible for 90% of lung cancer, 75% COPD, 25% CHD, and peripheral vascular diseases and many other fatal and nonfatal diseases.

Cigarette addiction is growing despite measures to curb it. The benefits of smoking cessation are invaluable, whatever the time. 40% of smokers try to quit each year. The success rate of those who quit on their own is about 5%. Most smokers make 5-10 attempts to quit. Unsuccessful attempts to quit are a sign of nicotine dependence.People who stop smoking often start again because of withdrawal symptoms, stress, and weight gain.

Benefits of Smoking Cessation

Overcoming the addiction to smoking will bring a multitude of benefits. Studies suggest that smoking cessation, not only will lower the risk of getting various cancers, including lung cancer, it also reducesthe chances of suffering from heart disease, stroke, emphysema, and other serious diseases. Also, quitting will help prevent heart disease and lung cancer in people who otherwise would be exposed to the second-hand smoke.

Although there are benefits to quitting at any age, it is important to quit as early in life as possible to avoid getting one of the serious illnesses caused by smoking.

Lowered risk for lung cancer and many other types of cancer.
Reduced risk for heart disease, stroke, and peripheral vascular disease (narrowing of the blood vessels outside your heart).
Reduced heart disease risk within 1 to 2 years of quitting.
Reduced respiratory symptoms, such as coughing, wheezing, and shortness of breath. While these symptoms may not disappear, they do not continue to progress at the same rate among people who quit compared with those who continue to smoke.
Reduced risk of developing some lung diseases (such as chronic obstructive pulmonary disease, also known as COPD, one of the leading causes of death in the United States).
Reduced risk for infertility in women of childbearing age. Women who stop smoking during pregnancy also reduce their risk of having a low birth weight baby.

Cigarette Smoke – What does it consists?

Cigarette is made up of 600 ingredients. When burned, they create more than 7,000 chemicals. At least 69 of these chemicals are known to cause cancer, and many are poisonous. Following are few of the chemicals that are found in tobacco smoke –

Acetone – found in nail polish remover
Acetic Acid – an ingredient in hair dye
Ammonia – a common household cleaner
Arsenic – used in rat poison
Benzene – found in rubber cement
Butane – used in lighter fluid
Cadmium – active component in battery acid
Carbon Monoxide – released in car exhaust fumes
Formaldehyde – embalming fluid
Hexamine – found in barbecue lighter fluid
Lead – used in batteries
Naphthalene – an ingredient in mothballs
Methanol – a main component in rocket fuel
Nicotine – used as insecticide
Tar – material for paving roads
Toluene – used to manufacture paint

Smoking and the use of other tobacco products, including cigars and smokeless tobacco, causes or worsens numerous diseases and conditions. Some products also expose nearby people to toxic secondhand smoke.

Smoking is the leading cause of preventable death in the U.S., causing over 438,000 deaths per year.
Secondhand smoke is a serious health hazard for people of all ages, causing more than 41,000 deaths each year.
Marijuana smoke contains many of the same toxins, irritants and carcinogens as tobacco smoke.
Electronic cigarettes are a new tobacco product, and the potential health consequences and safety of these products are unknown.
Smokeless Tobacco products are a known cause of cancer, and are not a safe alternative to cigarettes.
Cigars have many of the same health risks as cigarettes, including causing certain cancers.

Nicotine addiction

The major obstacle to quitting is the addictive nature of nicotine. Addiction begins when nicotine acts on nicotinic acetylcholine receptor leading to down-regulation of CNS Ach receptor, needing nicotine reinforcement to maintain elevated mood and thus causing dependence. Nicotine activates the brain reward center (in nucleus accumbens) by increasing dopamine release. When smokers try to quit, lack of nicotine leads to withdrawal symptoms – both physical as well as mental. Physically, the body reacts to absence of nicotine. Mentally, smokers are, faced with giving up a habit, which calls for a major change in behavior. Both must be addressed in order to make the quitting process work. The most comprehensive guidelines prepared on smoking cessation advocate by treating withdrawal symptoms like weight gain, depression.

Signs of nicotine dependence

Tolerance – Increasing the number of cigarettes smoked per day (Most smokers escalate to a pack)
Withdrawal – Mood changes, irritation, anxiety, insomnia, restlessness when unable to smoke
Loss of control – Most smokers do not intend to continue, but 5 years later 70% do
Increased time spent using the drug – Leaving office/ work-site to smoke
Continued use despite harm – cough, hypertension, heart disease
Giving up important activities – air travel

Effects of Smoking

Half of all smokers who keep smoking will end up dying from a smoking-related illness. In the United States alone, smoking is responsible for nearly 1 in 5 deaths, and more than 16 million people suffer from smoking-related diseases.

Cancer – Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also linked to a higher risk for many other kinds of cancer too, including cancer of the mouth, nose, sinuses, lip, voice box (larynx), throat (pharynx), esophagus, bladder, liver, kidney, pancreas, ovary, cervix, stomach, colon, rectum, and acute myeloid leukemia.

Heart attacks, strokes, and blood vessel diseases – Smokers are twice as likely to die from heart attacks as non-smokers. Smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles. Smoking also affects the walls of the vessels that carry blood to the brain (carotid arteries), which can cause strokes.And men who smoke are more likely to develop erectile dysfunction (impotence) because of blood vessel disease.

Lung diseases – Smoking greatly increases your risk of getting long-term lung diseases like emphysema and chronic bronchitis. These diseases make it harder to breathe, and are grouped together under the name chronic obstructive pulmonary disease (COPD). COPD causes chronic illness and disability, and gets worse over time – sometimes becoming fatal. Emphysema and chronic bronchitis can be found in people as young as 40, but are usually found later in life, when the symptoms become much worse.

Blindness and More – Smoking increases the risk of macular degeneration, one of the most common causes of blindness in older people. It promotes cataracts, which cloud the lens of the eye. It also causes premature wrinkling of the skin, bad breath, gum disease, tooth loss, bad-smelling clothes and hair, and yellow teeth and fingernails.

Special risks to women and babies – Women have some unique risks linked to smoking. Women over 35 who smoke and use birth control pills have a higher risk of heart attack, stroke, and blood clots in the legs. A woman who smokes is more likely to have an ectopic pregnancy (tubal pregnancy), which can’t be saved and can threaten the mother’s life. Smokers are also more likely to miscarry (lose the baby) or have a lower birth-weight baby. Low birth-weight babies are more likely to die or have learning and physical problems.

Types of Quit Smoking Therapies

Nicotine Replacement therapy – At present, NRT is the most common form of medication used for treatment of tobacco dependence which is approved by the US FDA.

Transdermal nicotine patches – Patches give a measured dose of nicotine through the skin.
Nicotine chewing gum– Nicotine gum is a fast-acting form of replacement in which nicotine is taken in through the mucous membrane of the mouth.
Nicotine polacrilex lozenge– Nicotine-containing lozenges can be bought without a prescription.
Nicotine nasal spray – The nasal spray delivers nicotine to the bloodstream quickly because it’s absorbed through the nose. Nicotine nasal spray requires a doctor’s prescription.
Nicotine oral inhale – Inhalers are available only by prescription. The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside.

Side effects of NRT include – Trouble sleeping, Nausea, Hiccups, Coughing, Heartburn, Headache, Gas, Coughing, Mouth and/or throat irritation, Upset stomach etc.

Medications

Drugs are also available to help smokers quit. Some can be used along with nicotine replacement therapy (NRT). Medications include –

Bupropion – Drugs is a prescription anti-depressant in an extended-release form that reduces symptoms of nicotine withdrawal. It does not contain nicotine.
Varenicline– This is a prescription medicine developed to help people stop smoking. It works by interfering with nicotine receptors in the brain.
Nortriptyline – This is an older anti-depressant drug. When used in groups of smokers, it has been found to double the chances of success in quitting smoking when compared to those taking no medicine.
Clonidine is another older drug. It’s FDA approved to treat high blood pressure. When used for smoking cessation, it can be given as a pill twice a day or as a once-a-week skin patch.

Alternative Therapies

Hypnosis – A popular option that has produced good results. Forget anything you may have seen from stage hypnotists, hypnosis works by getting you into a deeply relaxed state where you are open to suggestions that strengthen your resolve to quit smoking and increase your negative feelings toward cigarettes.

Acupuncture – One of the oldest known medical techniques, acupuncture is believed to work by triggering the release of endorphins (natural pain relievers) that allow the body to relax. As a smoking cessation aid, acupuncture can be helpful in managing smoking withdrawal symptoms.

Behavioral Therapy – Nicotine addiction is related to the habitual behaviors (the “rituals”) involved in smoking. Behavior therapy focuses on learning new coping skills and breaking those habits.

Motivational Therapies – Self-help books and websites can provide a number of ways to motivate yourself to quit smoking. One well known example is calculating the monetary savings. Some people have been able to find the motivation to quit just by calculating how much money they will save. It may be enough to pay for a summer vacation.

Magnet therapy to quit smoking involves 2 small magnets that are placed at a certain location, opposite each other on either side of the ear. Magnetism holds them in place. There’s no scientific evidence to date to suggest that magnet therapy is an effective method of helping smokers stop.

Filters that reduce tar and nicotine in cigarettes do not work. In fact, studies have shown that smokers who use filters tend to smoke more.

Smoking deterrents – Other methods have been used to help stop smoking, such as over-the-counter products that change the taste of tobacco, stop-smoking diets that curb nicotine cravings, and combinations of vitamins. At this time there’s little scientific evidence that any of these work.

Herbs and supplements – There’s little scientific evidence to support the use of homeopathic aids and herbal supplements as stop-smoking methods. Because they are marketed as dietary supplements (not drugs), they don’t need FDA approval to be sold. This means that the manufacturers don’t have to prove they work, or even that they’re safe.

Be sure to look closely at the label of any product that claims it can help you stop smoking. No dietary supplement has been proven to help people quit smoking. Most of these supplements are combinations of herbs, but not nicotine. They have no proven track record of helping people to stop smoking. These include –

B vitamins help to regulate and calm the nervous system, while reducing stress and fatigue. B vitamins can help alleviate the anxiety and insomnia that often occur with smoking cessation. Your body uses more B vitamins when you are under stress and smoking depletes the body of B vitamins, so it is important to start taking B vitamins at least 2 weeks before you plan to quit.
Vitamin C – Smoking depletes Vitamin C in the body. Smoking one cigarette uses up approximately 25mg of vitamin C. Smoking many cigarettes a day will use up any vitamin C which you get from your meals, causing the body to function in short supply of Vitamin C. Even moderate smokers are short on their vitamin C levels in the body.
Vitamin E is a potent antioxidants that protects tissues and cell membranes. Vitamin E helps to neutralize cancer-promoting free radicals in the lungs as well as other tissues . It also repairs cell damage caused by cigarette smoking.
Chromium is a mineral which is necessary for a healthy blood sugar balance. It can help reduce cravings for unhealthy foods by regulating the drop in blood sugar levels which is common after quitting smoking. Chromium will also help your body deal with stress as it reduces elevated cortisol levels.
Magnesium is an important mineral for proper nerve function. It calms the nerves and helps ease stress related withdrawal symptoms. Magnesium is also important for regular lung function. It acts as a bronchodilator, and allows for easier breathing.
Selenium – The anti-oxidant mineral selenium protects against free radical damage, reducing the risk of cancer, and also enhances the antioxidant properties of Vitamin E.
L-Glutamine is an amino acid which is most often used for muscle recovery and for promoting a healthy immune system, but it has many other benefits and can be a helpful supplement to take when you are in the withdrawal process.
Fish oil is high in Omega 3 essential fatty acids. Omega 3’s are an essential nutrient for nervous system health. Taking Omega 3’s can help to stabilize mood swings which can be commonly experienced when quitting smoking.
Lobelia – Is a very powerful herb that helps to calm the mind and relax the body. It has helped many people to control their cravings for nicotine. Lobelia is also reputed to have the effect of making cigarettes taste very bad.
John’s wort – One of the best known herbs for promoting a positive mental attitude–something people often need help with during the early phases of becoming a non-smoker.
Black cohosh – Is commonly used by women to help them stay balanced during their monthly cycle. However, it is also known to be a safe sedative that relieves nervousness and anxiety, which makes it useful for the irritability, restlessness, and nervousness associated with quitting smoking.
Blue vervain – Has been referred to as a natural tranquilizer and as such it can be used to calm the nerves. It can also be used for insomnia.
Korean ginseng – Is one of the most popular herbs in the world for stimulating energy and helping the body to deal with stress.