Smoking Cessation 

Smoking is implicated as a risk factor for many health problems, including:

• Premature death: Most premature deaths caused by smoking are due to lung cancer, chronic obstructive pulmonary disease and coronary heart disease.
• Cancers of the upper respiratory tract, oesophagus, bladder, kidney, stomach, and pancreas; myeloid leukaemia.
• Pneumonia.
• Cerebrovascular disease, aortic aneurysm, and heart failure caused by coronary heart disease.
• Peptic ulceration (gastric and duodenal).
• Angina, peripheral arterial disease (including Buerger's disease), macular degeneration, impotence, infertility, skin wrinkling, osteoporosis.
• Increased severity of asthma, respiratory tract infections and diabetic retinopathy.
• Passive smoking: exposure to environmental tobacco smoke causes an increased risk of smoking-related diseases, especially lung cancer and heart disease.
• Children exposed to environmental tobacco smoke are at increased risk of sudden infant death syndrome, asthma, otitis media and chest infections in the first years of life.
• Fetal exposure to maternal smoking increases the risk of miscarriage, premature birth, low birth weight and stillbirth. Smoking in pregnancy may also affect the child's physical growth and academic attainment may be reduced.

Smoking cessation interventions are a cost-effective way of reducing ill health.

Quitting at any age provides both immediate and long-term health benefits.

Smoking cessation should be seen as a treatment and in a current smoker it is one of the most cost-effective options in chronic disease management. This is especially important in COPD as it is the only intervention that will slow disease progression.

The body starts to recover in as little as 20 minutes when a person quits smoking.

• after 20 minutes blood pressure and pulse start returning to normal
• after 24 hours carbon monoxide is eliminated from the body and the lungs start to clear out smoking debris
• after 48 hours ability to taste and smell improves
• after 3–9 months lung function improves up to 10%
• after 5 years the risk of heart attack falls to about half that of a smoker
• after 10 years the risk of lung cancer is halved and the risk of heart ischaemia falls to that of someone who has never smoked. 

Smoking is a relapsing addiction and many people have 6–7 attempts before quitting long term. Receiving behavioural support will quadruple the chance of success especially in combination with nicotine replacement therapy and/or medication.

Behavioral Changes

Daily changes can be made to help quit smoking on your own; some people also choose to participate in individual or group support sessions.

Problem solving/skills training — When preparing to quit, it is important to identify situations or activities that increase your risk of smoking or relapse. After identifying these situations, you may need to develop new coping skills. This may include one or more of the following:

• Make lifestyle changes to reduce stress and improve quality of life, such as starting an exercise program or learning relaxation techniques. Vigorous exercise can enhance the ability to stop smoking and avoid relapse and also helps to minimize or avoid weight gain.
• Minimize time with smokers and in places where smoking is allowed. People who live with smokers can consider negotiating with them to stop smoking at home or in the car.
• Recognize that cravings frequently lead to relapse. Cravings can be prevented to some degree by avoiding situations associated with smoking, by minimizing stress, and by avoiding alcohol. Cravings will subside. Keep oral substitutes (such as sugarless gum, carrots, sunflower seeds, etc) handy for when cravings develop.
• Try to avoid thoughts like "having one cigarette will not hurt"; one cigarette typically leads to many more.
• Have as much information as possible about what to expect during a quit attempt and how to cope during this time. These can easily be found online, by calling a smokers' quitline, or by talking with a health care provider or counselor. Support groups can be helpful. Some medical centers have patient resources or learning centers with self-help materials. 

Support — Having consistent support is extremely helpful in quitting smoking and staying off cigarettes. Support can come from family and friends, a health care provider, a counselor, a telephone hotline, online resources, and/or support groups. In addition to getting ongoing encouragement, it is important to have someone you can talk to about any problems you have while trying to quit, such as weight gain, lack of support from family and friends, or prolonged withdrawal symptoms.

In-person support — Some people find it helpful to talk with a "coach" who can help support you throughout the process. This often involves regular visits beginning before your quit date and continuing for several months afterwards.Group counseling sessions are another option; many different organizations offer group programs. These typically include lectures, group meetings for mutual support, discussion of coping skills, and suggestions for preventing relapse.

Hypnosis and acupuncture — Hypnosis and acupuncture are popular stop-smoking methods. Although there is not convincing scientific evidence that these are effective, some people who have not had success with other techniques find these treatments to be helpful.

Nicotine Replacement Products

These slowly break addiction with controlled doses of nicotine and allow for management of cravings and provide some relief from withdrawal symptoms.

The doses reduce over a period of time so that less and less nicotine is administered before stopping altogether. There is up to a 70% greater chance of success especially in combination with behavioral changes.

Patch — Placed right on your skin, patches release a small amount of nicotine into your body. They’re available over the counter (OTC), which means that you don’t need a prescription.  Place a new patch on a different spot on your body every day. You can reuse a spot after a week has passed. It may be more effective to start using the patch a few days before your quit date and to use it along with another nicotine product.

Gum — You chew this OTC product just like regular gum. Your dose depends on how much you smoke. When you feel a tingle in your mouth, stop and put it in your cheek. When the tingling is gone, start chewing again. Do this over and over again until the tingle is gone – usually after about 30 minutes. For the first 6 weeks, you’ll chew one piece every 1 or 2 hours. Treatment should last around 12 weeks. If you feel the need to continue, talk to your doctor.

Lozenge — These OTC capsules are taken after meals and dissolve in your mouth. The dose depends on how much you smoke. Treatment should take 12 weeks.

Spray — This delivers nicotine through your nose or mouth. Some you can buy over the counter, and for others, you’ll need to visit your doctor to get a prescription. Like other nicotine products, you should use it for 12 weeks.

Inhaler — This cartridge is placed into your mouth and releases a puff of nicotine. It’s by prescription only, and you’ll use it for about 12 weeks.

Prescription Medications

These medications are only available via prescription. 

Varenicline (Chantix) works with the part of the brain that reacts to nicotine so that smoking is less enjoyed.  It also eases withdrawal symptoms. Varenicline is safe to use with nicotine products, and one study shows that a combination of the two may improve your chances of quitting for good. Side effects may include nausea, trouble sleeping, headaches and vomiting.

Bupropion is an antidepressant that lowers the desire to smoke. Common side effects are insomnia, nightmares and a dry mouth.  

For more information please contact our specialist for a consultation!