Cigarette smoking is the principal cause of identified preventable deaths in the United States. There are approximately 480,000 deaths each year from cigarette smoking. Nearly half of all smokers die from a smoking relating disease and smokers commonly lose 14 years of their life. Smoking cessation benefits, smoking cessation products, smoking cessation medications, smoking cessation methods, smoking cessation tips, smoking cessation options, smoking cessation timelines + more will be discussed on this post.
Statistics of cigarette smoking
Cigarette smoking is the cause of 25% of all deaths in the U.S. with an annual of 300 billion dollars cause by 170 Billion in direct medical care cost and 156 Billion due to lost productivity. 15.1% of people in the US smoke and 9.9% of high school students in the US smoke.
Types of Tobacco
Types of tobacco products include cigarettes, cigars, chews, snuff, orbs
Electronic cigarettes are utilized by many people who want to stop smoking. There is a universal misconception that it is safer or will help one quit smoking but there is not yet adequate data to prove this belief. The benefits of electronic cigarettes is that anecdotal data shows that it improves lung function, data also indicates that it has some effect on smoking cessation and electronic cigarettes may deliver less nicotine than regular cigarettes. The disadvantage of electronic cigarettes is that it still has nicotine in it so, therefore, there are always risks of cardiovascular disease and heart disease. Another con of electronic cigarettes is that it can reinforce your smoking habit, so you’re merely replacing the actual smoking of the cigarette with an electronic alternative, you will use it whenever you can’t smoke a real cigarette. Some electronic cigarettes contain diethylene glycol that is toxic to humans and can lead to cancer. Overall, the jury is still out on electronic cigarettes, it can have more adverse effects than benefits, and it isn’t a feasible form of tobacco cessation.
Health effects of cigarette smoking
The primary effect of cigarette smoking is lung cancer which is the number one type of cancer that leads to death, other types of cancers from cigarette smoking are; oral, esophageal, stomach, bladder, etc. Cigarette smoking can also cause heart disease and COPD. COPD is the 6th most expensive disease in the US, and cigarettes nearly wholly cause it. Furthermore, cigarette smoking worsens asthma, PVD (peripheral vascular disease), lowers taste and smell, tooth loss and gingivitis, impotence or decreased libido, decreased fertility, osteoporosis, impaired wound healing, increased blood sugar and cholesterol. When pregnant mothers smoke, cigarette smoking can cause premature birth, stillbirth, low birth weight, SDS and infections in infant and children.
Cost of cigarettes and Ingredients
Cigarettes cost about $5 per pack which equates $150 per month and about $1800 a year. That is a bill in its own. There are about 7000 + chemicals in lit cigarettes that control the burning, enhances the taste and increases absorption and penetration. Those chemicals are: butane, toluene, CO, Nh3, Pb, methanol, and arsenic
There are several myths about smoking and smoking cessations out there. One of the myths is that tobacco, in general, makes you lose weight or skinnier and therefore quitting it will make you fat. In actuality, what makes you gain weight is the fact that most people undergoing tobacco cessation replaces tobacco with foods since it tastes better and tobacco has an insignificant effect on metabolism. It is advised portions and eats healthy snacks during smoking cessation.
Pharmacological Aid in Smoking cessation
Some medications can aid in smoking cessation, and Nicotine replacement therapy (NRT) is the most commonly used. The NRT, unlike cigarettes, supply low doses of nicotine that will help quitters cut down on nicotine as well as aid the symptoms of nicotine withdrawal.
NRT products and doses
Patches- Come in 2 week supply, last 24 hours and come in 21, 14 and 7 mg doses. You can take off the patch at night to avoid side effects of insomnia or reactions in the area that it was placed in. The patches should be applied daily by replacing the old with the new in hairless part of the body. It is best to rotate the site of the body that the patch is used and fold patch and throw in garbage away from kids and pets. For patients who smoke more than > 10 cigarettes a day the dosings are 21mg x 6 weeks, 14mg x 2 weeks and 7mg x2 weeks. For patients who smoke less than > 10 cigarettes a day, the dosings are; 14mg x 6 weeks and 7 mg x2 weeks. There will be a harder dose for patients who use smokeless tobacco. The patches can be combined with other NRT’s.
Gums/Lozenges- These come in 2mg and 4mg. The side effects of gums/lozenges are a headache, diarrhea, flatulence, heartburn, hiccups, nausea, coughing, sore throat, URTI, jaw fatigue and belching. For gums, the directions are to chew until a tingly/peppery/spicy sensation is felt, place between cheek and gum and do not keep chewing on it like regular gum. If craving for smoking returns chew until another sensation is received and place the gum on the other unused side of the mouth. If a patient smokes 20 or more cigarettes a day, 4 mg every 1hr as needed the dosing, and if the patient smokes less than 20 gums a day 2mg every one hr prn or as needed is the dose. The primary thing to remember about using lozenges is not to chew it; the patient must suck on it until there is a tingly/peppery/spicy sensation, place between cheek and gum and if craving returns keep sucking on the lozenges until sensation returns and place it on the other side of the mouth. If patient smoke the first cigarette within 30 minutes of waking up than 4mg every 1-2 hrs as needed is needed and if patient smoke first cigarette after 30 minutes of waking up, then 2mg q 1-2 hours as needed is appropriate.
NRT also comes in inhalers that are very costly, hard to receive and tends to strengthen the smoking habits. Nasal sprays are expensive as well, hard to get and they have harmful side effects.
NRT Combination Therapy Dosing
Combination therapy is much more effective than monotherapy (which have dosing on boxes). For patients who smoke 1.5 packs or 30 cigarettes a day the dosing is 21 mg patches and 4mg gums or lozenges as needed. For patients who smoke 1 pack or 20 cigarettes a day, 21 mg patches or 2 mg gums or lozenges prn is the dose. For patients who smoke 1/2 pack or 10 cigarettes a day, the dose is 14 mg patches and 2 mg gums or lozenges as needed. For patients who smoke less than 1/2 packs or less than 10 cigarettes a day the dose is 7mg patches or none and 2 mg gums or lozenges per day.
Bupropion (Zyban) aka Wellbutrin IR is an NDRI antidepressant as it affects the neurotransmitter dopamine in addition to norepinephrine. Its exact mechanism of action for tobacco is not yet sure. It has been studied in all diseases of addition and tobacco, food and other drugs. The dosing for Zyban is usually 150mg daily three times a day and then 150 mg bid, it is set to quit just 1 week after initiation which allows for build up and the patient can smoke while using it. It is synergistic with Nicotine Replacement Therapy and has better success when it is combined with it. The side effects of bupropion are insomnia, dry mouth, nausea, weight loss, seizure, and it is contraindicated in epilepsy or other brain injury, asthma, suicidality, anorexia, and bulimia. Buproprion is also used for depression and obesity.
Chantix is typically used by social smokers and patients with proper insurances. Chantix is a nicotine partial receptor agonist. Chantix attaches to nicotine receptors so that nicotine can’t, dopamine is released but not as much as with nicotine and the efficacy of Chantix is believed to be the results of these actions. The dose of Chantix is 0.5 mg daily x 3 days, then 0.5mg bid x 4 days, then 1 mg bid. It is set to quit 1 week after initiation like Zyban, allows for buildup, and one can smoke while taking it. The side effects of Chantix are nausea, vivid dreams, heart disease, and mood changes. Mood changes include agitation, depression, suicidal ideation, and anger. As a result, Chantix should be avoided in patients with a psychiatric history of depression, schizophrenia, anxiety and mood disorders. Chantix is contraindicated with psychiatric prescriptions and heart disease.
Nortriptyline and Clonidine
These are other uses for smoking cessation, but there aren’t a lot of data to support their applications.
Smoking cessation during pregnancy
Patches fall under class D, and gum lozenge, bupropion, varenicline fall under pregnancy category part c. Caution must be employed for smoking cessation during pregnancy, lifestyle change should be ventured first, and pharmacotherapy should be used for as little time as feasible.