Smoking Cessation (Quitting Smoking)

smoking

Cigarette smoking is one of the leading causes of preventable death. About half of the people who continue to smoke will die of smoking related problems. Smoking cessation is the process of discontinuing tobacco smoking. Quitting is not easy. It has both physical and psychological dependence due to nicotine present in tobacco. Nicotine is addictive. Nicotine withdrawal causes several physical and psychological symptoms that makes the process of quitting prolonged and difficult. Some people try several times before they succeed or eventually fail.   

Tobacco smoke contains a deadly mixture of more than 7000 chemicals and about 70 can cause cancer.     

Major diseases caused by smoking are as follows. Some of the diseases are confined to female smokers only.

  1. Cardiac diseases: High blood pressure, heart attack, heart failure
  2. Neurological diseases: Stroke
  3. Respiratory diseases: Chronic Obstructive Airway Diseases (COPD), Lung diseases
  4. Cancers: Lungs, Oral cavity, Oesophagus (food pipe), Urinary bladder, Pancreas, Colon, Liver and Cervix (in females)
  5. Blood cancers
  6. Sudden infant death syndrome (female smokers)
  7. Infant Respiratory Distress Syndrome (female smokers)
  8. Low birth weight at delivery (female smokers)    

Nicotine Dependence:

Most smokers become addictive to smoking (nicotine). It has been found by several studies that nicotine may be as addictive as heroin, cocaine or alcohol. Quitting smoking may require several attempts. In fact people who stops smoking often start again because of withdrawal symptoms, stress, and weigh gain. Nicotine withdrawal involves physical, mental and emotional symptoms.

The causes of nicotine withdrawal is due to increase the number of nicotine sites in the brain of smokers. During smoking cessation these nicotine sites in the brain continue to expect nicotine. Due to non-availability of nicotine these sites in the brain undergo adaptation process that causes severe craving and other symptoms of withdrawal. The first week, especially days 3 to 5 are worst. The following are nicotine withdrawal symptoms that may occur in smokers:

  • Headache
  • Dizziness
  • Fatigue
  • Insomnia (loss of sleep)
  • Feeling irritable, angry or anxious.
  • Depression
  • Troubled thinking, lack of concentration (mental fog)
  • Carving for tobacco products
  • Feeling hungry
  • Cough for few weeks
  • Constipation

Nicotine is so powerful that even if someone smoke for only a few weeks, he still can go into withdrawal when quits. The symptoms of withdrawal will depend on duration and amount of cigarette smoked. 

Health Benefits of Smoking Cessation:

Health benefits of quitting smoking begin in as early as an hour after the last cigarette and continue to improve. Soon after quitting the blood circulation improves and blood pressure returns to normal. There are immediate and long term benefits of smoking cessation.    

  1. 20 minutes: Decreases in heart rate and blood pressure
  2. 12 hours: Decrease in the level of carbon monoxide. Carbon monoxide that is increased in smokers bind with haemoglobin in blood and impairs oxygenation of tissues and body organs.
  3. 2-12 weeks: Improvement in blood circulation and increase in lung functional capacity
  4. 1-9 months: Decrease in coughing and shortness of breath
  5. 1 year: Risk of cardiac disease (heart attack) is decreased by 50% as compared to smokers.
  6. 5 years: Risk of stroke (clot or bleeding in brain) is reduced to that of non-smoker.
  7. 10 years: Risk of lung cancer falls to about 50% that of a smoker. Also there is a significant  reduction in the risk of other cancers.
  8. 15 years: The risk of heart attack is that of non-smoker.

People who have developed smoking related health problems can still benefit from quitting. Benefits of quitting in comparison with people who continue smoking are:

  • At 30 years: gain about 10 years of life expectancy.
  • At 40 years:  gain 9 years of life expectancy.
  • At 50 years: gain 6 years of life expectancy
  • At 60 years: gain 3 years of life expectancy
  • After the onset of life threatening disease: rapid benefit, quitting smoking after having a heart attack reduce the chances of another attack by 50%.

Quitting smoking decreases the risk of many diseases related to second hand smoke in children like asthma and ear infections.

Besides quitting greatly reduces the risk of impotence, infertility both in males and females, premature birth and miscarriage. Quitting smoking can re-wire the brain and help break the cycle of addiction. The person who stops smoking keep hearing sharp, improve night vision, clean the mouth and work like anti-ageing solution. It will protect the skin from premature ageing and wrinkling. Quitting smoking will also increase blood thinning reducing formation of clots, lower blood cholesterol thus slow up the building process of fatty deposits in the blood vessels. The benefits of smoking cessation also include reduction in belly fat, and lower risk of diabetes. There is significant impact of smoking cessation on sexual functions like lower risk of erectile dysfunction and improved sexual desire.

It has also been found the smoking cessation has favourable effects on wound healing, immune system, muscular strength and stronger bones 

Treatment:

Both pharmacological (drug) and non-pharmacological interventions are used to quit smoking. Numerous nicotine containing products like nicotine gums, nicotine patch etc. are used for cessation of smoking. These products (Nicotine Replacement Therapy) are used for 3-6 months with decrease in dosage and increasing abstinence. They reduce the nicotine withdrawal symptoms and increase the rate of quitting by 50 to 70 percent.

The caution during nicotine replacement therapy is not to overdose or develop nicotine poisoning. Some of the symptoms of nicotine overdose are tremors, agitation, restlessness, headache, increase heart rate, nausea, vomiting, abdominal pain, diarrhoea, and cold sweats. Few serious complications of nicotine overdose could be disturbed vision, rapid breathing, confusion and seizures.

There are few antidepressants also that are used for quitting smoking. These drugs are more effective in patients with symptoms of depression or history of depression.  

Non-pharmacological interventions are mainly directed towards counselling and other measures to help quit smoking. Various smoking cessation programs are organized for 20-30 min each for 4-7 sessions. This help reduce or quit smoking in significant number of patients. Counselling by social groups including family and friends may also help in quitting smoking.  

The plan of smoking cessation should be Step-by-Step to facilitate the process. The basic steps of quitting involves the followings:

  1. Make the decision to quit
  2. Identify high risk times as smoking is also triggered by psychological factors like drinking coffee, finishing a meal, stressful situations, drinking alcohol and social events and celebrations.
  3. Stock up on supplies to reduce oral sensation of smoking. This may include gums, raw vegetables, carrot sticks, hard candy etc.
  4. Pick up a Quitting date to prepare mind subconsciously. It should be within few weeks.
  5. Let people know about your decision to quit smoking. Friends and family members can be truly helpful to you in this endeavour.
  6. Remove all smoking reminders like match box, lighter, ashtrays etc.
  7. The first 2 weeks are critical for success. It is advisable to be busy, avoid high risk situations, distraction to avoid cravings, talk to “self” for your will power.
  8. Think of quitting in short terms goals eg days, weeks and months.
  9. Work on stress management   

Prevention:

Majority of smokers initiate this behaviour during adolescence. Therefore, attempt to stop smoking should begin at an early phase, preferably during schooling. Students should be taught about the harmful effects of smoking and its complications. Physicians who are treating adolescents should take a note of this behaviour and initiate counselling with detailing of harmful and addictive nature of nicotine.