Cigarette Smoking Cessation: The Time is NOW

We all know that cigarette smoking is a major public health problem, leading to 400,000 deaths each year.  The habit is associated with lung cancer, COPD, heart attacks and many other conditions.  It is important to note that it is never too late to quit smoking.  Cessation has immediate health benefits at any age, although the earlier the better.  Smokers who quit prior to the age of 50 reduce their risk of dying by 50 percent over the next 15 years.  Specifically, with respect to heart disease, one year after stopping smoking the risk of coronary death is cut in half.  Lung damage caused by smoking is not reversible, but progression can be halted by avoidance of further tobacco products.

Quitting smoking is not easy.  Most patients will develop withdrawal symptoms such as irritability, sleep difficulty, anxiety and cigarette craving. Weight gain and even depression may also be seen. However, the medical benefits of smoking far outweigh the risks of continuing the habit.  The first step in quitting is to set an absolute quit date, although there is no clear evidence about whether a “cold turkey” or a gradual cessation plan is preferable. You should review your prior unsuccessful efforts to quit and evaluate what prevented success in the past. A review of likely “smoking triggers” such as stress, associating with other smokers, or drinking alcohol, should lead to a review of successful coping strategies. Many patients identify a low calorie handfood/snack (carrots, celery) to be used as an aid during the early tobacco free period.

There are non-medication modalities used to quit smoking. Support groups (1-800-QUITNOW), counseling thru your primary care provider, hypnosis and acupuncture have all been touted.  Exercise regimens may also be helpful.

There are several medications available to aid smoking cessation. Nicotine replacement therapy is aimed at decreasing the withdrawal symptoms associated with cessation.  Several different preparations-gum, lozenge, patch, nasal spray, etc.-are available. A patch used as steady maintenance along with an instant release formulation is often an effective combination.  Using nicotine replacement along with smoking is not safe or recommended.

Vanenicline (Chantrix) is a prescription medication that works by decreasing the brain’s reaction to the stopping of nicotine, and should begin one week before cigarette smoking is stopped. If you have a history of heart or vascular conditions, you need to discuss the possible risk of acute heart conditions if you try this therapy.  Bupropion (Zyban and Wellbutrin) is an antidepressant that has been shown to increase the likelihood of success in smoking cessation.

If you are a smoker, you should see your primary care physician to evaluate whether there is any evidence of smoking related medical illness, and to discuss the best cessation plan for you.