HOW CAN A SMOKER QUIT!
WHAT IS THE PROBLEM?
There are 5 million smokers in the United States. Smoking causes 20% of all the deaths in America (400,000). Life expectancy is 14 years less than that of a non smoker. Average life expectancy tops 85 years now and the average smoker will be dead around the age of 71. That gives a smoker 6 years of social security after 65. Almost all the time in those years involve going to doctors, getting medical tests, heart surgery, receiving chemotherapy, and taking expensive drugs. Folks, there is no time to travel after retirement.
WHAT ARE MY RISKS?
A smoker’s risk of stroke is 400% higher than a non smoker. A diabetic smoker (type II) progresses twice as quickly to type I diabetes. The risk of heart disease is 70% higher than a non smoker and there is a 4 times greater risk of sudden death.
Wound infections occur in twice as many smokers and they heal slower both after surgery and after a traumatic event. They need more medications and have more medical procedures done.
SECOND HAND SMOKE, PREGNANCY AND KIDS
40 million kids under the age of 18 are exposed to second hand smoke. Each year over 5000 kids die from second hand smoke exposure. Kids exposed to second hand smoking . account for three times more than all childhood cancers combined. These kids have 1.9 million visits to doctors for asthma, 3.5 million visits for ear inflammation, and 200,000 cases of pneumonia under 5 yrs of age, 10,000 visits for fire related injuries, and 1100 deaths from bronchial infections. Do parents who smoke realize what they are doing to their beloved children?
What about the pregnant mothers to be? They account for 26% of low birth rate in their newborns. Their babies have 90% of all the sudden infant death syndromes. When breast feeding, their infants have disrupted sleeping patterns.
WHAT IS NICOTINE AND HOW DOES IT WORK?
Nicotine is a naturally occurring pesticide present in the tobacco leaf. It is a colorless alkaloid that turns brown when it is burned. It can be absorbed not just through the lungs but also through the skin and the mucosa of the mouth. It is the most common cause of drug addiction in the whole world.
Fatal doses occurred with bolus doses of 60-100 mg of nicotine (1 cigarette has 1 mg of nicotine)
Symptoms of toxicity are nausea, vomiting, pale skin, weakness, headaches, dizziness. rapid heart rate, tremors, confusion increased salivation, and abdominal pain. And no wonder. There are over 5000 chemicals in a cigarette, and 50 of them are known to trigger cancer. Withdrawal symptoms are triggered by stopping cigarettes suddenly.
Symptoms can begin in just hours after stopping. This peak is in 1-4 days and withdrawal symptoms usually disappear in 2-4 weeks. However cravings can last years. The symptoms of withdrawal are craving, a depressed mood, trouble sleeping, irritability, anxiety and restlessness, difficulty concentrating and increased weight caused by an increased appetite.
Nicotine is burned up in the liver, turning to cotinine. Nicotine’s half- life is 2 hours while cotinine takes 20 hours to burn up. Some people have a more rapid metabolism. This leads them to smoke more cigarettes per day and they develop addictions to nicotine sooner.
Nicotine gives pleasure, relieves anxiety, makes one more arouse, and improves job performance. On the down side it makes the heart race, raises the blood pressure, and narrows the blood vessels in the heart and in the skin. It also suppresses the appetite by increasing the metabolic rate and relaxes skeletal muscles.
Addicted smokers keep a minimum concentration of nicotine in the blood to prevent withdrawal symptoms, to keep in a good mood, and maintain pleasure and arousal. They self-titrate their nicotine intake by smoking more intensely, sucking more deeply. and by blocking the vents when on low-nicotine brand cigarettes.
How much nicotine is in the cigarette, the cigar and the dips?
One cigarette has 1-2 mg of nicotine
One cigar has the same as one pack of cigarettes (12-24 mg)
One can of spit tobacco has 60-80 mg of nicotine
Sweet and Milds have 5-6 mg of nicotine.
DRUGS THAT CAN HELP KICK THE HABIT.
There are first line drug medications that can help one quit. Theses include: nicotine gum, patches, sprays, inhalers, lozenges and drugs as Zyban, Wellbutrin, and Chantix.
NICOTINE GUM
This is absorbed in the mucosa of the mouth. It comes in 2-4mg doses. The 2 mg dose is recommended in smokers under 24 cigarettes a day while the 4 mg is recommended for those over 24 cigarettes a day. It is obtained over the counter.
Each piece lasts 20-30 minutes. The gum is chewed between the gum and the cheek until a peppery taste is gone.
The advantages of the gum are that it can be delivered in 5-10 minutes, can be used on a planned schedule and one can add gum as needed with much flexibility.
The disadvantage are that it is not user friendly, makes saliva, causes GI problems, is expensive, causes havoc with dental work, and is very difficult to get off the gum.
NICOTINE PATCH
The patches come in six dosages: 21 mg, 14mg, 7 mg 15 mg 10mg and 5 mg . It is obtained both over the counter and also by prescription. It is placed above the waist over a non-hairy area. The patch begins to work in 2 hours and peaks in 8-10 hours. It lasts 16-24 hours.
The advantage of the patch is that it is user friendly. Just stick it on and go. Once a day dosage works well and different doses can be used.
The disadvantage is that it has a steady state dosing. It takes 2 hours to begin work, there can be skin reactions, and trouble sleeping if worn at night.
NICOTINE SPRAY
With the spray, nicotine is absorbed through the nasal mucosa. One spray is applied to each nostril after exhaling. It should not be inhaled. It should not be used more than 5 times an hour or 40 times in a day. Each bottle has 200 sprays (100 doses). It acts in 5 minutes and is obtained by prescription and is expensive without insurance.
The disadvantages are that the first week is difficult to get use to. There is burning of the eyes and throat. Nasal discharge occurs and it should not be used in sinusitis, allergies and nasal problems. There is also a problem quitting the nasal spray.
NICOTINE INHALER
This is also absorbed in the mucosa. It is delivered with a mouthpiece containing a 10 mg cartridge. The smoker sucks on the mouthpiece like a straw to deliver nicotine. Each cartridge i good for 80 puffs. The minimum is 6 cartridges daily with the maximum 16 cartridges per day. One should not drink or eat within 15 minutes of its use. Does not work too well in the cold below 40 degrees F.
The nice thing about the spray is the flexible dosing, quick delivery in 5-10 minutes, and mimics the hand to mouth behavior. The problems are throat irritation, and it is hard to get adequate dosing. It is expensive and not always covered by insurance.
COMBINATIONS OF GUM, PATCHES AND INHALERS
Some smokers use a combinations of patches, gum and spray. However, this can increase the chance of overdosing. It should not be used in pregnancy, in allergies to plastic tape, and smokers with irregular heart rate or who have angina or have had a recent heart attack.
DRUG THERAPY
WELLBUTRIN AND ZYBAN
Wellbutrin is an antidepressant and Zyban is a smoking cessation aid. Both have similar effects on the brain. It requires a prescription and should be taken for 7-10 days before stopping smoking. It takes 3-6 days to begin working. It is easy to use and can be used with the patches, gum or inhalers. Both drugs are covered by most insurance companies.
Side effects include trouble sleeping, dry mouth, and should not be used in seizure disorders, eating problems, heart trouble, and those smokers taking MA0 drugs.
CHANTIX
This is a non nicotine tobacco cessation aid. It is used by itself and never in combo with any of the above aids. It increases the brain’s response to nicotine and blocks he brain’s natural response to nicotine. One takes the medication 7-10 days before stopping smoking. Doses are 0.5mg daily for three days and then 0.5mg twice a day for four day and then 1mg twice a day.
Side effects include unusual dreams, insomnia, nausea and constipation. It is marketed for cardiac patients, and costs $355 for 3 months.
NON- DRUG THERAPY
Think of trying acupuncture to aid you in quitting the smoking habit. The only disadvantage is that it is not covered by most insurance companies. Regardless of the method you choose to quit, the important thing is to break the habit and add 14 years to your life.
Success is failure minus one. You can do it. There are no options and very little time. GOOD LUCK.
See STOP SMOKING SECTION of this web site for more information.
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