Quit Smoking Now or Suffer the Consequences

An estimated 40 million adults currently smoke cigarettes in the United States.

An estimated 40 million adults currently smoke cigarettes in the United States, according to the CDC. Cigarette smoking is the top cause of preventable disease and death, accounting for more than 480,000 US deaths per year, or 1 in every 5 deaths.

The starting age for smoking is getting lower and lower, with more than 3200 individuals younger than 18 years having their first cigarette. Of those kids, 2100 of them become daily smokers.

This article discusses the effects smoking has on the body and medications, and it outlines both nonpharmacological and OTC pharmacological smoking cessation options.

Cigarettes

Cigarette prices are increasing with demand as more and more individuals in the United States continue to smoke, causing harm to not only themselves, but also those around them. Cigarette smoke contains about 4800 compounds, including the addictive substance nicotine. Nicotine induces psychoactive effects by stimulating dopamine in the midbrain immediately after inhalation, which causes a rewarding sensation that leaves individuals wanting more. After a few uses, tobacco dependence develops, leading the individual to use even more.

How Smoking Affects the Body

Your patients might not realize smoking contributes to many health conditions. It doesn’t merely damage the lungs; it also can wreak havoc on multiple body parts and systems.

For instance, cigarette smokers have a higher risk of developing cardiovascular disease. When someone smokes a cigarette, blood pressure rises immediately. High blood pressure stretches out the arteries, which in turn leads to scarring. Bad cholesterol then gets stuck in the scar tissue in combination with white blood cells, leading to the formation of clots.

According to the American Heart Association, smoking also contributes to the buildup of fatty substances in the arteries and increases stroke risk. Smoking increases the strain on both the arteries and veins, which further raises the risk of an aortic aneurism. Smokers will likely see a decline in their good cholesterol, find exercising extremely difficult, suffer from slow and poor wound healing, and possibly even die 10 years sooner than they might if they were nonsmokers.

Smoking not only damages the heart, but is also the leading cause of cancer and related death. Long-term cigarette smoking can cause cancers of the lung, bladder, esophagus, mouth, larynx, kidney, throat, liver, stomach, pancreas, cervix, rectum, and colon, as well as acute myeloid leukemia, which is a cancer in the bone marrow. Another little-known fact is that smoking cigarettes makes it harder for women to get pregnant. Moreover, if a woman gets pregnant and continues to smoke, she’s at greater risk of a having a miscarriage, ectopic pregnancy, baby with a low birth weight or cleft lip/palate, or early delivery. Men’s reproductive health is also affected by smoking, which plays a part in sexual dysfunction, leading to increased risk of erectile dysfunction.

How Smoking Affects Medications

Some chemicals contained in cigarettes induce liver enzymes. For instance, polycyclic aromatic hydrocarbons are products of incomplete combustion and potent inducers of liver cytochrome P-450 isoenzymes 1A1, 1A2, and to a lesser degree 2E1. Cigarettes contain several other compounds that interact with these enzymes, like nicotine, benzene, and acetone, although their effects are far less significant.

Many medications are substrates for the hepatic enzyme CYP1A2, and their metabolism can be induced by smoking, which will result in a significant decrease in the medication’s effect. Consequently, many smokers require larger doses of medications. Furthermore, individuals often don’t admit to smoking when asked during a physical examination or office visit, which could mean they’re not receiving the adequate dosage of the medications they need.

One example of a common medication affected by smoking is insulin. Smoking decreases subcutaneous absorption and can lead to insulin resistance, requiring the patient to take a higher dosage. Another common prescription medication hampered by cigarette smoking is any oral contraceptive, as heavy smoking (eg, more than 15 cigarettes a day) increases the risk of stroke, myocardial infarction, and thromboembolism. Smoking cigarettes also tends to lower the effects of many opioids, leaving patients prescribed routine doses still in pain. Several of these medications would need their doses reduced if the patient were to quit smoking in order to avoid toxicity, so it’s very important to track your patients’ smoking behaviors.

Why Patients Should Quit Smoking

Despite all these scary consequences, there’s still hope for smokers who wish to quit. According to the US Department of Health and Human Services, 70% of those who smoke have admitted to wanting to quit, although only 44% are actually attempting to do so.

Patients must realize that almost immediately after they quit smoking, their body will start to repair itself, so no one is ever too old to quit. Resolution can start as soon as in 20 minutes—when blood pressure drops back down to normal.

Smoking cessation leads to lowered risk of lung cancer along with various other types of cancers. After 1 to 2 years of quitting, the risk of heart disease, stroke, and peripheral vascular disease is reduced. Patients who experienced respiratory symptoms like wheezing, coughing, and shortness of breath will quickly see a significant improvement. Meanwhile, women of childbearing age will have a reduced risk of infertility and delivering a baby with an abnormally low birth weight.

Nonpharmacological Options

When attempting smoking cessation, it’s important to combine pharmacological treatments with nonpharmacological treatments in order to increase the odds of success. A popular option is behavioral and cognitive interventions, which play a significant role in success rate.

It’s important to try to manage smoking urges, as cravings only last about 5 to 10 minutes. In order to manage cravings, it’s best to avoid places or routines that stimulate the urge to smoke. Stress leads many individuals to smoke, so they should try to avoid stressful situations and control all anxiety. Some individuals find it helpful to participate in positive self-talk or mental rehearsal convincing themselves they’re better off not smoking. Reinforcing this new lifestyle and behavior change isn’t easy, and it may take up to 6 months to see reduced cravings, but there are many benefits in the long run.

There are also helplines available for individuals to call to get the support they need. An effective national hotline is 1-800-QUITNOW. Individuals can call this number when they have an urge or even to get more information concerning smoking cessation and the best ways to quit. Those in the process of quitting should also reach out to family and friends for support, or even attend local support groups being held in the area. It’s also recommended to avoid alcohol for the first few months because there’s a significant association between alcohol use and smoking relapse.

OTC Pharmacological Options

Nicotine replacement therapy (NRT) is a first-line option for smoking cessation and is available in several different forms OTC. NRT has proven effective in reducing both cravings and withdrawal symptoms. It’s important to know that patients shouldn’t smoke cigarettes while on NRT because toxicity may occur.

One popular form of NRT, nicotine gum, has a fixed schedule of 1 piece every 1 to 2 waking hours during weeks 1 to 6, 1 piece every 2 to 4 waking hours during weeks 7 to 9, and 1 piece every 4 to 8 waking hours during weeks 10 to 12. The gum dosage is based on when a a patient would smoke the first cigarette of the day.

Another form of NRT is a nicotine lozenge—a quick-acting option that begins to take effect after 20 to 30 minutes. It’s also taken on a fixed schedule: 1 lozenge every 1 to 2 hours for the first 6 weeks, 1 lozenge every 2 to 4 hours during weeks 7 to 9, and 1 lozenge every 4 to 8 hours during weeks 10 to 12. Likewise, this dose is based on when the individual would smoke the first cigarette of the day.

Another OTC-available NRT, the nicotine patch, is dosed a bit differently: its dosage is based on the number of cigarettes the individual would smoke per day. The patch is different from the other forms in that the release of nicotine peaks after 6 to 9 hours. Patients are instructed to apply 1 patch every morning in a hairless area, rotating sites each day.

Smoking affects not only your body, but also those around you, as they breathe in second-hand smoke from your exhalations, clothes, even the upholstery in your car and home. It’s important for your patients to stop smoking now in order to decrease their chances of developing various, serious diseases and ultimately adding 10 years back on to their lives. Smokers can and do quit smoking every day. In fact, according to the CDC, today there are more former smokers than current smokers. Get your patients the support they need to become former smokers now.