Friday, September 23, 2011

Smoking Cessation

Tobacco use is considered the most common cause of preventable death and about half of habitual smokers will likely die of smoking-related illnesses. Quitting smoking (or at least significantly reducing smoking) will provide many health benefits. After you stop smoking, blood pressure and circulation improve, breathing becomes easier, your sense of smell and taste return and other issues such as anxiety will often improve. There is no doubt that giving up tobacco will help you live longer and the risk of cancer decreases yearly.

Quitting smoking may be the most difficult thing that you have ever done. You probably will experience intense short-term effects such as irritability, insomnia, anxiety or weight gain. Most people will try to quit a number of times before succeeding. There are a number of helpful ways to quit smoking including prescription medications and products that reduce nicotine addiction. Most experts suggest not quitting "cold turkey" due to the severely addictive nature of nicotine. You should remove all ashtrays and try to remove all traces of cigarette residue from the home. A majority of former smokers say a support network of family and friends was vital during their trials with smoking cessation. You should be open about your plans to quit and try to spend time with ex-smokers for guidance. You must try to avoid social situations with current smokers especially if they include alcohol.

Stop smoking programs, especially group ones, are designed to help smokers recognize and cope with significant difficulties that arise when attempting to quit. These programs  provide support, guidance and encouragement during the process. The best programs should include one-on-one and group counseling. There is a strong correlation between how often and how long counseling lasts and the success rate. Overall, the more intense the program, the greater the chance of success.

Nicotine Replacement: 
Nicotine patches: give a continual dose of nicotine through the skin. Several different strengths are available and the 16-hour patch works well if you are an average smoker. You slowly wean off of nicotine by switching to lower-dose patches over a course of weeks. Sixteen hour patches have less side effects like a racing heartbeat, sleep problems or headache, but may not be right for those with early morning withdrawal symptoms. The 24-hr patch provides a steady dose of nicotine through the night, therefore it helps with early morning withdrawal. The rule of thumb is that regular smokers will probably be better suited for a 24-hr patch. The recommended initial dosage for people who smoke more than 10 cigarettes per day is one 21-mg patch per day for four to six weeks. After which, you should step down to one 14-mg patch per day for two weeks. Finally, you should use one 7-mg patch (preferably a 16-hr patch) per day for the final two weeks of treatment. The patch should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist, such as on the upper arm or chest.

Most common side effects of the nicotine patch include:
 Skin irritation
 Racing heartbeat
 Sleep problems

Nicotine gum: is a fast-acting form of nicotine replacement. If you have sensitive skin, you may prefer the gum to the patch. You can buy it without a prescription and it comes in 2 mg and 4 mg strengths. If you smoke more than a pack a day or upon waking, you may need to start with the higher gum dose (4 mg.) For best results chew the gum slowly until you note a tingle or hot taste. Then "park" it next to your cheek until the taste fades. Repeat the process for 20 or 30 minutes. Do not eat or drink for at least 15 minutes before and during gum use. Chew no more than 20 pieces of gum in one day. Nicotine gum is usually recommended for 6 to 12 weeks. You should taper down the amount of gum you use within six weeks. The gum can be used as needed or on a fixed schedule and most research has shown that scheduled dosing works better. A schedule of 1 to 2 pieces per hour is most common.

Side effects of nicotine gum:
 Bad taste
 Throat irritation
 Mouth sores
 Jaw discomfort
 Racing heartbeat

Nicotine nasal spray: relieves withdrawal symptoms very quickly and smokers usually like the nasal spray because it is rapid and easy to use. Since nicotine is so addictive, a person can also become dependent on the nasal spray. The FDA recommends that the spray be prescribed for 3-months and that it not be used for longer than 6 months to help reduce this risk.

Common side effects can include :
 Nasal irritation
 Runny nose
 Watery eyes
 Throat irritation

Nicotine inhalers: are available only by prescription. When you use the inhaler, a nicotine vapor which is absorbed in the mouth, not the lungs. Each puff contains about 10 times less nicotine than a puff of a cigarette. The absorption of nicotine is slower than from a regular cigarette, with peak nicotine doses occurring about 10 minutes after the end of puffing. The best results have been achieved by frequent puffing for 20 or more minutes. The recommended dose is between 5 and 15 cartridges a day, for up to 6 months.

Common side effects include:
 Throat irritation

Nicotine lozenges: are non-prescription and are available in 2 mg and 4 mg strengths. You should stop smoking when you start using the lozenge. Smokers may also consider the lower dose if they smoke less than ten cigarettes daily. The recommended dose is 1 lozenge every 1 or 2 hours for 4-6 weeks, then 1 lozenge every 2 to 4 hours for weeks two weeks and finally, 1 lozenge every 4 to 6 hours for the final two weeks. Do not eat or drink for 15 minutes before using the lozenge. Suck on the lozenge until it is fully dissolved, about 20 minutes. Do not bite, chew or swallow it.  Do not use more than one lozenge per hour, or more than 20 per day. Discontinue the lozenges after 12 weeks if not sooner. Do not use the lozenge if you continue to smoke or use any other product containing nicotine.

 Possible side effects  include:
  Trouble sleeping

Medications for smoking cessation:
Welbutrin (bupropion): the mechanism of action for this agent, originally marketed as an antidepressant, is thought to be due to its ability to increase the neurotransmitters dopamine and norepinephrine, reducing cravings and symptoms of withdrawal. Patients should initiate bupropion therapy 1 to 2 weeks before their quit date, starting with 150 mg once a day for a few days, then increasing to 150 mg twice a day. Cessation rates in patients who use bupropion are generally 2 times higher than those who do not.
Clonidine: is an antihypertensive agent that also doubles smoking cessation rates. Initial recommended doses include 0.1 mg orally twice a day or the 0.1-mg/day patch applied weekly. The dose may be increased to .3mg twice daily (orally) and to 0.2 mg patch (transdermally) for up to 12 weeks.
Nortriptyline (Elavil): a tricyclic will also greatly increase the success rates of quitting smoking. The recommended initial dose is 25 mg at bedtime, gradually increasing to a target dose of 75 or 100 mg daily for 12 weeks.
Chantix (Varenicline): is in a class of medications called smoking cessation aids. It works by blocking the pleasant effects of nicotine on the brain. Your doctor will probably start you on a low dose of varenicline and gradually increase your dose over the first week of treatment. Chantix is usually taken once or twice a day with a full glass of water after eating. You will probably take varenicline for around 12 weeks. Some people have had changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts while taking varenicline.

Natural herbal therapies:
Bupleurum D: is based on the formula bupleurum and dragon bone; it decreases irritability, reduces cravings, and stabilizes the emotions.  
Crave Arrest:i s a proprietary blend which has been shown to help up to with the cravings.
5HTP(5-hydyoxytryptophan): keeps serotonin levels balanced which helps with mood, cravings, and 
general well being.  
Calm Spirit: helps with excessive anxiety, stress, and emotional disturbance.

Other options:
Acupuncture: works by balancing the flow of Qi (chi) in the body and mind.Qi is frequently translated as life force or "energy flow." In acupuncture theory, addictions are due to a number of potential imbalances in the way that energy flows through the body, which is often believed due to a history of abuse or a betrayal.
Hypnosis: is now used in hospitals and medical centers. The hypnotherapist can decrease cravings and help address fears one might have about quitting, like gaining weight by giving you helpful subconscious suggestions.
Yoga: helps calm the mind and strengthen the determination. It also helps bring heightened awareness to breathing and the body, which helps with a healthier attitude toward the lungs.

Other tricks:
For those who desire to simply decrease their level smoking, try these tips:
 Buy no more than two packs of cigarettes at a time.
 Do not smoke in the house or car.
 Try different brands of cigarettes each time you buy them.
 Wait an extra 10-15 minutes when you disire a cigarette.
 Chew gum.
 Avoid smokers.