What Is Smoking Cessation?
While most ads for smoking cessation focus on lung cancer, few people realize that they can also risk losing their legs. Smoking is one of the leading risk factors associated with peripheral vascular disease or PVD, which can result in narrowing of your blood vessels. The nicotine in cigarettes raises your blood pressure, speeds up your heart rate and constricts the arteries throughout the body. This constriction narrows the opening of the arteries, making it harder for the heart to pump blood through them. This also causes the body to release its stores of fat and cholesterol into the blood, resulting in more plaque buildup on the walls of your arteries.
Smoking not only accelerates the hardening and narrowing of your arteries with plaque, but also puts you at a much higher risk of developing blood clots because it makes your blood thicker. This puts you at a much higher risk for stroke, heart attack, and limb loss. To protect the health of your vascular system and prevent future damage, it is vital to quit smoking.
Is There a Test or Diagnosis for Smoking?
There is no test for smoking, as the diagnosis is based on whether one smokes or does not. Testing related to smoking is for the effects of smoking and second-hand smoke on the lungs and the cardiovascular system.
- COPD and emphysema: Pulmonary function tests, pulse oximetry, and diagnostic imaging.
- Lipid profiles to identify dyslipidemia for treatment with lifestyle change and statins.
- Atherosclerosis: Non-invasive tests for arterial disease, including segmental limb pressure measurements, exercise testing, and ultrasound imaging; invasive tests such as arteriography.
- Serial sphygmomanometry: For blood pressure trends related to the onset or surveillance of hypertension.
- Coagulation studies to identify hypercoagulable states.
What Is the Best Way for Me to Quit Smoking?
Smoking cessation is definitely not an easy task, because it has both a physical and mental control over a person. There are four main ways to quit smoking: quitting on your own, behavioral support, nicotine replacement therapy, and prescription medications. Discuss with your physician the best method or combination that will work for you.
How Can I Quit on My Own or “Cold Turkey”?
This method works but requires preparation and support from your family and friends. Ways to better prepare yourself includes:
- Pick a quit date and commit to it.
- As you get closer to your quit date, throw out every reminder of tobacco use. Clean your house, car, and office, throwing away all cigarettes, lighters, and ashtrays.
- Make a list of reasons of why you want or need to quit and another list of people you know who have quit. These will remind you of why quitting is so important and that you are just as strong as the others you know who have stopped smoking.
- Plan a way to deal with withdrawal symptoms, which peaks about 1-3 weeks after you quit. Make a list of diversional activities to do with your hands and mouth.
- Avoid areas where you could be exposed to secondhand smoke to decrease temptation. This includes family and friends. Make sure they understand how important it is to you to quit and that you need their support.
- Reward yourself once you have quit for good. Save the money you would have spent on cigarettes every week and spend it on something special for yourself.
How Can I Quit Smoking with Behavioral Support?
When you quit cold turkey, it can be very helpful to have extra support from others. Many employers, insurance plans, hospitals, and clinics offer individual or group counseling sessions to help with quitting. The National Smoking Cessation Hotline at 1-800-QUIT-NOW provides telephone support 24 hours a day for those who are trying to quit.
Smoking Cessation with Nicotine Replacement Therapy
This is a safe method to assist with the withdrawal symptoms when you quit smoking. These therapies give you less nicotine than cigarettes and you aren’t taking in any of the tar and carbon monoxide associated with use of tobacco. Start with the daily nicotine dose that you were averaging every day from smoking cigarettes. There is an average amount of 1-2 mg of nicotine per cigarette. Gradually taper the dose down over the course of a few months, until you can stop using the replacement therapy completely. Remember that you should not be smoking cigarettes during this time. Therapies include the following:
- Nicotine inhalers (such as Nicotrol): Available by prescription, these cartridges deliver a vapor like puff that contains about 4 mg of nicotine. Average dose is 6-12 cartridges daily for 3 months, then gradually reducing the over the next 3 months until addiction resolves.
- Nicotine lozenges (such as Commit): Available over the counter, the average dose is 1 lozenge every 1-2 hours for 6 weeks, with a gradual reduction over another 4-week period until addiction resolves.
- Nicotine gum (such as Nicorette): Available over the counter, the average dose is one piece of gum whenever the urge to smoke arises- up to 30 pieces a day. The goal is to gradually wean use over a 3-month period until addiction resolves.
- Nicotine patches: Available over the counter, one patch is applied daily, with a reduction in patch dose every 1-2 months until the addiction resolves.
- Nicotine nasal spray (such as Nicotrol NS): Available by prescription, one spray in each nostril can be used whenever the urge to smoke arises, up to 10 sprays an hour, or 80 sprays a day for up to 3 months.
- Vapor cigarettes: These are available with and without nicotine; patients should use the nicotine free variety because those containing nicotine aren’t formulated for those who want to quit. Nicotine free vapor cigarettes can be a good diversion for people who need something to do with their hands during withdrawal.
What Medications Can I Use to Aid In Smoking Cessation?
There are two prescription drugs that have been approved for use to help people stop smoking.
- Bupropion (Wellbutrin, Zyban): Initially approved to treat depression, it was then approved to help people quit smoking. The drug should be started two weeks prior to the planned quit date and can be used in conjunction with other nicotine replacement therapy.
- Varenicline (Chantix): This is a new drug that helps reduce nicotine withdrawal symptoms. There are some undesirable side effects that can occur with this medication, such as nausea and nightmares.
Primary Prevention of Smoking Effects
This is the simplest method. This prevention is by never starting to smoke. Of every 3 young smokers, only 1 will eventually quit, and of the remaining two, one will die from the long-term health consequences. 3 out of 5 who take their first puff become lifelong smokers and over 2,000 children become smokers in the USA daily. Since most smokers begin smoking before the age of 18, educating the young is the best primary prevention strategy.
Secondary Prevention of Smoking Effects
Once a person is a smoker, prevention is by stopping the addiction which is fueled by genetics and a craving for the reward neurotransmitter dopamine. The genetics connection doesn’t prevent quitting but must makes it more difficult.
Prevention of smoking’s effects by quitting uses these strategies:
- Quitting abruptly and totally, and when it fails, do it daily.
- Quit with your household. You will likely fail if your spouse, parents, or siblings under your roof also smoke. A smoking cessation pact will improve the chances of success while providing a support group.
- Use medications to address the craving for dopamine, such as Chantix. This makes more sense than nicotine-containing patches or gum, which still give a patient that to which he or she is addicted.
- Refuse to attend or, if attending, leave any social event or gathering at which you feel you may be smoking by the end of it. Alcohol-related celebrations and activities are particularly risky.