Cancer doctor urges smokers to quit for at least a day
By Harsha Poola, MD
James Beck Cancer Center
The third Thursday in November marks the Great American Smokeout, a day when many smokers quit for a day, giving themselves a glimpse of a smoke-free future, and a number of others make the commitment to at least attempt to quit for good.
Statistics show that about five percent of those who try to quit “cold turkey,” without any outside assistance, will be successful. But if you compare quitting a long-term habit to running a marathon, that’s hardly surprising. Runners put in months of planning and training to prepare for the big day. So it is with quitting smoking for many.
Smoking is highly addictive, both to the body and mind. As much as most of those who want to quit dislike the habit, it’s a source of relaxation, comfort and physical pleasure. It’s not easy to leave all that behind.
There are 40 million smokers in the United States, 17 percent of the adult population. That’s down from a high of 42 percent in 1965, before the health hazards of smoking were fully realized.
Lifelong smokers live, on average, 10 years less than nonsmokers. Smokers die earlier because of their increased risk of heart disease, stroke, breathing disorders including COPD and emphysema, lung cancer and a host of other types of cancer that are seen more often in smokers. Recognizing these risks, almost 70 percent of current smokers say they want to quit.
Balanced against the many negative effects of smoking are the positive effects of quitting, some of which begin immediately; others come with time. Twenty minutes after your last cigarette, your blood pressure and heart rate begin to drop. After 12 hours the carbon monoxide level in your blood returns to normal. By three months your circulation improves, and your lung function increases.
Between one and nine months your smoker’s cough will improve and you won’t be as troubled by shortness of breath.
Fifteen years after quitting you will have lowered your risk of heart disease to that of a non-smoker.
Most smokers are addicted to nicotine, a drug found in tobacco, so a plan to quit will have a greater chance of succeeding if you develop a plan that helps you deal with the inevitable nicotine cravings you will experience.
Using either over-the-counter or prescription medications to help with the initial nicotine withdrawal will double your chances of quitting successfully.
The nicotine patch is a small, adhesive patch that delivers a small dose of nicotine to help with withdrawal and nicotine cravings for 24 hours. It can be used with other quit-smoking aids and can be gradually tapered off as withdrawal symptoms decrease.
Nicotine gum delivers a small dose of nicotine and is often used in tandem with the nicotine patch to help with sudden cravings. Available without a prescription, the gum is available in two sizes. Up to 24 pieces can be used a day.
To be effective the gum must be used according to directions. The nicotine is absorbed via the lining of your mouth.
It’s recommended to use the gum for up to 12 weeks with use gradually tapering off as cravings decrease.
Nicotine lozenges, also available over the counter, are available in two small dose sizes and are sucked to allow the lozenge to dissolve slowly. Like the nicotine gum they can be used in addition to another quit-smoking aide to help with sudden cravings.
The lozenges are used as needed throughout the day, with a maximum of 20 per day advised.
A nicotine nasal spray is available with a prescription from your doctor. It is used by spraying into the nostrils repeatedly throughout the day to control cravings and withdrawal. It may cause irritation to the nose, sinuses or throat.
Bupropion (Zyban) is available only by prescription and is a non-nicotine medication. An antidepressant, the extended-release pill has been effective in decreasing both cravings and withdrawal symptoms.
It can take up to a week for the drug to become active so it should be started about a week before trying to quit.
Varenicline (Chantix) requires a prescription and can be used in combination with other smoking cessation products. It works by blocking the pleasure centers in the brain activated by smoking. It too, should be started a week or two before quitting smoking.
Supportive therapy, in addition to medication, can further increase a person’s odds of success. Quit help lines, group therapy and individual counseling that can help you identify your smoking triggers and strategies to overcome them can all be effective.
There’s no one way to quit and, like marathon training, it takes determination, planning and support.
Harsha Poola, MD is a hematology/oncology specialist at the James Beck Cancer Center at Ascension St. Mary’s Hospital in Rhinelander.