Quitting Smoking Is Hard But Worth It

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Lung cancer comes from many different sources that can trigger a mutation. Some sources come from the environment, such as exposure to Radon. Some sources are byproducts of fossil fuels. Some come from smoking cigars, cigarettes, and second-hand smoke. Knowing your surroundings and keeping your distance from potential carcinogens can help reduce the risk of contracting many different forms of cancer.

Tobacco products contain many carcinogens associated with developing lung cancer, yet many people start -- and have a tough time stopping their use. Smoking can quickly become a “friend” you rely on day and night. But as in real life, not all friends are telling you the truth about their actual plans. When nicotine takes hold of all your life’s activities, you can’t do anything without its support. The more you use tobacco products, the more likely you will continue.

Smoke, such as that ingested while smoking, causes your cilia to be paralyzed. Cilia are the tiny hairs that continuously move any debris up and out of the lungs. If you continue to smoke, the cilia will turn into goblet cells. Goblet cells produce mucus to help the lungs stay moist even though they are being dried out by the smoking. The more goblet cells that are created, the more you create a reservoir for bacteria to grow.

Nicotine is a potent psychoactive drug that causes physical dependence and tolerance. Once you stop smoking, the withdrawal effect will peak in the first three days and will not subside until 3-4 weeks later.

One of the main challenges during this time is dealing with all the secretions that now exist. You will begin to start coughing more because of the increases in goblet cells secretions. Plus, soon the cilia that are left will be unparalyzed and start working again, moving the secretions up and out of the lungs. Most people will restart smoking to stop their coughing by re-paralyzing the cilia to stop the secretion from moving. If the secretions stop moving, they will retain bacteria. This is why smokers are more likely to get colds and pneumonia.

Other symptoms of withdrawal can include increased appetite/weight gain. The weight gain is usually 2-4 pounds in the first few weeks, and 4-10 pounds over the next 4-5 months. The average weight gain during a person’s decision to stop smoking is usually 8-12 pounds. Symptoms can include depression, insomnia, anxiety, irritability, frustration, anger, difficulty concentrating and restlessness.

But for your overall health and wellness, it’s important to know that all of the negatives are outweighed by the tremendous benefits of quitting smoking. When someone tries to quit smoking, they have a 3-6 percent chance of staying cigarette-free without any help. With optimal treatment, the rate may increase to greater than 30 percent; meaning that most attempts to quit will still fail. It can sometimes take 3-4 tries before you achieve a successful effort.

Quit rates are highest for those that abruptly stop smoking versus slowly tapering your tobacco use over several weeks.

The first step in the process is setting your quit date. This can often depend on which -- if any -- smoking cessation aids you are using. It should be 1-2 weeks from when the decision is made to stop.

For that needing assistance in the path to a smoke-free life, the first type of medication available to assist you is nicotine replacement therapy. This includes nicotine patches, lozenges, gum, nasal spray and oral inhaler. The patches, lozenges, and gum are all available without a prescription. The most effective regimen is the combination of a long-acting patch with a short-acting agent such as the gum or lozenge. The patch does require several hours to reach peak levels, and therefore the gum or lozenge can help bridge the time to onset of action.

The most common side effect of the nicotine replacement therapies is insomnia or vivid dreams. If this occurs, it is best to remove the patch at night and avoid nicotine use close to bedtime. Be sure to follow the instructions for the use of the gum/lozenge because these medications are not to be used like other gum/lozenge products.

There is an oral tablet called Varenicline or Chantix® available to help with smoking cessation. This medication works by reducing symptoms of nicotine withdrawal AND by lowering the rewarding feeling associated with cigarette smoking. This medication is associated with the highest rate of continuous tobacco abstinence.

Chantix® can take up to one week to reach stable blood levels; therefore you should set your quit date for one week after starting the medication. Be aware, however, that it has been associated with neuropsychiatric and cardiovascular side effects. Patients and families are advised to notify their physician if they notice any unusual mood or behavioral symptoms after starting this medication. There is also a small increased risk of non-fatal heart attacks with its use.

The last medication that can be used to aid someone in stopping the use of tobacco products is bupropion (Zyban®/Wellbutrin SR®). This medication is also an anti-depressant and can help blunt the depression symptoms that some patients experience during nicotine withdrawal. Bupropion should be started one week before your quit date. The recommended treatment length is 12 weeks. Bupropion can also reduce the weight gain associated with withdrawal and would be a good choice for those concerned about that aspect. The most common side effects with bupropion are insomnia, agitation, dry mouth, and headache.

A nicotine vaccine is in the works that would generate antibodies to nicotine so that users would not feel the rewarding effects of using tobacco products. E-cigarettes are also a standard option for those wanting to move away from cigarettes and cigars. Trials are currently underway to assess the use of e-cigarettes in the quest to stop smoking.

Other options include finding new “friends” such as carrots and cabbage that can help reduce the cravings. Some have had success grabbing a cinnamon stick instead of a cigarette when the craving hits. These friends are telling you the truth – and they will help your body’s immune system instead of damaging it. These friends will keep you from gaining unnecessary weight. Know that you are not alone in this fight. It is entirely worth the struggle.

About the Author

Author: Mark Hadley, Director of Cardiopulmonary Services

Mark Hadley began working in Respiratory Therapy in 1992 at City Hospital in Martinsburg, West Virginia. After moving to California in 1994, Hadley worked at Northridge Hospital and the Sherman Oaks Burn Center. In 2000, he was employed at John’s Hopkins in the Neonatal Intensive Care Unit and was attending college to earn a bachelor’s degree. In 2001, he returned to California and was hired at Lompoc Valley Medical Center as a respiratory therapist. In 2003, he became the Director of Respiratory Therapy, which in 2010 became the Cardiopulmonary Services Department.

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