Smoking Kills-Many Ways of Quitting

Smoking cigarettes has been around for hundreds of years but it has been in decline since the last ten years. Having said that, tobacco smoking is still one of the most preventable cause of disease and death around the world. Smoking is not only harmful to your health but it has a huge impact on the environment which affects animal life as well. Quitting smoking can add a lot of years to your life!

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What's in a Cigarette?

Tobacco cigarettes contain approximately 600 ingredients. The cigarette smoke however contains 7000 identified chemical compounds of which 250 are harmful and 69 are carcinogenic (cancer causing agents). To name a few:

• Acetone—found in nail polish remover

• Acetic acid—an ingredient in hair dye

• Ammonia—a common household cleaner

• Arsenic—used in rat poison

• Benzene—found in rubber cement and gasoline

• Butane—used in lighter fluid

• Cadmium—active component in battery acid

• Carbon monoxide—released in car exhaust fumes

• Formaldehyde—embalming fluid

• Hexamine—found in barbecue lighter fluid

• Lead—used in batteries

• Naphthalene—an ingredient in mothballs

• Methanol—a main component in rocket fuel

• Nicotine—used as an insecticide

• Tar—material for paving roads

• Toluene—used to manufacture paint

Health Effects of Smoking

Cigarette smoking is linked to many diseases and organ damage. It affects nearly every part of your body in one way or another. Smoking reduces blood flow to the brain and so can cause a stroke and brain damage. After you quit the risk of stroke decreases and after 15 years it is reduced to a level similar to that of a non smoker.

Smoking reduces your ability to smell and increases the chances of getting cancer in the nose. Sense of smell can recover quickly and fully given time once smoking is ceased. Smoking is linked to macular degeneration which can lead to blindness and can cause hearing impairment. One of the major causes of mouth and throat cancers is smoking.

There is no doubt that 80% of all lung cancers are due to smoking as toxic

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chemicals from cigarettes deposit in the lungs and this is one of the most common types of cancer. Chronic obstructive pulmonary disease (COPD) is an irreversible disease of the lungs caused by excessive smoking.

You know if someone is a smoker by looking at their fingers which are tar stained with yellowish brown fingernails.

Smoking damages blood vessels thereby reducing peripheral blood flow (cold hands and feet) which makes smokers feel the cold more than non smokers provided there are no other underlying causes. Smoking can increase heart rate and blood pressure and reduce the amount of oxygen in the blood. Therefore smokers have an increased risk (2 to 3 fold more) of sudden cardiac arrest compared to non smokers.

Low oxygen and high carbon monoxide levels decrease muscles strength leading to tiredness. There is an increased risk of falls in both men and women due to low bone density. Smokers with diabetes have a greater risk of heart disease, stroke, kidney damage and nerve damage compared to non smokers. Since smoking reduces blood flow to the skin, it has an adverse effect on collagen and elastin production causing smokers to have more wrinkles.

Smoking increases the risk of cervical and ovarian cancers in women, difficulty falling pregnant, have irregular and painful periods and may cause early onset of menopause. Women who smoke while on the contraceptive pill have a greater risk of cardiac arrest and the risk increases with age.

Due to reduced blood flow to the penis, smoking can cause erectile dysfunction in men.

Smoking affects the digestive system by increasing acidity levels in the stomach thus, causing acid reflux.

Most harmful effects of smoking on the different organ systems can be reversed by quitting early.

Environmental Effects

A significant number of people visit our national parks annually. Smokers have an impact on the environment if cigarette butts are not disposed of properly. Cigarette butts are not only seen in parks but all around the suburban areas as well. It is one of the most littered item polluting the environment every year. The filters in most cigarettes are made of cellulose acetate which is a type of plastic and we all know plastic is not biodegradable. Cigarettes release harmful chemicals such as cadmium, lead, formaldehyde and arsenic in the environment including waterways when disposed improperly. In addition to chemical pollution, cigarette butts carelessly thrown start forest fires which we are all too familiar with, potentially damaging thousands of hectares of national parks etc. We can only imagine the effect this has on wild life. The list goes on....

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Break Down Barriers

Are there barriers which prevent you from quitting? Barriers may include;

• weight gain

• unable to cope with nicotine withdrawal symptoms

• increased stress

• peer and social pressure to smoke

• fear of failing (disappointment)

• fear of being alone

• side effects from medications/interactions

Your body's metabolism changes after you give up smoking and this can make you feel hungrier than usual. Do not eat large meals to compensate. Eat healthy and nutritious meals in smaller quantities more regularly and add a regular 30 minute exercise of your choice everyday. Start this from day one of quitting or it will be too difficult once you have put on the kilos. Keep in mind average weight gain is small compared to the harmful effects of smoking on your health. Avoid replacing the hand to mouth habit with a high calorie craving. Have prepared healthy snacks such as;

• carrot sticks

• celery sticks

• apple slices

• sugar free snacks

Let friends and colleagues know that you are quitting so you can get moral support and avoid peer pressure by making a conscious decision to quit. Avoid situations where you may be faced with social pressure to smoke. Change break times at work so you are with non-smokers. Come to terms with the fact that if you don't quit on the first attempt it is not a failure it is just a small hurdle to reach your goal. The key is to never give up giving up smoking. It is important to get assistance from your health care professional if you are on other medications as quitting may have an impact on their metabolism.

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Nicotine Replacement Therapy (NRT)

NRT is a safe alternative to smoking. It is the most commonly used pharmacotherapy to quit smoking. NRT reduces cravings and withdrawal symptoms associated with quitting smoking. It is available in the form of;

• nicotine patches

• nicotine gum

• nicotine lozenges

• nicotine mouth spay

• nicotine inhaler

• nicotine combination therapy

Nicotine Patch

Nicotine patches are available in a 16 hour patch or a 24hour patch. Patch is applied once a day to control cravings. Nicotine is released slowly throughout the day as it gets absorbed through the skin and enters your bloodstream. There is a three step down approach when using a NRT patch. Dose depends on the number of cigarettes you smoke ie. level of addiction.

16 hour patch

12 week therapy

More than 15 cigarettes/day - start with step 1

step 1 - 25mg/16hr for 8weeks

step 2 - 15mg/16hr for 2

step3 - 10mg'16hr for 2 weeks

Less than 15 cigarettes/day - start with step 2

step 2 - 15mg/16hr for 8 weeks

step3 - 10mg/16hr for 4 weeks

24 hour patch

10 week therapy

More than 10 cigarettes/day - start with step 1

step 1 - 21mg for 6weeks

step 2- 14mg for 2 weeks

step 3- 7mg for 2 weeks

Less than 10 cigarettes/day - start with step 2

step 2 - 14mg for 6weeks

step 3 - 7mg for 2-4 weeks

Apply patch to a clean, dry and hairless area. Rotate site of application, can be applied on arm, chest, hip. thigh and shoulder. If site of application gets itchy, you can prime the area by applying 1% hydrocortisone cream for half an hour on the site of application, wash and dry it off then apply NRT patch.

Some people may get bad dreams or nightmares. You can take the patch off before bed if it is 24 hour patch or try the 16 hour patch. The other option is to try another form of therapy. If you get morning cravings the 24 hour patch may be a better option as you can leave it on overnight and get a 24 hour control.

For those who still have cravings, you can use a combination therapy with one of the following types of NRT.

Nicotine Gum

Nicotine gum is available in two strengths ; 2mg and 4mg

If you smoke less than 20 cigarettes/day start with 2mg strength.

If you smoke more than 20 cigarettes/day start with 4mg strength.

Chew a gum whenever there is an urge to smoke. Chew slowly and when you feel a tingling sensation rest the gum between teeth and cheek. This is the chew and park method. When the tingling or taste fades chew few more times till taste gets stronger then rest it again. One piece of gum should be chewed over a period of 20 minutes. Always chew slowly or you can get indigestion.

8-12 pieces of gum are recommended per day. Gradually reduce to 1-2 pieces per day then stop. This can be used together with a nicotine patches to relieve sudden cravings.

Nicotine Inhaler

Nicotine inhaler helps those who need a hand to mouth action and find it hard to quit due to missing a cigarette in the hand.

The inhaler consists of a plastic tube and replaceable cartridge which releases nicotine to help curb cigarette cravings and nicotine withdrawal symptoms.

weeks 1-12

1 cartridge when you have an urge to smoke or 1 every 2- hourly.

3-6 cartridges can be used per day.

After 12 weeks

Gradually reduce 1 to 2 cartridges a day and then cease. Use beyond 12 months is not recommended.

When you have a craving take a shallow puff about every 4 seconds or take 2 deep puffs every minute. Each cartridge lasts for approximately 40 minutes of frequent puffing.

Nicotine Quickmist

The quickmist is a mouth spray and is available in a 1 mg nicotine/spray strength. When a spray is taken nicotine enters the blood stream by absorption through the the buccal cavity therefore it is important not to swallow the quickmist or it will not work effectively. You have to prime this device by spraying away from you few times till a fine mist sprays.

It is usually used for 3 months but no longer than 6 months. 3 stepdown approach is taken to reduce cravings.

Step 1: Weeks 1-6

Use 1 or 2 sprays when you have a craving, if 1 spray doesn't work use 2 sprays at a time

May need 1-2 sprays every 30 minutes to 1 hour depending on your level of addiction.

Maximum 4 sprays/hour for 16 hours or 64 sprays/day.

Step 2: Weeks7-9

Start reducing number of sprays per day. By the end of week 9, the number of sprays should be reduced to half the number of sprays used in step 1.

Step 3: Weeks 10-12

Number of sprays should be reduced to 4 sprays per day . Treatment should be ceased when dose is maintained at 2-4 sprays per day.

If more sprays are used than recommended, you may experience nausea, salivation, abdominal pain, sweating, diarrhoea, headache or dizziness.

Nicotine Mini Lozenges

Lozenges are small and discreet and are available in 2 strengths 1.5mg and 4mg.

Depending on your level of addiction the dose varies.

If you smoke less than 20 cigarettes/day use 1.5mg lozenges

If you smoke more than 20 cigarettes/day use 4mg lozenges

12 week stepdown program involves 3 steps

Step 1 - 6 weeks

Take 1 lozenge every 1-2 hours

Step 2 - 3 weeks

Take 1 lozenge every 2-4 hours

Step 3 - 3 weeks

Take 1 lozenge every 4-8 hours

Lozenge should be placed in the mouth and be allowed to dissolve slowly to be effective. Do not chew lozenges.

Apart from NRT, there are prescription medications that help you quit, so have a chat with your doctor if NRT doesn't work for you.

Finally, smoking not only has an effect on your health but affects your entire family.

There are only harmful effects of smoking but only positive effects of quitting, so why wait? Set a date on your calendar, make up your mind and get ready to quit. Whether or not you use pharmacotherapy it usually takes several attempts to quit smoking successfully. The vital message is not to give up giving up smoking!

I have 3 words for you quit, quit quit!

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