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How Can I Quit Smoking?

by James N. Kim, MD, FCCP

Smoking cessation is associated with significant health benefits for smokers of all ages.  Smoking cessation can reduce the risk of developing heart diseases, chronic obstructive pulmonary disease (COPD), many types of cancer, peptic ulcer disease, pregnancy complications, osteoporosis, and premature menopause.  In addition, a large number of smokers with cough and phlegm production have an improvement in symptoms after quitting.  Smoking cessation has also been connected to improvement in asthma and a decrease in the risk of several types of infections.

There are several key elements in quitting smoking successfully.  Once the decision is made to quit smoking, one should set a quit date and choose a quit plan.  Gradual cutback in smoking can be occasionally successful, but quitting "cold turkey" is generally more successful and is the preferred strategy. Set up a support network of family, friends, and coworkers as you plan to quit.  Anticipate nicotine withdrawal symptoms and have a plan to deal with them to prevent relapse.  Both behavioral and pharmacological approaches may be utilized in this regard.

Behavioral Approaches

When preparing to quit, you should avoid situations, places or activities that may increase the temptation to smoke.  People who live with smokers can ask them not to smoke around you or leave cigarettes out where you can see them.  Nicotine cravings can be prevented to some degree by using oral substitutes, such as sugarless gum or raw vegetables, by reducing stress, and by avoiding alcohol.

Be committed and obtain as much information as possible about what to expect during the quitting process.  It will be helpful to arm yourself with coping strategies on how to deal with the physical and psychological effects of smoking cessation.  Having social support can be beneficial during the quitting process.  Group programs are also available to help transition this period.  Hypnosis and acupuncture are popular smoking cessation methods, although there is little scientific evidence to support their effectiveness.

Pharmacological Approaches

Nicotine replacement therapy, bupropion, and varenicline are medications commonly used to aid in smoking cessation.  During the initial phase of smoking cessation, you may develop withdrawal symptoms from nicotine, such as dizziness, irritability, feelings of frustration and anger, sleep disturbances, trouble concentrating, restlessness, fatigue, and depression.  Weight gain can also occur with smoking cessation.

Nicotine replacement therapy provides nicotine in the form of gums, lozenges, patches, nasal sprays, or inhalers without the other harmful chemicals in tobacco.  All forms appear similarly effective, although individual smokers may find one form more effective than others.  Nicotine appears to be safe, even in people with known heart diseases.  However, smoking while using nicotine replacement is not recommended.

Bupropion (Zyban┬«, Wellbutrin®) is a prescription antidepressant that reduces symptoms of nicotine withdrawal.  Bupropion does not contain nicotine, but it may be more effective than nicotine replacement therapy, especially if combined together.  Bupropion may cause insomnia and dry mouth.  It should not be taken by those who have seizures, head trauma, anorexia, or heavy alcohol consumption.

Varenicline (Chantix®) is a newer medication that may be more effective than nicotine replacement and bupropion.  One should start varenicline one week prior to the quit date.  The drug is well tolerated, but reported side effects include nausea, vomiting, insomnia, and unusual dreams.

Many smokers may go through several attempts before they are able to quit completely.  If you do not succeed the first time, make your attempt more successful by adding another method or technique to help you quit.  National organizations that provide helpful information regarding smoking cessation include American Cancer Society, American Lung Association, American Heart Association, Centers for Disease Control and Prevention, and National Cancer Institute among others.