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About half to two-thirds of all long-term smokers die prematurely because of their smoking; on average 16 years earlier than if they did not smoke. The main causes of death attributable to cigarette smoking are cancers, diseases of the heart and circulation and lung disease. Giving up smoking can reduce the risk of developing many smoking related illnesses.
These include: Age-related hearing loss, Chronic back and neck pain, Cataracts, Cold injuries (tissue damage caused by exposure to cold environment), Crohn's disease, Diabetes (type 2, non-insulin-dependent), Erectile dysfunction, Gum disease, Macular degeneration (causing blindness), Osteoarthritis, Osteoporosis, Rheumatoid arthritis, Skin wrinkling.
About 4,000 chemical compounds have been identified in cigarette smoke, of which over 40 are known to cause cancer. The three significant components of cigarette smoke are:
The Cost of Smoking
Wheezing, shortness of breath, lack of energy, poor concentration, dull skin, nicotine-stained fingers, premature wrinkling, reduced fertility, risky pregnancy, baby at risk, damaged taste buds, stained teeth, lung cancer, emphysema, stroke, heart attack.
Children at higher risk of asthma, cot-deaths, bronchitis and glue ear, Smoke gets in your eyes; dusty, stuffy home; nicotine stains your walls as well as your fingers; increased risk of fire in the home.
At today's rates, a 20-a-day smoker will spend approx £1800 a year on cigarettes which could have been spent on, for example, a holiday, a car, home improvements etc.
How to Give Up
There a various methods employed to help give up smoking. These include Acupuncture, Hypnotherapy, Cold Turkey, Help lines (e.g. NHS Smoking Helpline 0800 169 0 169), and Nicotine Replacement Therapy (NRT).
Nicotine replacement therapy; In the UK all medicines licensed for smoking cessation are available on NHS prescription. NRT is also available over the counter, with some products on general sale. The most effective treatment involves medication and behavioural support.
Rationale for using NRT; For many smokers, it is the withdrawal symptoms that lead to a failed stop attempt. Nicotine replacement therapy acts by providing a 'clean' alternative source of nicotine that the smoker would have otherwise received from tobacco. Nicotine delivered from NRT is not satisfying, as it is absorbed more slowly and generally in a lesser amount. But it is sufficient to reduce the severity of withdrawal symptoms and so can assist in maintaining abstinence.
All NRT products provide a clean source of nicotine. There is no difference in the efficacy of the various NRT products, and little evidence for matching products to individual smokers. Therefore it is generally agreed that choice of product can be guided by patient preference. However, smokers with higher dependency benefit more from a higher-dose product such as 4 mg gum, 4 mg lozenge or nasal spray. It is recommended that all products should be used for 8-12 weeks.
Nicotine Transdermal Patch
The nicotine patch is one of the most commonly used NRT products. Patches are available in 16 and 24-hour preparations, both releasing approximately 1 mg nicotine per hour. Current evidence shows no difference in efficacy between the two, which means the choice of patch, can be guided by patient preference. Patches are also available in lower strengths designed for 'weaning off' although there is no evidence to suggest that this is absolutely necessary.
The advantage of patches is that they are very simple to use and there is generally good adherence to treatment. They are applied to a clean, dry, hairless area of skin and removed at the end of the day (16 hours) or the next day (24 hours). A possible disadvantage of the patch is the slow nicotine delivery. Time taken to reach plateau concentrations varies between two and eight hours depending on the brand. Skin irritation is the most common side effect. The 24-hour patch may cause sleep disturbance.
Nicotine absorption from oral NRT products, including the inhalator, is via the buccal mucosa (lining of the mouth). Peak plasma concentration is reached in 20-30 minutes. Oral products should be used on a regular basis to maintain blood nicotine levels and to have the best effect. Additional use can be helpful at times when urges to smoke are more intense or more frequent. An initial unpleasant taste is common to all these products, and this can be a barrier to correct use. Smokers should be reassured that they will become tolerant of this after a short period (usually a couple of days). Incorrect use of oral products, for example chewing gum too vigorously, usually results in more nicotine being swallowed. This is not hazardous, but means that less nicotine is absorbed, and may cause local irritation and hiccups.
Nicotine Chewing Gum
Nicotine gum comes in two strengths, 2 and 4 mg; more highly dependent smokers should use the latter. The bio-availability is not 100%: the 2 mg gum typically yields only about 0.9 mg of nicotine, whereas the 4 mg gum yields about 1.2 mg. Users should aim to use between 10 and 15 pieces of gum a day. Instructing smokers to use a piece an hour is a convenient way to encourage the correct dosage. There is a specific technique for using the gum. Each piece should be chewed slowly to release the nicotine, and a hot peppery taste will be experienced. The gum should then be 'parked' between the cheek and gums so that the nicotine can be absorbed. After a few minutes the gum can be chewed again, then parked and repeated, for 20/30 minutes.
Nicotine Sublingual Tablets
These small 2 mg tablets are made to dissolve under the tongue, although the nicotine is absorbed through any part of the oral mucosa. Hourly use should be recommended to achieve the best effect, but the tablets can be used more frequently if desired. After 30 minutes the residual tablet can be removed.
The inhalator consists of a small plastic tube containing a replaceable nicotine cartridge. This method may provide more behavioural replacement than the other products (some people miss the hand-to-mouth action of smoking when they quit), but there is no strong evidence for this. Despite its name, nicotine from this device is not inhaled into the lungs, but is deposited on the oral mucosa through which it is absorbed. To achieve sufficient blood nicotine levels the user should puff on the inhalator for 20 minutes each hour. After three 20-minute puffing sessions, the cartridge should be changed. The average smoker should aim to use six cartridges a day. In cold weather it is advisable to keep the inhalator warm so that the nicotine vapour can be released from the cartridge.
The lozenge is available in three different strengths: 1 or 2 mg for smokers with lower dependency and 4 mg for those with higher dependency. The lozenge should be dissolved in the mouth and moved around intermittently. It can be removed after 30 minutes use. To achieve the greatest benefit, lozenges should be used regularly, approximately one lozenge per hour.
Nicotine Nasal Spray
Some people dislike using this method because of its initial adverse effects, including sneezing and a burning sensation in the nose. Smokers need to be warned about these unpleasant effects, but should also be reassured that the nasal spray does not cause any damage to their nose, and that they will become used to it after a day or two of use. The recommended dose is one squirt (0.5 mg) to each nostril each hour, with additional doses as required.
Staying Stopped & Benefits
Staying a non-smoker can be difficult and factors such as complacency, boredom, other smokers, going to the pub (for a social smoker), can all contribute to a non-smoker lapsing and starting to smoke again. There are health, lifestyle and financial benefits.
Beneficial health changes on stopping smoking
Stopping smoking is the most important change you can make to improve your health. Anybody can stop if they want to. You are less likely to get cancer of the throat, lungs, bowels and skin if you give up. You are less likely to have a heart attack or stroke, or get bronchitis or emphysema. Your children and those close to you will also benefit from not breathing in your smoke. You will get your sense of smell and taste back and you will be able to do more exercise without losing your breath.
Products we recommend for this condition are:
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