About 15% of adult Americans smoke daily. Smoking is the Largest preventable cause of disease and death in the US as it is a known cause of multiple cancers, heart disease, stroke, pregnancy complications, COPD, and other diseases. Smoking accounts for 480,000 U.S. deaths or 6 million deaths worldwide yearly. Among these, about 10% of the deaths are from secondhand exposure to smoking. At any age, there are benefits to quitting smoking.
CDC identified that quitting smoking is associated with following health benefits:
The combination of counseling and medication is more effective than either alone. Counseling can be cognitive therapy such as positive self-talk or behavioral therapy such as controlling environments and social support. Medications include nicotine replacement therapy or prescription medications. A national network of tobacco quitlines 1-800-QUIT-NOW is also available for patients who need help with smoking cessation.
There are two prescription medications and many over the counter nicotine replacement products that can be purchased to aid in the process of quitting smoking. For nicotine replacement, a combination of long-acting (patch) plus immediate release (lozenge/gum) can be an effective strategy to stop smoking. Using the patch will help to reduce cravings, and using a lozenge or gum piece can satisfy breakthrough cravings.
|Cigarette Use||Weeks 1-6||Weeks 7-8||Weeks 9-10|
|> 10 cigarettes/day||21 mg patch||14 mg patch||7 mg patch|
|≤ 10 cigarettes/day||14 mg patch||7 mg patch||No recommendations|
|First cigarette of the day||Weeks 1-6||Weeks 7-9||Weeks 10-12|
|1st cigarette > 30 min after waking up||2 mg lozenge or gum every 1 to 2 hour||2 mg lozenge or gum every 2 to 4 hour||2 mg lozenge or gum every 4 to 8 hour|
|1st cigarette ≤ 30 min||4 mg lozenge or gum||4 mg lozenge or gum||4 mg lozenge or gum|
|after waking up||every 1 to 2 hour||every 2 to 4 hour||every 4 to 8 hour|
*Nicotine replacement nasal spray and inhaler are also available
There are several different timelines for quitting with varenicline (Chantix) and it can vary from patient to patient. A discussion with a healthcare provider will help to determine what plan is best for each patient.
Nausea, trouble sleeping, abnormal dreams, and headache are the most common side effects with varenicline. To decrease nausea, take with a full glass of water. To decrease trouble sleeping take earlier than bedtime. Although rare, changes in mood, agitation, seizures, suicidal thoughts or behaviors can occur with varenicline. The physician should be notified if any of these rare side effects are noticed.
The most common side effects of bupropion are dry mouth and trouble sleeping, which may disappear after a few weeks. Take the first dose in the morning after waking up and the second dose 8 hours after. If you have a seizure or an eating disorder, do not take bupropion.
Written By: Eddie Chang and Ellie Sung