How To Break A Smoking Addiction And Live Longer
Last month I promised to write about how individuals and families can make their habits healthier, starting with one of the hardest but most important of all, stopping smoking. Everybody knows that smoking is expensive and bad in all kinds of ways, but most smokers find it extremely hard to stop! That’s because one’s body becomes both habituated and usually addicted to smoking and the nicotine it delivers. I base the following suggestions on decades of trying to help 1000s of smokers kick the habit.
Let me review quickly the damage smoking does. Most importantly, by age 50+ it increases bronchitis and emphysema, which then kill people by suffocation over the next 10-15 years. That is unless they die sooner from smoking-related pneumonia, lung/throat/gullet/bladder cancers, or heart disease. Smoking also markedly increases asthma and those same diseases in adults and children living in the same house. On average, smokers die 10 or more years earlier than non-smokers. Does smoking help anything? Not much! It does lower smokers’ weights by 5-10 lbs; a few patients with rare conditions like Crohn’s disease of the bowel get some disease improvement. And it transiently relaxes those who are habituated/addicted.
Some general principles on quitting. Set a quit date and perhaps taper to it; suddenly quitting works for many, tapering for fewer. Stopping in the middle of a respiratory illness, like a cold, is often easier. If possible, undertake quitting with others; formal and informal social support helps. After quitting, avoid situations you have habitually associated with smoking, like coffee in your old smoking haunts, or companions not interested in quitting. Work, play and eat, if you can, in places where newer state no-smoking laws prohibit smoking, including bars/restaurants and other public places. Don’t be discouraged by relapses; most people who stop successfully do so after going back to smoking several/many times. Use the Maine resources available by phone or on-line: Maine Tobacco Helpline 800-207-1230; http://www.tobaccofreemaine.org/quit_tobacco/index.php.
Use some aids. Hypnosis helps some people. Medications (with a clinician’s prescription) help many succeed. Three drug classes are available and are covered by most health insurances. MaineCare cut coverage for these prescriptions last year; but it looks like that penny-wise, pound-foolish decision will be reversed in 2014.
•Low dose nicotine in various forms: Nicotine patches (Nicoderm, Habitrol, Prosten) achieve 25% one year quit rates and cost about $100/month. They are changed every 24 hr, using 21 mg patches the first 2-3 weeks, then 14 mg patches for another 2-3 week, then 7 mg ones for a similar or longer period of time. The 2 or 4 mg gum (Nicorette, and other brands), up to 20 pieces a day, costs about the same and achieves similar cessation rates. Nicotrol inhalers and nasal sprays cost more but also do as well as the gum and patches. The newest are the electronic cigarette systems, which deliver nicotine via a plastic “cigarette” without the tobacco smoke, are expensive and no data yet on 1-yr quit rates. All nicotine treatments have side effects like sleeplessness, high blood pressure, and worsened angina, congestive heart failure, or leg ulcerations.
•Bupropion (as long-acting Zyban or generic forms) works when taken as 150 mg daily for the week before stopping smoking, then increased to twice a day and used for at least 2 months. Costs are in the same $100+/month range and success rates, when used alone, are also 25% at one year; success can be as high as 36% when used in combination with nicotine medications as described above.
•Varenicline (as Chantix, no generic) taken ½-1mg by mouth twice a day, started a week before quitting and for at least 3 months afterward, reportedly results in 43% quit rates at one year, but costs $250/month and can cause agitation and rarely suicide.
Flu shots are crucial for smokers! Smokers have a much higher likelihood of getting bacterial pneumonia if they get the flu. Don’t let anybody tell you that they “cause the flu”; that’s impossible with a killed vaccine. The immunization ameliorates or prevents influenza in 75% of those exposed.
This just out from the Maine Center for Disease Control: “Influenza activity in Maine is widespread with laboratory confirmed influenza reported in all counties. Influenza A/pH1N1, Influenza A/H3, and influenza B have been confirmed in Maine indicating all three strains are circulating. Maine CDC has followed up on six outbreaks of influenza as of Tuesday, January 7th. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of severe disease. The vaccine appears to be a good match to the circulating strains this year, and it is not too late to get vaccinated." Smokers and/or people with lung and heart disease and/or their families should not pass up this effective prevention.
Quitting is not easy; don’t give up; keep trying! It is the single most important thing you can do for your own and your family’s health.
Dan Onion, MD
Vienna Health Officer