Tobacco Cessation
© editorial team Bibliomed
In this article:
– Introduction
– Smoking Risks
– Benefits of Smoking Cessation
– Preparing To Quit Smoking
– Behavioral Approach (Therapy)
– Medicines
– Bibliographic references
Introduction
Smoking is a major cause of illness worldwide and is estimated over 400,000 deaths each year due to this habit in the US alone. Furthermore, exposure to passive smoking seems to be responsible for about 40,000 deaths per year due to heart disease. Tobacco is also a major cause of non-fatal diseases, such as osteoporosis, wrinkles, peptic ulcer disease, impotence and complications of pregnancy.
Most smokers accept the fact that smoking is dangerous, but think that the risk acts like a roulette: believe that every cigarette you smoke is as if they made a bet. The "prize" would be a heart attack, lung cancer or other disease. If your "number" is drawn, you will have the disease; if your number never appears, you can avoid the harmful effects of smoking and live life not being affected by smoking. However, this is a misconception. Every cigarette a person smokes affects the body the same. The truth is that the more you smoke, the greater the harm. Quitting smoking and staying well is difficult, but not impossible.
Risks of Smoking
– Lung cancer: the risk of lung cancer increases by approximately 50% to 100% for each cigarette smoked per day.
– Heart disease: the risk increases approximately 100% for each pack of cigarettes consumed per day.
– Filter Cigarettes: switching to filter cigarette consumption (rather than hand-rolled cigarettes) reduces the risk of lung cancer by about 20%, but does not reduce the risk of heart disease.
– Smokers spend 26% more time hospitalized and more than twice in intensive care units (ICU), when compared to individuals who do not smoke.
– Each cigarette relates consumed within 5-20 minutes of life.
– Smokers have a two times higher risk of dying before age 65, compared to non-smokers.
– In addition to previously mentioned, smoking is associated with increased risk of other diseases, such as cancers of the head and neck, bladder cancer and pancreatic cancer, osteoporosis, peptic ulcer disease, emphysema, among others.
Benefits of Smoking Cessation
Smoking cessation has major and immediate effects on the health of men and women of any age. The sooner a person quits smoking, the greater the benefit. We know that individuals who stop smoking before 50 years of life, reduce their risk of death over the next 15 years by 50%, compared to those who continue to smoke. In addition, the termination also benefits individuals exposed to passive smoking, which is responsible for some diseases as well.
1. Heart Disease
Cigarette smoking increases twice the risk of coronary heart disease (which causes heart attack and angina), and the cessation leads to rapid reduction of this risk. One year after quitting smoking, the individual risk of death is reduced by 50% and continues to reduce over time.
2. Pulmonary Disease
Cigarette smoking increases the risk of lung diseases in the long term, such as chronic obstructive pulmonary disease. Although much of the lung damage caused by smoking is irreversible, smoking cessation can reduce further lung damage, and many smokers who have chronic cough and sputum reported improvement of symptoms in the first 12 months after the habit of interruption. Asthma is more common among children exposed to smoking, in addition to these cases, treatment is more difficult.
3. Cancer
Smoking is responsible for about 90% of cases of lung cancer. Smoking cessation reduces the risk of this cancer in the first five years, although the former smokers still present a greater risk than individuals who never smoked. Stopping smoking reduces the risk of other cancers such as head and neck, esophagus, pancreas and bladder. The benefit exists even after these cancers have been diagnosed as it reduces the risk of second cancers and increases the chance of survival to the first cancer.
4. Peptic Ulcer Disease
Cigarette smoking is associated with increased risk of peptic ulcer disease. The termination reduces the risk of developing ulcers and accelerates the healing rate, if they have already been developed.
5. Osteoporosis
Smoking cessation increases bone loss and increases the risk of fractures in women. The interruption begins to reverse this risk after about 10 years. Increased bone loss was also noted in men, but it is not known how the risk of fracture is increased in these patients.
Preparing To Quit Smoking
After deciding to quit smoking, the first step is to set a date. This is the day to completely stop smoking. That date, ideally, should be in no more than two weeks, although the choice of special dates (such as a birthday, anniversaries) can be useful.
The gradual reduction can be occasionally successful, but the abrupt cessation is associated with greater success. Some people change consumption for cigarettes with lower nicotine content and tobacco, prior to termination, but it makes the person inhale more deeply, not bringing benefit.
Other actions that help in cessation are as follows:
Tell friends, family and coworkers and request support;
Avoid smoking at home and in the car and other places where you spend much of their time;
Remind your previous attempts, trying to identify what worked and what did not;
Prepare to deal with the symptoms of nicotine withdrawal, such as anxiety, frustration, depression, intense urge to smoke. A few weeks after stopping, it is easier to deal with them;
Prepare to handle situations that lead you to smoke, such as stressful events and alcohol consumption.
Talk to your doctor about your desire to stop smoking. The two most successful approaches are as behavioral and medicines, can be to employ them concomitantly.
Behavioral approach (Therapy)
This approach can be done independently or in individual and group sessions. In the smoking cessation process, it is important to identify situations or activities that increase the risk of smoking or start smoking again. After this identification, new skills to deal with them will be needed. It is recommended lifestyle modification to reduce stress and improve quality of life, such as starting the practice of regular physical activity or relaxation techniques. Vigorous exercise may improve the ability to stop smoking and to prevent relapse, and prevent / minimize weight gain.
Reduce the time you spend with smoking. People who live with smokers may consider negotiating with them for them to stop smoking at home or in the car. Recognize that "crack" can often lead to relapse. This can be prevented by at least partly avoiding situations associated with smoking such as stress and alcohol consumption. Keep oral substitutes are available (such as chewing gum, carrots, sunflower seeds) by hand, for when "cracking" occur. Avoid thoughts like "smoking just one cigarette will not hurt me"; a cigarette usually leads to another.
The key to success in smoking cessation is to have as much information as possible about what to expect and how to deal with what occurs. self-help materials can be useful.
Medicines
There are several medications that can assist a person in the smoking cessation process and these should be prescribed and supervised by a doctor.
1. Nicotine Replacement
In the absence of nicotine, smokers lose the good feeling that nicotine induces developing withdrawal symptoms, including depressed mood, trouble sleeping, irritability, frustration or anger, anxiety, difficulty concentrating. The replacement therapy is designed to reduce the intensity of these symptoms, while former smokers deal with the behavioral aspects of the cessation program. However, the replacement not completely prevent symptoms. The use of concomitant replacement to smoking is not recommended. Nicotine replacement is available in various forms: chewing gum, skin patches, nasal spray and inhaler.
2. Bupropion
Bupropion is an antidepressant that can be used to help people quit smoking. At first, it is taken once daily for three days, with a gradual increase to the recommended dose, before the date selected for termination. After the interruption, the drug is maintained for seven to twelve weeks. Bupropion appears to be more effective than nicotine replacement therapy, and combination of the two appears to be more effective. It is a well tolerated medication, can be accompanied by symptoms of dry mouth and insomnia.
3. Varenicline
This drug works in the brain and reduces the symptoms of nicotine withdrawal and "crack" by smoking. In several studies that drug was more effective than bupropion and non-medicinal use. Should be taken after a meal with a full glass of water. Patients initiate use a week before to stop smoking, and should continue to use for twelve weeks before they determine the effectiveness. Those people who are still not smoking after twelve weeks, can continue to use the drug for another twelve weeks. The most common side effects are nausea and abnormal dreams. However, in 2007 it was reported that some patients developed abnormal behavior, becoming aggressive, and have developed suicidal thoughts. Therefore, the drug should be used with careful medical supervision.