Smoking
Cessation: Resources And Remedies
First
and foremost, it is the responsibility of primary care physicians
to emphasize to their patients the risks of smoking and the benefits
associated with stopping, and to encourage patients to improve their
diets and exercise regimens, which may make easier the transition
away from cigarettes.
Physicians should try to make their patients desirous of eliminating
cigarettes from their lives, as some of the medications only work
if a patient has been able to cut down the number of daily cigarettes
to a certain level. However, these discussions are not occurring on
a regular basis. Surprisingly, while 70 percent of the nation's smokers
see physicians each year, only one-third of them are advised on how
to quit.
The current artillery includes both over-the-counter (OTC) drugs as
well as the prescription variety, with variable success rates. With
the exception of buproprion (described below), the rest are
forms of nicotine that deliver steady doses of nicotine into the body
to relieve withdrawal symptoms.
Several studies are currently ongoing which suggest that the use of
combinations of these drugs are more efficacious than one of them
alone.
1. Nicotine patch
- This transdermal drug is sold under a few names
(Nicoderm CQ, Nicotrol) with varying doses and lengths
of treatment (typically 6-10 weeks), and the doses are tapered throughout
the treatment. Although the patches are sold OTC, it is essential
that smokers use them only with the guidance of a health professional
- as the nicotine can build up to toxic levels if one continues to
smoke while wearing them. Roughly 20 percent of smokers who try this
method are still free of cigarettes after 6 months. Smokers who have
skin problems or allergies to adhesive tape may find this therapy
difficult to tolerate; in addition, the drug is also not recommended
in patients who are pregnant (risk to fetus), have angina or a heart
rhythm abnormality, or have a recent history of a heart attack.
2. Nicotine gum
- Also sold over the counter (as Nicorette) in 2 and 4 mg pieces,
the chewing gum delivers nicotine through the oral mucosa - while
for some smokers it also satisfies the oral urge previously developed
with cigarettes. The gum is initially chewed about one piece per hour,
with a target of weaning off within 6 months (or sooner). Some complain
about transient hiccups, stomach pain or jaw aching, as well as the
taste, but no serious side effects have been reported.
3. Nicotine nasal spray
and inhaler - These two forms, sold only with a
prescription, are used much less frequently and are not recommended
in patients with nasal, sinus or bronchial conditions (especially
asthma) - which are inherently more common in smokers.
4. Bupropion
- Sold only as a prescription tablet (Zyban), this drug mimics nicotine's
effect on dopamine and nor-epinephrine, two of the brain's neurotransmitter
chemicals. Some studies have shown a success rate as high as 49 percent
after one week, but only 23 percent after one year. Some smokers like
the fact that buproprion can induce temporary weight loss,
possibly offsetting the weight gain often associated with smoking
cessation. However, many patients are unable to tolerate this drug
because of gastrointestinal problems, headache, insomnia, dry mouth,
and irritation; seizures have also been reported, but in those who
had a predisposition to seizures or took too high of a dose.
Finally, perhaps equally as important as the pharmacologic therapies
now available to smokers are the many counseling services and programs.
In fact, smokers who receive counseling from support groups, smoking
programs and physicians do even better than those relying solely on
the above medications, with quitting rates of between 25 percent and
35 percent. Primary care physicians can refer their patients to such
assistance, and patients can find many of these state and local agencies
in the local or county government section of the phone book. Some
other resources are listed below:
1. National Cancer Institute's Cancer Information Service (CIS)
1-800-4-CANCER (1-800-422-6237)
Web site: http://cis.nci.nih.gov
2. National Institute on Drug Abuse (NIDA)
1-888-NIH-NIDA (1-888-644-6432)
Web site: http://www.nida.nih.gov
3. The Office on Smoking and Health of the Centers for Disease
Control
National Center for Chronic Disease Prevention and Health
Promotion Centers for Disease Control and Prevention
Mailstop K-50, 4770 Buford Highway, NE.
Atlanta, GA 30341-3724
1-800-CDC-1311 (1-800-232-1311)
770-488-5705 Fax: 770-488-5393
FAX Information Service: 770-332-2552
Web site: http://www.cdc.gov/tobacco/
E-mail: ccdinfo@cdc.gov
4. The American Lung Association (ALA) --
Freedom From Smoking clinics
1740 Broadway
New York, NY 10019-4274
1-800-LUNG-USA (1-800-586-4872)
212-315-8700
Web site: http://www.lungusa.org
5. Nicotine Anonymous (NA), a 12-step program
Nicotine Anonymous World Services
Post Office Box 591777
San Francisco, CA 94159-1777
415-750-0328
Web site: http://www.nicotine-anonymous.org
E-mail: info@nicotine-anonymous.org
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