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Smoking

Definition

Smoking involves inhaling and absorbing nicotine-containing tobacco smoke into the body. Nicotine is a poisonous, addictive chemical found in tobacco.

What is going on in the body?

In the 1960s, medical research began to show that cigarette smoking was harmful for a person's health. At least 70% of smokers in the United States have made at least one attempt to quit smoking. The nicotine in tobacco is as addictive as cocaine. It is because of this addiction that smoking cessation can be so difficult.

Risks

What are the causes and risks of the condition?

People quickly become dependent on nicotine when using tobacco products. Anyone who uses these substances is at risk of experiencing withdrawal symptoms. A trigger or desire is anything that creates an impulse to use tobacco.
Triggers can be feelings, such as stress, anxiety, depression, or boredom. They can be visual, such as a picture of a poised, glamorous movie star taking a long, seemingly satisfying drag. Triggers can even be certain times of the day, such as work breaks or meals. Being in social settings with people who smoke may also be a trigger to resume smoking.

Prevention

What can be done to prevent the condition?

Once a person starts smoking, he or she quickly becomes addicted to nicotine. The key is never to start smoking. Antismoking campaigns can be effective in spreading this message.

Diagnosed

How is the condition diagnosed?

Someone who is addicted to nicotine will have strong cravings for it. When the person does not smoke for a period of hours to a few days, he or she will have nicotine withdrawal symptoms.

Long Term Effects

What are the long-term effects of the condition?

The health risks from the chemicals found in tobacco are significant. Tobacco use can cause the following diseases:
  • chronic bronchitis
  • coronary artery disease and other forms of heart disease
  • emphysema
  • gastroesophageal reflux disease
  • lung cancer
Tobacco also is a factor in causing the following conditions:
  • decreased life expectancy
  • erectile dysfunction, or impotence
  • gray hair and baldness
  • high blood pressure and circulation problems
  • infertility in men and women
  • osteoporosis and increased risk for bone fractures
  • premature wrinkles
  • weakened immune system

Other Risks

What are the risks to others?

Smoking is a form of air pollution. It exposes others to secondhand smoke. People who are exposed to a significant amount of secondhand smoke share many of the same risk factors as people who smoke. A pregnant woman who smokes increases her risk for miscarriage and other health problems for her baby.

Treatments

What are the treatments for the condition?

The first step in smoking cessation is setting up a Quit Plan. A Quit Plan includes the following:
  • quit date and written commitment to stop smoking
  • preferred quit option(s)
  • preferred quit method(s)
  • support team
  • coping strategies for dealing with triggers, withdrawal symptoms, and other challenges
There are a number of methods for quitting smoking that address the addiction to nicotine. Going cold turkey, which means stopping smoking abruptly, is one method. Two other methods are non-nicotine medication and various forms of nicotine replacement therapy.
The person's level of nicotine dependence and any prior quit attempts should be taken into consideration. The individual can work with the healthcare professional to choose the best method. Regardless of the method chosen, the person must also pay attention to breaking the smoking habit.
Research shows that smokers who use behavior modification strategies in addition to addressing the physical addiction have a better chance of succeeding. Nicotine replacement products help reduce the physical withdrawal symptoms that occur with smoking cessation. These medicines reverse the process in which the person's body learned to crave more and more nicotine. Over time, they help the person's body stop craving nicotine.
However, nicotine replacement therapy does not completely eliminate withdrawal symptoms. It does not give the individual any more willpower. It does let the person focus on breaking the habit of smoking as the body adjusts to lower levels of nicotine.
Some of the types of nicotine replacement therapy are as follows:
  • nicotine gum, which is available over-the-counter or by prescription
  • nicotine inhalers, which are available by prescription
  • nicotine nasal spray, which is given by prescription
  • nicotine patches, which are available over-the-counter in various strengths
Since these products replace the nicotine the person would have gotten from a cigarette, nothing new is being introduced into the body. The direct effect from nicotine is the same. A person using nicotine replacement products should not continue to smoke.
Nicotine can cause serious medical problems, including death, if it is abused. Nicotine replacement products are not recommended for people in the following situations:
  • people who have had a heart attack within the past 2 weeks
  • people who have serious arrhythmias, or irregular heartbeats
  • people who have angina, the chest pain associated with heart disease
  • women who are pregnant, unless their healthcare professional recommends it
Bupropion (i.e., Zyban), has been approved by the the U.S. Food and Drug Administration (FDA) for smoking cessation. How Zyban works is largely unknown. It is thought to act on certain pathways in the brain that are involved in nicotine addiction and withdrawal. The person feels less of an urge to smoke. Zyban also helps reduce some of the more bothersome nicotine withdrawal symptoms associated with smoking cessation. For example, it can reduce anxiety, irritability, frustration, difficulty concentrating, and restlessness.
In 2006, the FDA announced the approval of varenicline tartrate (i.e., Chantix) tablets for smoking cessation. Chantix-treated patients have been shown to be more successful in giving up smoking than patients treated with Zyban (bupropion).
Varenicline is a new molecular entity that received a priority FDA review because of its significant potential benefit to public health. Chantix acts at sites in the brain affected by nicotine and may help those who wish to give up smoking in two ways:
  • by providing some nicotine effects to ease the withdrawal symptoms and by
  • by blocking the effects of nicotine from cigarettes if they resume smoking

Side Effects

What are the side effects of the treatments?

The most-reported side effect from the nicotine patch is skin irritation. Those who use a 24-hour patch sometimes report having vivid dreams. The patch may also cause headache or joint pain. Nicotine gum can cause some minor mouth, tongue, and throat irritation. It may also cause an arrhythmia and palpitations. Swallowing the gum can cause nausea or vomiting.
The most common side effects from the nasal spray are irritation of the nose and throat, watering eyes, sneezing, and cough. These side effects may lessen in intensity after the first week of use. The most common side effect of the nicotine inhaler is irritation of the lining of the mouth and throat. Some people may experience cough, runny nose, or nausea.
The most common side effects of Zyban include dry mouth and insomnia. If side effects occur, they are generally mild and disappear after a few weeks. Other side effects include shakiness, skin rash, dizziness, and anxiety.
In clinical trials, the most common adverse effects of Chantix were nausea, headache, vomiting, flatulence (gas), insomnia, abnormal dreams, and dysgeusia (change in taste perception).

After Treatment

What happens after treatment for the condition?

Withdrawal symptoms are temporary. They usually last only 1 to 2 weeks. The person can derail smoking triggers by using counteractions. Counteraction involves actively responding to the trigger, but not in the usual way. Instead of smoking, the individual comes up with a different and healthier response.
There are three main ways to cope with triggers.
  • Avoid the situation. Someone who smoked while driving a car can choose a different route that requires more concentration.
  • Change the situation. The person may choose to sit in the nonsmoking section of restaurants.
  • Find a substitute for a cigarette. Pens, small toys, or rubber bands are good options. Chew sugarless gum or hard candy, or try carrot sticks.
A relapse occurs when a person who has stopped smoking slips and has a cigarette.
Following are some keys to dealing with a relapse.
  • Learn from the relapse and move on.
  • Figure out the details that led to the slip.
  • Review the Quit Plan and reasons to stop smoking.
  • Revise the Quit Plan and set a new quit date.

Monitor

How is the condition monitored?

To remain nicotine free, smokers should avoid tempting situations and do something else when the urge to smoke arises.

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