Women’s Health

Smoking Cessation

Smoking increases your risk for heart disease, strokes, chronic obstructive pulmonary disease (emphysema or COPD), lung cancer, cataracts, macular degeneration (which causes blindness), Graves disease, thyroid cancer, cancers of the lips, mouth, throat and larynx (voice box). Smokers also have an increased risk of other cancers including esophageal, stomach, kidney, bladder, skin and pancreatic cancer. Apart from cancer smoking causes premature aging of the skin and increases your risk for peptic ulcer disease.

According to the CDC between the years 1997-2001 “The three leading specific causes of smoking-attributable death were lung cancer (123,836), chronic obstructive pulmonary disease (COPD) (90,582), and ischemic heart disease (86,801).”

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htm

There are many, many other reasons to quit if you’re a woman. Smoking has potentially devastating effects on fetal well-being for women who smoke during pregnancy. Smoking increases the likelihood of stillbirths, low birth weight infants, premature births and even sudden infant death syndrome (SIDS). Smoking is associated with an increased risk of cervical cancer, osteoporosis and urinary stress incontinence.

Smoking is deadly and is responsible for the deaths of nearly 430,000 people a year–more lethal than AIDS, automobile accidents, homicides, suicides, drug overdoses and fires combined!

Smoking diminishes the quantity and quality of life. On average, female smokers reduce their life from by 14.5 years! Apart from that, smoking also decreases the quality of life and is associated with many disabilities.

The smoke contained in cigarettes contains tar along with many other inhaled chemicals. Some of the chemicals are known carcinogens—cyanide, benzene, formaldehyde, methanol, ammonia and acetylene.

No wonder the U.S. Surgeon General has stated” Smoking cessation represents the single most important step that smokers can take to enhance the length and quality of their lives.”

No matter how old you are right now you can improve your life expectancy by quitting. Quitting before the age of 50 reduces by half your risk of dying in the next 15 years. Former smokers also have a reduced rate of bronchitis and pneumonia.

Why is quitting so tough?

The answer is nicotine. Nicotine is a drug naturally found in tobacco. It is highly addictive. Arguably, nicotine is more addictive than heroin and cocaine. Nicotine causes a real psychological and physical dependence in exchange for a temporary pleasant and calming sensation for most smokers. As the nervous system adapts to nicotine, smokers tend to increase the number of cigarettes they smoke in order to overcome to the tolerance they develop.

When smokers try to cut back or quit, the absence of nicotine leads to withdrawal symptoms. These include dizziness, depression, frustration, anger, irritability, sleeplessness, headaches, restlessness, fatigue, an increased appetite. No wonder Mark Twain once said “quitting smoking is easy. I’ve done it a thousand times.”

Why should I quit?

The simple answer is “your health”. The Centers for Disease Control (CDC) estimated that the average female smoker loses 14.5 years of life!

Smoking is related to a long list of cancers (see above), progressive non-cancerous lung diseases (chronic obstructive pulmonary disease) and other diseases that dramatically shorten life expectancy. In all age groups smokers are twice as likely to die of a heart attack as non-smokers. Smoking also dramatically increases the risk of strokes and peripheral vascular disease. Just as smoking narrows medium and small blood vessels it also causes narrowing of the large blood vessels to the arms and legs.

There are plenty of other reasons to quit too. There many workplace restrictions today on smoking. Some employers may not hire you if you’re a smoker. Public buildings, hospitals, concerts and sporting events all have restrictions on smoking. New York State doesn’t allow smoking in restaurants and bars. In the last 10 years smoking has gone from being socially acceptable to unacceptable. With evidence mounting against second-hand smoke you also have the health of others to consider—especially if those “others” are your children or loved ones. If you have children you need to think about setting a good example for them too. And if that isn’t enough consider this—you’ll pay twice as much for life insurance if you’re a smoker.

Lastly, many work places from large corporations to small businesses are beginning to require not only smoke free environments on the job but that you lead a healthy lifestyle. Some businesses go so far as “drug testing” to see if you are “smoke-free”. This issue is still working its way through the court system to determine whether or not it’s legal for businesses to do so. In the meantime, business have fired smokers and refused to hire them.

Common reasons for not quitting

  • It’s stressful—this may “lead the pack” in realistic reasons that women don’t want to quit. Nicotine does cause psychological and physical dependence.
  • I’ll gain weight—no question this happens in most cases. In every case the cigarettes are worse for you health than the weight gain. Deal with one problem at a time. Expect to gain some weight and then make sure that your next lifestyle change you will address are the issues of diet and exercise.
  • I worry about the side effects of medications—not all women who quit require medications. But even if you’re taking medications remember that whatever side effects they may have (a) you’re not going to taking them for the rest of your life and (b) they are far less risky to your health than cigarettes!
  • I can’t afford the medications—that’s ridiculous! Consider that a pack of cigarettes are now costing 5-7 dollars a pack. If you’re smoking a pack a day that’s $1800 – 2500 dollars per year! You can pay for your medications and still have a lot of money left over. Landlords may not rent to you and friends may not allow you to smoke in their homes. Public buildings, hospitals,
  • Now is not a good time—perhaps you’re right about this one. If you’re in the midst of a divorce, a legal action, mourning over the loss of a loved one or dealing with an acutely sick family member or job loss it might be best to put this decision off for a few weeks or even a few months. But don’t use this as a chronic excuse. In most cases there’s never a better time than right now.

How do I get started?

There is no one right way to quit. Success has come from “going cold turkey”, acupuncture, hypnosis, nicotine replacement (lozenges, patches, gum), bupropion (Zyban or Wellbutrin) and verenicline (Chantix). And all of these methods have failed.

The key elements of successfully quitting involve four crucial steps:

  • Make a decision to quit
  • Set a quit date, and choose a quit plan
  • Manage withdrawal
  • Maintain success

Learn more about ways to quit by visiting the American Cancer Society’s “Kick the Habit” web page:

http://www.cancer.org/docroot/PED/ped_10_3.asp

Generally speaking smoking cessation requires a combination of approaches—behavioral and often medical. There is no single and simple approach for most people.

The American Cancer Society web-link above is a great resource. Additionally,

New York State has a great many resources available to its residents through the following links:

www.nysmokefree.com/newweb/default.aspx

www.nicotine-anonymous.org/

If you need help here are some resources available in Monroe County

American Lung Association
1595 Elmwood Avenue, Rochester NY 14620
585-442-4260 

Greater Rochester Area Tobacco Treatment Center
220 Alexander St. Suite 409, Rochester NY 14607
585-530-2050

NYS Smokers’ Quitline
1-866-NY-QUITS
1-866-697-8487

Medications you should be aware of

We are not advocating the use of medications as a “one size fits all approach”. However, many women have found medications very helpful for them while others experience no relief from nicotine withdrawal whatsoever. As of this writing Chantix has recently been approved by the FDA and we are just now getting more experience with this particular medication.

Some commonly used medications are:

Nicotine replacement therapy (NRT)

The AHA (American Heart Association) believes that nicotine replacement in the form of patches, lozenges, spray, inhaler and gum can help smokers quit as part of a comprehensive approach to smoking cessation. NRT almost doubles the chances of someone being able to successfully quit smoking. As already noted nicotine is a very addictive substance whose withdrawal leads to irritability, depression, food cravings and headaches. Learning the skills to quit smoking while dealing with nicotine withdrawal just makes it harder to successfully quit.

If you’re planning on using NRT it’s best to select a “quit time” for smoking cessation and plan the use nicotine replacement immediately. Remember that symptoms of nicotine withdrawal start in hours after smoking cessation. If you are using NRT use it consistently in the beginning and not just “every now and then”. Some experts even advocate a combination approach to NRT such as using a patch as a form of baseline suppression along with lozenges, gum or spray when cravings become more acute.

If you’re pregnant or have heart disease you should have a thorough discussion with your health care provider before using NRT.

What about smoking while taking NRT? It’s not unusual, in the early stages of cessation for someone to smoke a few cigarettes while using a nicotine patch or other forms of NRT. If you’re smoking only 2-3 cigarettes per day it’s okay to use the NRT with the understanding that your goal is stop smoking completely in a short period of time. However, if you find yourself smoking as much as you did before attempting to quit you should stop taking NRT and consult your health care provider.

Bupropion (Wellbutrin, Zyban)

Buproprion has a long history as a very useful adjuvant to smoking cessation. It can be used with nicotine replacement therapy and is generally very well tolerated provided that one starts it at a very small dose. Some women are very sensitive to this medication’s temporary side effects which include rapid heart rate, jitteriness, anxiety, headache, insomnia, nausea and dizziness. If you find that you’re experiencing severe side effects stop the medication but ask to be re-started at half the dose. These side effects may last 2-4 days but improve quickly thereafter. Generally, this medication is started at 150 mg and increased to 300 mg per day after a week. Some women require only a minimal dose to appreciate profound improvement in the withdrawal cravings. It is recommended that you avoid excess alcohol with this medication especially if you have alcoholism or severe depressed. Ask your health care provider, however, about alcohol use while taking Bupropion.

Bupropion is an anti-depressant in a category of medications known as dopamine-reuptake inhibitors. These medications are not sedating and do not have the sexual side effects in selective serotonin reuptake inhibitors (SSRIs). Some women are able to take bupropion for a few months and then taper themselves off the medication. Other women require bupropion for long periods of time in order to stay smoke free. Just remember that the long term use of bupropion is safe—that’s not true of cigarettes.

If you are taking bupropion you can minimize any sleep disturbance by taking it first thing in the morning.

Varenicline (Chantix)

Chantix was introduced by Pfizer in May of 2006 and is currently a less well known drug. As with any new drug its true effectiveness over a long period of time has not been studied on large populations. It has two mechanisms of action. First it mimics the effects of nicotine on the brain and helps stave off nicotine cravings. When used with nicotine it blocks some of the pleasurable effects of smoking. In clinical trials the main side effect was nausea (40%). Other significant side effects are insomnia (18-19%), headaches (15-19%) and abnormal dreams (9-13%). Many of the side effects can be reduced by starting at a low dose and gradually increasing the medication to a maintenance dose.

For the first week Chantix is taken at the dose of 0.5 mg per day for 3 days, followed by 0.5 mg twice a day for the next 4 days. That completes the first week on Chantix. Thereafter Chantix is taken at the dose of 1.0 mg twice daily for another 11 weeks. The total treatment program is 12 weeks though it has been approved for longer use in patients who have successfully quit.