Just quit smoking

Strategies to help you quit smoking successfully.

TOBACCO epidemic death toll:

·100 million dead in the 20th century

·By 2030, there will be more than eight million deaths every year

·By 2030, more than 80% of tobacco deaths will be in developing countries

·One billion estimated deaths during the 21st century – WHO report on the global Tobacco epidemic, 2008

Tobacco use is a major cause of premature and preventable death in the world. It is currently responsible for the deaths of about 10,000 Malaysians each year and more than five million worldwide. If current smoking patterns continue, it will cause more than eight million deaths annually by 2030. It has been shown that up to 50% of long-term smokers will die of a smoking-related disease.
According to the World Health Organization, 95% of smokers who attempted to quit without assistance did not make it. – Reuters

Cigarettes and other smoked tobacco products rapidly deliver nicotine to the brain immediately after smokers inhale. But because the effects of smoked tobacco last only a few minutes, smokers experience withdrawal symptoms unless they continue to smoke.

Although standard cigarettes are the most commonly used type of smoked tobacco, other smoked tobacco products, such as bidis, kreteks and shisha, are gaining popularity – often in the mistaken belief that they are less hazardous to health. However, all forms of tobacco are lethal.

Smoked tobacco in any form causes up to 90% of all lung cancers and is a significant risk factor for strokes and fatal heart attacks.

The feel-good effect of nicotine reinforces the sustained need for tobacco, thus creating nicotine dependence. Because nicotine is so addictive, quitting smoking is one of the hardest things to do.

According to Assoc Prof Mohamad Haniki Nik Mohamed, Head for Department of Pharmacy Practice, smokers not only need to deal with physiological changes but also psychological and physical dependence to be successful at quitting and staying quit.

When you stop smoking, the absence of nicotine in your system will cause withdrawal symptoms. Among the symptoms you may experience are restlessness, fatigue, dizziness and irritability. Heavy perspiration, diarrhoea or constipation, and headache are common symptoms as well.

Learning to deal with withdrawal symptoms is an important part of the quitting process.

Assoc Prof Haniki highlighted the fact that many smokers want to quit, but are unaware that professional assistance is available to overcome nicotine dependence.

Most smokers attempting to quit today still make unaided quit attempts, or what is commonly known as “cold turkey”. According to the World Health Organization, 95% of smokers who attempted to quit without assistance did not make it. Most smokers take five to seven attempts, without assistance, before succeeding.

There is growing evidence that smokers who receive clinician’s advice and assistance with quitting smoking reported greater satisfaction with their healthcare than those who do not. A series of new data presented at the 2008 annual congress of the Society for Research on Nicotine & Tobacco (SRNT) reinforces the need for healthcare professionals to proactively support smoking cessation.

Assoc Prof Haniki said: “There are numerous effective medications available for nicotine dependence, and clinicians (physicians, pharmacists, nurses, dentists, etc) should encourage their use by all smokers attempting to quit.”

Medications approved as first-line for smoking cessation treatment which reliably increase long-term smoking abstinence are divided into two groups, non-nicotine and nicotine based.

The two current non-nicotine based medications are bupropion SR (sustained release) and varenicline, the latest drug launched in the local market recently. The nicotine based products include: nicotine gum, nicotine inhaler, nicotine lozenge and nicotine patch.

“Some smokers would require a combination of the above medications, but this should be done with the assistance and supervision of a healthcare professional,” added Assoc Prof Haniki. “In Malaysia, all of the mentioned medications for smoking cessation are available through the pharmacist without prescriptions, except for bupropion SR and varenicline, which are prescription items. Smokers need to discuss with their pharmacists or doctors to determine the right course of therapy.”

Both counselling and medication are effective when used independently for treating nicotine dependence. However, the combination of counselling and medication is even more effective than either alone.

Based on Assoc Prof Haniki’s experiences in smoking cessation, a support programme is also crucial to the success in quitting smoking. Do remember to get the support of a close friend, co-worker and family members.

Some may find cessation programmes using the telephone (help or quitline) as well as the internet to be supportive and useful. When in need, reach out to a pharmacist or doctor for a helping hand or tips on coping skills.

As the saying goes, “If you fail to plan, then you plan to fail”.

Assoc Prof Haniki advises smokers who want to quit to have a quit plan, which can help a smoker significantly achieve smoking cessation. You should plan on the quitting strategy, i.e., cutting down (gradual reduction) or cold turkey (giving up totally and abruptly), methods to overcome withdrawal symptoms, especially craving and how to stay tobacco-free. Knowing the important benefits of quitting, a list of situations in which you smoke and the reasons for smoking, for example, should help you identify what are your “triggers” to lighting up – and finally, a list of healthy alternatives to replace smoking.

Assoc Prof Haniki further elaborates that in order to get the quitting plan moving, smokers should choose a quit date that is the nearest (eg within two weeks or so) and most suitable (eg birthdays, anniversary, etc) because simply reducing without absolute cessation does not work.

A quit date is the beginning of becoming smoke free, and towards a new, healthier life. During the initial week, you may experience more intense withdrawal symptoms. The use of appropriate medication as suggested by your pharmacist or doctor should help you reduce these symptoms significantly.

In addition, remember DEAD, an acronym for “Delay, Escape, Avoid and Distract”. Apply one or more each time you feel like having a cigarette. Also remember that the intensity of the withdrawal symptoms gradually decrease with time. So, stick to the plan and avoid “slips” as much as possible to ensure a successful attempt as well as preventing relapse.

Other tips to quitting successfully, provided by Assoc Prof Haniki, include drinking a lot of water (six to eight oz. glasses are ideal) to flush tobacco-related toxins from your body and facilitate expulsion of phlegm.

Eat more fresh fruits and vegetables and limit your fat intake. This would also be useful in preventing the weight gain after quitting, as often experienced by smokers.

Another tip to prevent weight gain associated with cessation is to include more physical activities in your daily routine, and exercise is also a great way to improve your stamina and health.