Questions on Stop Smoking

Dear Dr. Spence,
How can I stop smoking?
I have heard there are some new medications that may help me.
Signed,
Nick O’Tine

Dear Nick,
Cigarette smoking is one of the single biggest modifiable risks known in health care. We all know its effects on the lungs, but it is directly linked to six of the eight most common causes of death. It can affect nearly every organ system, therefore, attempts at smoking cessation, though difficult, are absolutely worthwhile. Based on data from the Surgeon General’s report from the United States Department of Health, at day one after the last cigarette there is no further damage to the skin from smoking. At day two, carbon monoxide levels in the blood return to normal. At two to twelve weeks, lung function may increase and circulation may improve. At one year, risk of coronary artery disease is one-half of that of a smoker’s and at ten years, the risk of lung cancer is half as well. Finally, at fifteen years, the risk of stroke and coronary artery disease are equivalent to that of a nonsmoker. A host of agents have been utilized to assist patients in their quest to stop smoking; most have shown minimal to moderate benefit. These include tried and true products like patches, gum, lozenges and inhalers that mimic the hand-to-mouth "psychologic" aspects of smoking. Others have tried zyban (also marketed as wellbutrin for depression) albeit with mixed results. The newest agent in the war against smoking is varenicline (chantix), a nicotine receptor blocker that appears to block the ability of nicotine to exert its effect, namely the stimulation of the central nervous system. Further, the stimulation of dopamine centers in the brain appears to be the driving force in the reward and reinforcement of smoking. Chantix appears to blunt this "reward" system. Studies indicate a fairly high quit rate in those taking chantix. My own experience is quite positive. I venture to guess that 60-75% of my patients have had success, even the most hardened, yellow fingered professional smokers! Side effects include nausea (30% in studies), sleep disturbances, constipation, flatulence and vomiting, though I have not seen a tremendous amount of these issues pop up. There may be a worsening of pre-existing psychiatric illness, so care should be taken in those patients with a history of any mental disorder. Cost can be prohibitive – imagine that! The up-front cost may exceed $100 but the long-term savings may be magnified 10-fold, both monetarily and from an overall health standpoint. In my clinic, it appears that 50% or more may quit with the first prescription (starter pack) while the rest may require a second month (continuation pack). The company recommends at least a twelve week period of therapy with a possible extension out to 24 weeks.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.