Smoking: how to quit this bad habit?

Nicotine is a highly addictive drug contained in tobacco and is the main component of cigarette smoke.

This drug stimulates the reward mechanism in the brain, which activates during the pleasant sensations in the same way as most other similar addictive drugs. People smoke to quench their addiction to nicotine, but they also have to inhale hundreds of carcinogenic substances, harmful gases and chemical additives that are part of cigarette smoke. These components are responsible for many health problems among smokers.

Epidemiology of smoking

The percentage of Americans who smoke cigarettes began to decline since 1964, when the Chief Surgeon first announced the link between smoking and ill health. But about 45 million adults (almost 23%) still smoke. Smoking is most common among men, people with less than 12 years of education, people living on the edge or below the poverty line, non-Hispanic white, non-Hispanic blacks, American Indians and Aboriginal people in Alaska. Smoking is the least common among Americans of Asian descent.

Most people start smoking as a child. Children aged 10 actively experiment with cigarettes. Every day, more than 2,000 people begin to smoke, 31% of them start before they reach 16 years of age, with the age of smoking beginning to decline. Risk factors for beginners to smoke in childhood include the parental example, the desire to imitate peers and celebrities; bad progress in school; high-risk behaviors (for example, excessive dieting among boys or girls, physical struggle, drunk driving) and inability to solve life problems.

Smoking causes damage to almost every organ of the human body; Since 2000 - is the leading cause of death in the US, statistics show about 435 000 deaths per year. About 1/2 of today's smokers will die prematurely from a disease directly caused by smoking, losing 10-14 years of life on average (7 minutes per cigarette). 65% of deaths caused by smoking - from ischemic heart disease, lung cancer and chronic lung disease; the rest is from non-cardiovascular diseases (eg, heart attack, aortic aneurysm), other cancers (eg, bladder, occipital region, esophagus, kidney, larynx, oropharynx, pancreatitis, stomach, throat), pneumonia and perinatal conditions , premature birth, low birth weight, sudden infant death syndrome). In addition, smoking is a risk factor for other disorders that cause serious illness and disability, such as acute myelocytic leukemia, frequent acute respiratory infections, cataracts, reproductive harm (infertility, unexpected abortion, displaced pregnancy, premature menopause) and periodontitis.

[1], [2], [3], [4], [5], [6], [7], [8], [9],

Throwing

More than 70% of smokers every year apply for first aid and care in the relevant institutions, but only a small number leaves them, receiving recommendations and information about treatment to help them in life after smoking. Most smokers under the age of 18 believe that they will not smoke after 5 years, but year after year it is reported that such smokers tried to quit smoking after a year. However, studies show that 73% of people who smoke every day during the school period continue to smoke in the same volume and 5-6 years later.

Second hand smoke

Passive inhalation of cigarette smoke (secondary smoke, environmental tobacco smoke) has serious consequences for the health of children and adults. The risk for newborns, infants and children includes low birth weight, sudden infant death syndrome, asthma and other related respiratory illnesses and otitis media. Children who inhale the smoke of cigarettes miss more school days due to illnesses than children who have not undergone such influence. In smoking-related fires, 80 children die each year and nearly 300 more are maimed; they are the leading cause of deaths resulting from unintentional fires in the US. Treatment of children from smoking-related diseases is estimated to cost $ 4.6 billion a year. In addition, 43,000 children each year lose one or more caregivers who die from smoking-related illnesses.

Passive smoking in adults is associated with the same neoplastic, respiratory and cardiovascular diseases that threaten active smokers. In general, secondary smoke is estimated to be responsible for 50,000-60,000 deaths per year in the US. These results led to the fact that 6 states and municipalities of the United States banned smoking in the workplace in order to protect the health of workers and other people from the risk of exposure to environmental tobacco smoke.

Symptoms of quitting smoking

Smoking cessation often causes intense signs of abstinence, primarily a craving for cigarettes, as well as anxiety, depression (mostly mild, but sometimes deep), inability to concentrate, irritability, insomnia, drowsiness, impatience, hunger, sweating, dizziness , headaches and digestive disorders. These signs are most unbearable at week 1, improvement occurs at 3-4 weeks, but many patients start smoking again when symptoms are at their peak. It is very common average weight gain of 4-5 kg, and this is another reason for relapse. Smokers with ulcerative colitis often experience an exacerbation soon after quitting smoking.

Treatment of nicotine addiction

The craving for smoking and the signs of failure are strong enough, so even realizing many health risks, a large number of smokers often do not want to try to quit, and those who tried often fail. A small number of smokers quit smoking at the first attempt, but most continue to smoke for many more years, long interrupting smoking cessation for resumption. An optimal approach based on the testimony of patients, especially those who do not want to quit, or those who have not yet thought about quitting, should be guided by the same principles that guide the treatment of chronic illness, namely:

• Continuous assessment and control of smoking status.
• Setting realistic goals, including those that are not associated with total smoking cessation, like temporary abstinence and reduced consumption (reducing smoking can increase the motivation to quit, especially when combined with nicotine replacement therapy).
• Use of various interventions (or combinations thereof) for different patients in the manner that is necessary.

Effective intervention requires 3 main components: recommendations, treatment with medications (for patients without contraindications) and consistent identification and intervention in the life of the smoker.

The approach associated with the recommendations is similar for children and adults. By the age of 10, children should be examined for smoking and risk factors. Parents should be advised to support the house free from smoking and to inculcate the addiction to such an atmosphere for their children. Cognitive-behavioral therapy, which includes the notion of the consequences of using tobacco, providing motivation for quitting, preparing for it and providing strategies for supporting abstinence after failure, is effective in treating nicotine-dependent adolescents. Alternative approaches to quitting, such as hypnosis and acupuncture, have not been adequately studied and can not be recommended for regular use.

Recommendations

Tips and recommendations begin with 5 main points: ask at each visit, whether the patient smokes, and document the response; clear, strong-willed language, understandable to the patient, advise all smokers to quit smoking; Assess the willingness of a smoker to quit smoking within the next 30 days; help those who wish to make an attempt to stop smoking with advice and treatment; schedule a regular visit, preferably within the next week after quitting smoking.

For smokers who want to quit, clinicians should set a clear date for quitting smoking within 2 weeks and emphasize that complete abstinence is better than reducing the dose. Past experiences of quitting smoking can be considered in terms of effectiveness - what helped and what did not help; any risk associated with quitting should be taken into account in advance. For example, alcohol use is associated with disruptions, so there should be a ban on alcohol or abstinence. In addition, quitting is more difficult if there is another smoker in the house; spouses and cohabitants should be encouraged to quit smoking at the same time. In general, patients should be instructed that social support should be developed in the family and among friends so that the attempt to quit is successful; Clinicians should strengthen the willingness of close people to help. Although these strategies of the recommendations bear common sense and provide important and patient support to the patient, there is very little scientific evidence to confirm the usefulness of their use in quitting smoking.

Approximately 40 states in the US have a smoking cessation line, which can provide additional support to smokers trying to quit smoking. Telephone numbers can be found within the state or from the Американского общества ракаAmerican Cancer Society (1-800-ACS-2345).

Drugs to stop smoking

Drugs for smoking cessation, the efficacy and safety of which has been proven, include bupropion and nicotine (in chewable form, in the form of a sucking tablet, inhaler, nasal spray or adhesive strip). Some evidence suggests that bupropion is more effective than the replacement of nicotine. All forms of nicotine are equivalent as monotherapy, but the combination of an adhesive band of nicotine with a chewable tablet or nasal spray increases the long-term abstinence from smoking compared to any form individually. Nortriptyline 25-75 mg orally at bedtime may be an effective alternative for smokers who are prone to depression. The choice of the drug depends on the clinician's knowledge of the drug, the patient's opinion and his previous experience (positive or negative) and contraindications.

Medicinal therapies used to stop smoking

Drug therapy	Dose	Duration	Side effects	Comments
Bupropion SR	150 mg every morning for 3 days, then 150 mg 2 times a day (starting treatment for 1-2 weeks before quitting)	Initially 7-1 2 weeks, you can take up to 6 months	Insomnia, dry mouth	Only by appointment of a doctor; contraindicated in patients with a history of seizures, eating problems, use of monoamine oxidase inhibitor within the last 2 weeks
Nicotinic chewing gum	When smoking 1-24 cigarettes a day, 2 mg of chewing gum (up to 24 gum per day) When smoking 25 or more cigarettes a day (up to 24 gum per day)	Up to 12 weeks	Pain in the mouth, indigestion	Only without a prescription
Nicotine tablets	When smoking more than 30 minutes after walking - 2 mg; when smoking less than 30 minutes after walking - 4 mg Schedule for both doses - 1 every 1-2 hours for 1-6 weeks; 1 every 2-4 hours for 7-9 weeks; 1 every 4-8 hours for 10-12 weeks	Up to 12 weeks	Nausea, insomnia	Only without a prescription
Nicotine inhaler	6-16 cartridges per day for 1-12 weeks, then decrease over the next 6-12 weeks	3-6 months	Local irritation of mouth and throat	Only by appointment of a doctor
Nicotine Nasal Spray	8-40 doses per day 1 dose = 2 sprays	14 weeks	Irritation in the mouth	Only by appointment of a doctor
Nicotinic plaster	21 mg / 24 h for 6 weeks, then 14 mg / 24 h for 2 weeks, then 7 mg / 24 h for 2 weeks. When smoking more than 10 cigarettes a day, start with a dose of 21 mg; when smoking less than 10 cigarettes a day, start with a dose of 14 mg or 15 mg / 16 hours when smoking more than 10 cigarettes a day	10 weeks 6 weeks	Local skin reaction, insomnia	Without prescription and doctor's prescription

Contraindications to the adoption of bupropion include prehistory of seizures, eating disorders and the use of monoamine oxidase inhibitor for 2 weeks. Nicotine replacement should be used cautiously by patients with a certain degree of risk of developing a cardiovascular disorder (people with myocardial infarction for 2 weeks, with severe arrhythmia or angina). Contraindication to the use of chewing nicotine is the temporomandibular joint syndrome, and for the adhesive strips of nicotine - a serious local sensitization. All these medicines should be used with great care, if at all, by pregnant and breast-feeding women and adolescents, and because nicotine poisoning is likely, and evidence of the usefulness of such medications is lacking, by patients who smoke less than 10 cigarettes a day. These drugs slow down, but do not prevent weight gain.

Despite its proven effectiveness, less than 25% of smokers trying to stop smoking use smoking cessation drugs. The reasons for this include low insurance coverage, doctors' doubts about the safety of simultaneous smoking and the use of nicotine replacement, and frustration over past unsuccessful attempts to quit smoking.

Today's current therapies for quitting smoking use a vaccine that intercepts nicotine before nicotine reaches its specific receptors and rimonabant, a cannabinoide CB 1 receptor antagonist.

Forecast

More than 90% of the approximately 20 million smokers in the US who try to quit every year, resume smoking within a few days, weeks or months. Almost half reported that they tried to quit last year, usually using a method called "cold turkey" or another approach that did not work. The percentage of success is 20-30% among smokers who use the recommendations of a doctor or medication.

[10], [11], [12], [13], [14], [15]

Other types of tobacco

Smoking cigarettes is the most harmful form of tobacco use, although smoking pipes, cigars and smokeless tobacco can also have negative consequences. In the United States, smoking only a tube is not very common (less than 1% of people over 12 years old), although this type of smoking is gradually spreading among secondary and high school students since 1999. About 5.4% of people over 12 years of age smoke cigars. Although the percentage has dropped since 2000, people under the age of 18 constitute the largest group of new cigar smokers. The risk of smoking cigars and tubes - the development of cardiovascular disease, chronic obstructive pulmonary disease, cancer of the mouth, lungs, larynx, esophagus, large intestine, pancreas, as well as periodontal disease and tooth loss.

About 3.3% of people over 12 years of age use tobacco without smoke (chewing tobacco and snuff). The toxicity of smokeless tobacco depends on the manufacturer. The risk includes the development of cardiovascular disease, oral disorders (eg, cancer, gum recession, gingivitis, periodontitis and its effects) and teratogenicity. Refusal to smoke smokers smokeless tobacco, pipes and cigars occurs in the same way as cigarette smokers. The probability of success is higher in people who use tobacco without smoke. However, the success rate of cigar and tube smokers is not as well documented and is affected by the simultaneous use of cigarettes, as well as whether smokers smoke.