“Smoking is the easiest thing to give up, I have given it up a hundred times,” commented Kareem, while puffing. The missing link was why did he restart ninety nine times? On the other extreme, a very accomplished doctor after undergoing bypass surgery and angioplasty told his wife in unambiguous terms, “I can leave you, but I cannot quit smoking.” Yet, there are many people who have given up smoking and feel very happy about it. They cannot stand the smell of cigarette and refused to inhale nicotine actively or passively. Having learnt their lesson, they openly question the wisdom behind smoking. They find it difficult to rationalize their previous ‘smoking status’. There has been an unending war against smoking and more than 60 million people around the world have quit smoking. You can, too! If you have never tried to quit smoking and failed, you are not alone. Many people try to quit smoking several times before they succeed.
This article will off you inspiration, reasons and ways to quit smoking. Every one knows and appreciates that smoking cigarettes is bad for health. Smoking causes more than a half million premature deaths worldwide each year. A smoker has a two to four time greater risk of sudden cardiac death than a nonsmoker. If a person has any other risk factors for heart disease, smoking synergistically increases overall risk of heart attack. Smoking predisposes to cancers of lung, upper respiratory airway, upper and one lower ends of food pipe and mouth. Smoking also predisposes a person to progressive narrowing of vessels involving brain and legs. Smoking worsens the health of the smoker and the people around the smoker. Infants and children exposed to passive smoking develop more respiratory problems like bronchitis, pneumonia, ear infections, coughing, wheezing, and worsen asthma. Passive smoke can cause heart disease and lung diseases in nonsmokers. Children of smokers are much more likely to smoke than children of nonsmokers. Pregnant women who smoke put their babies at risk for low birth weight, developmental problems, and even death of babies.
Can quitting smoking be beneficial?
The first question every smoker asks is, “ I have been painting my lungs black with smoking and depositing atheroma in my vessels and accumulating all types of carcinogens in my body, will it do any good if I stop smoking now?” Fortunately the answer is a BIG affirmative and various studies have documented the benefits of quitting smoking. When one stops smoking, the body starts repairing itself most immediately. The risk of heart attack, stroke, and cancer starts dropping immediately. Risk of a heart attack drops quickly within days as soon as one stops smoking. Stopping smoking reduces the risk of smoking-related cardiovascular disease by approximately 50% within one year, and to normal levels equivalent to people who never smoked within five years. The cough becomes less and less severe. Food starts to taste better. One’s sense of smell gets sharper and clothes start smelling laundry-fresh. The nicotine stains on hands or face start to disappear. Quitting smoking prolongs life and reduces the risk of disease including heart disease, heart attack, high blood pressure, lung cancer, throat cancer, emphysema, ulcers, gum disease and other conditions. One feels healthier and can endure prolonged activity by increasing stamina.
Can doctor’s intervention be effective?
All doctors have unwavering faith in the known hazards of smoking and the amply demonstrated benefits of cessation. But even now the literature continues to document the failure of doctors and other healthcare professionals to intervene with all of their patients who smoke. Even in the west, only half of current smokers report having been encouraged to quit and even fewer receiving specific counseling. Doctors have their own problems and report the following barriers to providing smoking interventions: a belief that they are not effective, poor intervention skills, a belief that patients do not want their doctors to intervene, and little time to fit intervention into their practice.
There is no doubt that healthcare settings like hospitals or clinics provide an important teachable moment for smoking cessation intervention specially after an acute illness like a heart attack, episode of angina or a procedure like angiography, angioplasty or bypass surgery. On average seventy-five percent of the adult population visit a physician at least once a year. In the doctor’s office, patients are often conscious of their health and most receptive to risk factor intervention. This provides an important opportunity for change. Many studies have documented that doctor-delivered counseling for smoking cessation can be effective. However, these studies have also shown that two factors are especially important: the doctor should receive skill-building training in counseling methods, and an office system that facilitates delivery of such counseling and enhances its effect, must be in place. We, in Pakistan lack both of them, but resources can be recruited for both as long as we appreciate and identify our goals. With such training and support, more intensive interventions produce a greater effect. In general, doctor-based primary-care interventions have yielded cessation rates of 10% to 20%, a threefold to fivefold increase over the 1-year maintained cessation rate of 4% seen in the general population.
What if smokers do not give up smoking, is it a wasted effort?
Even if patients do not give up smoking, smokers clearly value and appreciate their doctor’s advice and counsel. They believe that it is helpful in their efforts to quit smoking. Furthermore, they see the provision of such counsel as an indicator of caring on the part of the provider, and they appreciate it even if they do not intend to quit. Advice alone, taking no more than a few minutes, is of value. It helps to goad them on the path of ‘quit smoking’. For the healthcare professional interested and willing to do more, a patient-centered approach in which the patient is an equal partner is optimal. Such an approach helps smokers gain confidence in their ability to quit. Such an intervention process can be adapted to any time frame but optimally takes 5 to 10 minutes.
Multi-prolonged attack – any advantage?
The person who smokes often has one or more additional risk factors. There is substantial evidence for risk factor clustering, and the smoker is more likely than the nonsmoker to have elevated cholesterol and hypertension. Thus, smoking is often only one of several risk factors that must be addressed simultaneously. Important aspect of this is to recognize the importance of approaching all modifiable risk factors with equal zeal and vigor. Of all the risk factors smoking cessation is most cost effective and useful in more than one way. Patient-centered counseling methodology is as applicable to counseling for diet change or exercise as it is to smoking.
Specific multi-component programs entail treatment of patients who have already experienced a heart attack or an episode of unstable angina. One such developed by Debusk and colleagues demonstrated favorable effects on smoking, cholesterol, and exercise in patients who had suffered a heart attack, with an increase in 1-year smoking cessation rates from 53% to 70%. In this program trained nurse case managers follow computer-generated treatment program. We may not have access to such luxuries like computer generated programs and trained nurses but within our limited resources we can develop our own system and program and train our own staff.
Can drugs be helpful to quit smoking?
Most patients may not require any drugs but in certain smokers who consume more than fifteen cigarettes daily, craving for nicotine is strong enough to be substituted by other preparations of nicotine. Although various drugs have been used in the past to help smokers, nicotine replacement therapy has been shown to be more effective and should be an important constituent in all smoking cessation programs. Nicotine delivered through skin by special patches called transdermal nicotine, has been shown to be safe and effective. Its safety is amply documented in patients with known heart diseases. These are applied to skin and can be applied anywhere on the body. Nicotine-containing gum and the transdermal nicotine patch are equally efficacious an safe, but in general the patch is preferably for routine clinical use, although gum may be preferable in certain clinical situations like some persons prefer the oral stimulation that the gum provides. In addition, a nicotine nasal spray is now available in the west, and a nicotine inhaler is likely to be available soon.
There is little evidence available on the value of nicotine replacement therapy in light smokers less than fifteen cigarettes per day; in these patients, assessment of nicotine dependency should include time of starting smoking and number of cigarettes – whether increasing or decreasing. A new drug called ‘Chantix’ has been shown, in various studies to be effective in ‘motivated’ persons to quit smoking. The effects are apparent after a fortnight and the drug has to be continued for three months.
How you may feel after quitting?
There is a lot of mystery surrounding this topic. The world does not end after quitting smoking rather a new world unfolds – a world of reason, health and aroma of ‘good smell’. Most smokers who have quit smoking would not like to sit next to a smoker. Most of the quitters never want to restart smoking. Many of them regard smoking as absolute stupidity where a person is actually paying for his ill health and cancer. For sure this is one habit where one ‘invests’ in cancer and deadly diseases. Most people have no problems as all except for slight ‘off mood’ for a couple of days. So you should be mentally prepared for it. You may crave cigarettes, be irritable, feel very hungry, cough often, get headaches or have difficulty in concentrating. These symptoms of withdrawal occur because your body is used to nicotine, the active addicting agent within cigarettes.
When withdrawal symptoms occur within the first two weeks after quitting, stay in control. Think about your reasons for quitting. Remind yourself that these are signs that your body is healing and getting used to being without cigarettes. The withdrawal symptoms are only temporary. They are strongest when you first quit but will go away within 10 to 14 days. Your major inspiration should be to remember that withdrawal symptoms are easier to treat than the major diseases that smoking can cause. You may still have the desire to smoke, since there are many strong associations with smoking. People may associate smoking with specific situations, with a variety of emotions or with certain people in their lives. The best way to overcome these associations is to experience them without smoking.
A relapse is not a reason to lose hope. If you smoke again (called a relapse) do not lose hope. Seventy-five percent of those who quit relapse and most smokers quit three times before they are successful. If you relapse, don’t give up! Review the reasons why you wanted to become a nonsmoker. Plan ahead and think about the reasons for not smoking.
Steps You Must Take Today:
There are certain tricks which work very well for those who find quitting very difficult. If you have not decided to quit, try smoking one cigarette for two cigarettes so you can reduce by half. Smoke only half and throw away the other half. Smoke one less cigarette today and smoke two less tomorrow. Smoke in only one place and make it an inconvenient place. Keep your cigarettes, lighter, and ashtray in that one place and do not give yourself license to smoke anywhere else. Smoke with your opposite hand, the trick here is to break up your smoking routine. Allow yourself to run out of cigarettes before you buy another pack. Buy only one pack at a time and avoid buying cartons. Decide on a date to quit for good and write it down on your calendar and then stick to it.
To conclude, there is overwhelming evidence demonstrating both the cardiovascular hazards of smoking and the prompt benefits that occur with smoking cessation. The provision of advice alone significantly increases the smoking cessation rate, and even minimal counseling yields further benefits. Intervention with patients who have already suffered a cardiac event yields particularly significant benefits. The smoking status of all patients should be assessed and appropriate intervention offered to those who smoke. Doctors should be trained in counseling techniques and the use of nicotine replacement therapy. The universal application of these modalities will contribute to the continued decline of smoking and subsequently heart diseases and cancers.
_____________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
This article will off you inspiration, reasons and ways to quit smoking. Every one knows and appreciates that smoking cigarettes is bad for health. Smoking causes more than a half million premature deaths worldwide each year. A smoker has a two to four time greater risk of sudden cardiac death than a nonsmoker. If a person has any other risk factors for heart disease, smoking synergistically increases overall risk of heart attack. Smoking predisposes to cancers of lung, upper respiratory airway, upper and one lower ends of food pipe and mouth. Smoking also predisposes a person to progressive narrowing of vessels involving brain and legs. Smoking worsens the health of the smoker and the people around the smoker. Infants and children exposed to passive smoking develop more respiratory problems like bronchitis, pneumonia, ear infections, coughing, wheezing, and worsen asthma. Passive smoke can cause heart disease and lung diseases in nonsmokers. Children of smokers are much more likely to smoke than children of nonsmokers. Pregnant women who smoke put their babies at risk for low birth weight, developmental problems, and even death of babies.
Can quitting smoking be beneficial?
The first question every smoker asks is, “ I have been painting my lungs black with smoking and depositing atheroma in my vessels and accumulating all types of carcinogens in my body, will it do any good if I stop smoking now?” Fortunately the answer is a BIG affirmative and various studies have documented the benefits of quitting smoking. When one stops smoking, the body starts repairing itself most immediately. The risk of heart attack, stroke, and cancer starts dropping immediately. Risk of a heart attack drops quickly within days as soon as one stops smoking. Stopping smoking reduces the risk of smoking-related cardiovascular disease by approximately 50% within one year, and to normal levels equivalent to people who never smoked within five years. The cough becomes less and less severe. Food starts to taste better. One’s sense of smell gets sharper and clothes start smelling laundry-fresh. The nicotine stains on hands or face start to disappear. Quitting smoking prolongs life and reduces the risk of disease including heart disease, heart attack, high blood pressure, lung cancer, throat cancer, emphysema, ulcers, gum disease and other conditions. One feels healthier and can endure prolonged activity by increasing stamina.
Can doctor’s intervention be effective?
All doctors have unwavering faith in the known hazards of smoking and the amply demonstrated benefits of cessation. But even now the literature continues to document the failure of doctors and other healthcare professionals to intervene with all of their patients who smoke. Even in the west, only half of current smokers report having been encouraged to quit and even fewer receiving specific counseling. Doctors have their own problems and report the following barriers to providing smoking interventions: a belief that they are not effective, poor intervention skills, a belief that patients do not want their doctors to intervene, and little time to fit intervention into their practice.
There is no doubt that healthcare settings like hospitals or clinics provide an important teachable moment for smoking cessation intervention specially after an acute illness like a heart attack, episode of angina or a procedure like angiography, angioplasty or bypass surgery. On average seventy-five percent of the adult population visit a physician at least once a year. In the doctor’s office, patients are often conscious of their health and most receptive to risk factor intervention. This provides an important opportunity for change. Many studies have documented that doctor-delivered counseling for smoking cessation can be effective. However, these studies have also shown that two factors are especially important: the doctor should receive skill-building training in counseling methods, and an office system that facilitates delivery of such counseling and enhances its effect, must be in place. We, in Pakistan lack both of them, but resources can be recruited for both as long as we appreciate and identify our goals. With such training and support, more intensive interventions produce a greater effect. In general, doctor-based primary-care interventions have yielded cessation rates of 10% to 20%, a threefold to fivefold increase over the 1-year maintained cessation rate of 4% seen in the general population.
What if smokers do not give up smoking, is it a wasted effort?
Even if patients do not give up smoking, smokers clearly value and appreciate their doctor’s advice and counsel. They believe that it is helpful in their efforts to quit smoking. Furthermore, they see the provision of such counsel as an indicator of caring on the part of the provider, and they appreciate it even if they do not intend to quit. Advice alone, taking no more than a few minutes, is of value. It helps to goad them on the path of ‘quit smoking’. For the healthcare professional interested and willing to do more, a patient-centered approach in which the patient is an equal partner is optimal. Such an approach helps smokers gain confidence in their ability to quit. Such an intervention process can be adapted to any time frame but optimally takes 5 to 10 minutes.
Multi-prolonged attack – any advantage?
The person who smokes often has one or more additional risk factors. There is substantial evidence for risk factor clustering, and the smoker is more likely than the nonsmoker to have elevated cholesterol and hypertension. Thus, smoking is often only one of several risk factors that must be addressed simultaneously. Important aspect of this is to recognize the importance of approaching all modifiable risk factors with equal zeal and vigor. Of all the risk factors smoking cessation is most cost effective and useful in more than one way. Patient-centered counseling methodology is as applicable to counseling for diet change or exercise as it is to smoking.
Specific multi-component programs entail treatment of patients who have already experienced a heart attack or an episode of unstable angina. One such developed by Debusk and colleagues demonstrated favorable effects on smoking, cholesterol, and exercise in patients who had suffered a heart attack, with an increase in 1-year smoking cessation rates from 53% to 70%. In this program trained nurse case managers follow computer-generated treatment program. We may not have access to such luxuries like computer generated programs and trained nurses but within our limited resources we can develop our own system and program and train our own staff.
Can drugs be helpful to quit smoking?
Most patients may not require any drugs but in certain smokers who consume more than fifteen cigarettes daily, craving for nicotine is strong enough to be substituted by other preparations of nicotine. Although various drugs have been used in the past to help smokers, nicotine replacement therapy has been shown to be more effective and should be an important constituent in all smoking cessation programs. Nicotine delivered through skin by special patches called transdermal nicotine, has been shown to be safe and effective. Its safety is amply documented in patients with known heart diseases. These are applied to skin and can be applied anywhere on the body. Nicotine-containing gum and the transdermal nicotine patch are equally efficacious an safe, but in general the patch is preferably for routine clinical use, although gum may be preferable in certain clinical situations like some persons prefer the oral stimulation that the gum provides. In addition, a nicotine nasal spray is now available in the west, and a nicotine inhaler is likely to be available soon.
There is little evidence available on the value of nicotine replacement therapy in light smokers less than fifteen cigarettes per day; in these patients, assessment of nicotine dependency should include time of starting smoking and number of cigarettes – whether increasing or decreasing. A new drug called ‘Chantix’ has been shown, in various studies to be effective in ‘motivated’ persons to quit smoking. The effects are apparent after a fortnight and the drug has to be continued for three months.
How you may feel after quitting?
There is a lot of mystery surrounding this topic. The world does not end after quitting smoking rather a new world unfolds – a world of reason, health and aroma of ‘good smell’. Most smokers who have quit smoking would not like to sit next to a smoker. Most of the quitters never want to restart smoking. Many of them regard smoking as absolute stupidity where a person is actually paying for his ill health and cancer. For sure this is one habit where one ‘invests’ in cancer and deadly diseases. Most people have no problems as all except for slight ‘off mood’ for a couple of days. So you should be mentally prepared for it. You may crave cigarettes, be irritable, feel very hungry, cough often, get headaches or have difficulty in concentrating. These symptoms of withdrawal occur because your body is used to nicotine, the active addicting agent within cigarettes.
When withdrawal symptoms occur within the first two weeks after quitting, stay in control. Think about your reasons for quitting. Remind yourself that these are signs that your body is healing and getting used to being without cigarettes. The withdrawal symptoms are only temporary. They are strongest when you first quit but will go away within 10 to 14 days. Your major inspiration should be to remember that withdrawal symptoms are easier to treat than the major diseases that smoking can cause. You may still have the desire to smoke, since there are many strong associations with smoking. People may associate smoking with specific situations, with a variety of emotions or with certain people in their lives. The best way to overcome these associations is to experience them without smoking.
A relapse is not a reason to lose hope. If you smoke again (called a relapse) do not lose hope. Seventy-five percent of those who quit relapse and most smokers quit three times before they are successful. If you relapse, don’t give up! Review the reasons why you wanted to become a nonsmoker. Plan ahead and think about the reasons for not smoking.
Steps You Must Take Today:
There are certain tricks which work very well for those who find quitting very difficult. If you have not decided to quit, try smoking one cigarette for two cigarettes so you can reduce by half. Smoke only half and throw away the other half. Smoke one less cigarette today and smoke two less tomorrow. Smoke in only one place and make it an inconvenient place. Keep your cigarettes, lighter, and ashtray in that one place and do not give yourself license to smoke anywhere else. Smoke with your opposite hand, the trick here is to break up your smoking routine. Allow yourself to run out of cigarettes before you buy another pack. Buy only one pack at a time and avoid buying cartons. Decide on a date to quit for good and write it down on your calendar and then stick to it.
To conclude, there is overwhelming evidence demonstrating both the cardiovascular hazards of smoking and the prompt benefits that occur with smoking cessation. The provision of advice alone significantly increases the smoking cessation rate, and even minimal counseling yields further benefits. Intervention with patients who have already suffered a cardiac event yields particularly significant benefits. The smoking status of all patients should be assessed and appropriate intervention offered to those who smoke. Doctors should be trained in counseling techniques and the use of nicotine replacement therapy. The universal application of these modalities will contribute to the continued decline of smoking and subsequently heart diseases and cancers.
_____________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
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