by Kenneth Capek, MPA, RRT
According to the CDC, 19% of Americans still smoke. Approximately 1200 people die from smoking related disease every day. Smoking is still the main cause of COPD and the number one cause of death among smokers is heart disease. Smoking will kill one-half of all smokers who smoke over 25 cigarettes a day. Cigarettes are clearly a weapon of mass destruction.
So what are we doing to address this major health problem? Not enough, but there are some new treatment options that healthcare providers can use to help smokers quit. The main methods for quitting smoking are still available and successful; cold turkey, counseling, Zyban, Chantix, and nicotine reduction or weaning methods such as nicotine replacement therapy (NRT) or brand-switching. New recommendations have been published to enhance the success of these methods. The most important is to use a combination of some of these methods to achieve success. For example, if someone smokes more than a pack of cigarettes a day or smokes a high nicotine level brand, they are probably getting at least 42 mg of nicotine a day. The highest-level patch is 21 mg which represents a 50% decrease on day 1 of the smokers plan. That’s a big first step for what should be a gradual, measured weaning plan and therefore has a higher risk of failure due to more intense, initial withdrawal symptoms. We can make it easier for smokers to quit by supplementing the patch with other nicotine delivery methods so the decrease in nicotine is gradual. This can be accomplished for example by using the patch with some nicotine mini-lozenges (2 or 4mg). A few 2-4mg lozenges added throughout the day could keep someone on the plan and moving them toward success. Another method is to gradually replace the number of cigarettes smoked daily with lozenges over period of weeks or months. Brand switching is another method but you must know the nicotine level for each brand chosen for the weaning process to succeed. NRT dose titration can be accomplished if the smoker increases their dose when experiencing cravings and withdrawal symptoms and decreasing doses with feelings of dizziness and nausea (overdosing). Weaning is meant to be a slow, stress-minimizing process.
Electronic cigarettes, which are not approved by the FDA as a smoking cessation device, are the latest craze and even the big tobacco companies are getting into the business. So how safe are they? They are still nicotine delivery devices which will keep smokers addicted, but on the positive side, they lack the 4,000 other deadly chemicals found in cigarette smoke. I question whether there is potential harm to others from secondhand nicotine aerosols, especially since smokers are using these “smokeless” devices in more smoke free locations. The policies and testing regarding these products are still lacking. These devices could only be used as “weaning” devices if the dose of nicotine delivered is accurately known and a multi-level dose reduction can be administered.
Counseling along with medications is still proven to increase quitting success rates and respiratory therapists should be uniquely qualified to speak to smokers to help them quit. We know respiratory disease and function and the damage smoking causes. If you are not comfortable about the how to specifically help, there are many sources available. The CDC site is a good start!
