Smoking cessation

Combining pharmacotherapy with behavioral interventions is the most effective way to help smokers sustain abstinence.
Smoking cessation reduces the risk for all cause mortality, cardiovascular diseases, chronic obstructive pulmonary disease, adverse reproductive health outcomes, and 12 types of cancer.
Combining pharmacological therapy and behavior therapy is the most effective smoking cessation approach.
The combination leads to the best results for achieving and maintaining abstinence from smoking or smoking reduction for those not ready to quit.
Pharmacotherapy helps reduce nicotine withdrawal symptoms and or minimizes the favorable effects experienced while smoking, while behavioral interventions seek to change learned behaviors associated with smoking.
Smoking sensation is a challenge as it requires individuals to overcome both physical nicotine dependence and long-standing rewarding behavior.

Cigarette smoking causes 480,000 premature deaths annually due to a twofold increase of cardiovascular disease and the 20 fold increase of lung cancer.

Cigarette smoking has reached the record low, with a decline to 14% among US adults.

Two thirds of smokers want to quit, but only 7.5% succeed.

Approximately 34 million US adults continue to smoke cigarettes.

The risk of coronary artery disease drops promptly but the risk of lung cancer does not.

Within a few months of quitting smoking, most form a smokers have an improved blood circulation and lung function and less coughing.

Quitting smoking before 40 years of age reduces the risk of death from a tobacco related disease by approximately 90%.

Former smokers who have not smoked for one year have half the risk of heart disease as that of smokers and at five years the risk becomes the same as that of lifelong non-smokers.

Risk of coronary artery disease decreases by one-third, two years after smoking cessation.

Smoking sensation at any time after a cancer diagnosis is associated with improved outcomes, enhanced quality of life, and reduced disease among cancer survivors.

Smoking tobacco after a diagnosis of cancer, decreases efficacy of cancer treatments, increases side effects of cancer treatments, and increases the risk of death from all causes, and adds to treatment complexities and cost of cancer care, as well as adding to new or worsening comorbidities.

Former smokers who have not smoked for five years have half the risk of smoking related cancers of the lung, mouth, throat, esophagus, cervix, and bladder as that of smokers and at 15 years former smokers’ risk for these cancers becomes the same as that of lifelong non-smokers.

In a Korean study cancer risk among people who had stopped smoking for at least 15 years was about 50% of the risk of those who continue smoking.

Individuals who stop smoking before age 50 had a much lower chance of developing lung cancer than those who quit after age 50.

Lung cancer patients who continue to smoke have more severe side effects while undergoing treatment, lower response rates to therapy, lower five years survival rates, and a higher risk of secondary cancers or lung cancer recurrence ithan patients who quit smoking.

Compared with never smokers, former heavy smokers may have a significantly elevated cardiovascular disease risk beyond five years after cessation (Duncan MS)

About 50% of American adults have smoked and about half of them have quit.

Abrupt cessation of smoking is as effective as gradual reduction.

41% of smokers attempt to quit smoking each year but only 10% achieve and maintain abstinence.

The average smoker attempts to quit six times before achieving long-term tobacco abstinence.

Most individuals relapse within three months of quitting smoking.

More than 60% of US adults who have ever smoked are  now former smokers.

Older adults are half as likely to try to quit smoking as smokers aged 18 to 24 i.e., 25.3% versus 53.1%.

Success rate without help is only 4-7%.

More than 2/3 of current smokers are interested in quitting, but only 20% report interest in quitting in the next 30 days.

About 6% of smokers quit smoking each year.

Women have a more difficult time quitting smoking cigarettes than men, both for current and former female smokers the number of years of smoking has increased.

The difficulty quitting smoking can be assessed by knowing the number of cigarette smoke daily and whether the first days cigarette is smoked within 30 minutes of waking.

Other factors that are associated with an increased inability to quit smoking include earlier age of smoking initiation, comorbid psychiatric or other substance-abuse disorders, another smoker in the household, a little social support for quitting, and an individual’s low confidence level to do so.

Associated with weight gain.

Associated with a reduction in readmission rates and up to 50% lower mortality in patients with established cardiovascular disease.

May be more effective in reducing mortality inpatients with myocardial infarction than aspirin, beta-blocker or ACE inhibitor therapy.

Only one third to one half of patients that smoke and have an myocardial infarction quit smoking.

Smokers are 3 times more likely to have an MI, and persistent smoing after an acute MI carries a 50% higher chance of death in the firts two years.

Smoking cessation highly cost-effective in patients with acute MI, as intervention with smoking cessation can prevent 1 death for every 11 patients who stp smoking (Critchley J et al).

Smoking cessation benefits virtually all smokers, no matter how heavily or how long they have smoked, or how ill or how old they are when they stop (Fiore MC. et al).

After myocardial infarction, cardiovascular mortality falls 36% over two years, if they stop smoking.

Smoking cessation 4 to 8 weeks before surgery reduces postoperative complication rates by half to two thirds.

Quitting smoking before surgery is beneficial as smoking is associated with increased rates of postoperative complications and mortality, impaired wound healing, increased infection rates, more pulmonary complications, longer postoperative hospital stays and a higher postoperative mortality rate.

Smoking-related impairment in wound healing decreases and pulmonary function improves within 4-8 weeks of smoking cessation

Decreases the risk of squamous cell carcinoma of the esophagus substantially.


Counseling and pharmacologic therapy of the most effective measures, and the more intensity intervention the greater the probability of success.

A minimum of 12 weeks of drug therapy, or typically longer, is recommended for initial treatment of quitting attempt.

Maintenance therapy can be extended to promote continued absence for a year or more with longer courses of certain cessation regimens may be associated with higher rates of abstinence.

Three classes of first-line drugs available include nicotine replacement therapy, sustained release buproipion hydrochloride and varenicline tartrate.

All three treatment classes are associated with increased odds of quitting compared with placebo: its ratio for nicotine reduction replacement therapy was is 1.84, bupropion 1.82,and varenicline 2.80 (Cahill K et al).

Pharmacological treatments help smokers adapt to the absence of nicotine after quitting smoking by reducing nicotine withdrawal symptoms.
Nicotine replacement therapies deliver nicotine to nicotinic receptors in the CNS in the lower dose and at a substantially slower rate than tobacco cigarettes.

Cognitive behavioral therapy improves the rate of smokers who are ready to quit smoking, by enhancing motivation, increasing social support, and identifying and managing nicotine withdrawal symptoms, cravings and temptations.

For tobacco dependent adult in whom treatment is being initiated, varenicline is recommended over nicotine patches, bupropion and e-cigarettes.

Among smokers with serious mental illness who attain abstinence with varenicline and cognitive therapy, additional maintenance therapy with varenicline prolongs abstinence rates compared with placebo (Evins AE et al).

Varenicline outperforms bupropion, all forms of nicotine replacement therapy and placebo with 26% abstinence rate to 24 weeks to follow up among participants without psychiatric diagnoses.

Among smoking adults there was no significant difference in smoking abstinence at 52 weeks among those treated with combined varenicline plus nicotine patch therapy versus varenicline  monotherapy: findings do not support the use of combined therapy or extended treatment duration.

The gradual reduction in the number of cigarettes smoked may be as effective as abrupt cessation of smoking.

Transcranial magnetic stimulation is available for patients to quit smoking.
Smoking sensation may lead to nicotine withdrawal syndrome, and the use of pharmacotherapy may increase the risk for seizures, depressed mood, and anxiety.
Varencline compared to other agents is associated with lower rates of serious adverse effects.
Varencline plus  nicotine patches is associated with an increase in abstinence compared  with Varencline alone.
The addition of an electronic nicotine delivery system to standard smoking cessation counseling results in greater absence from tobacco use amongst smokers than smoking cessation counseling alone.

Leave a Reply

Your email address will not be published. Required fields are marked *