Smoking Cessation

The dangers of smoking have been well known for many years. In the UK, it is estimated that every year around 22% of all male deaths, and 16% of all female deaths, are due to smoking. In the year 2000, this was around 114,000 deaths, all directly attributable to smoking. Smoking can lead to blood clots, a reduction in the amount of oxygen that the blood can carry, and an increase in blood pressure and heart rate.

There are many methods to help you stop smoking, but you'll have a much greater chance of being successful if you know more about the different options that are available and which ones are more likely to be of benefit in your particular situation.

One of the most important elements of any effort to stop smoking is willpower. You must be determined to give up, and keeping up your motivation to reach this goal all the way through your smoking cessation programme is most important. There are some tips for keeping motivated below.

Why stop smoking?

As mentioned above, smoking is one of the biggest causes of premature death. It is an important cause of many serious illnesses, including cancer, heart disease, lung disease, and pneumonia. Also, it causes or aggravates a number of other illnesses including asthma, osteoporosis, erectile dysfunction, stomach ulceration, and multiple sclerosis.

As well as the significant health benefits associated with giving up smoking, there are many social benefits too - smoking is an expensive habit, and it's getting more so. It can cause bad breath, discoloured teeth and facial hair, and breathing second-hand smoke can seriously harm those around you as well as yourself. Smoking in many public places is already banned, and this ban is being extended.

The good news is that once you stop smoking, your life expectancy gets better very quickly. Smokers under the age of 35 who stop will have a near-normal life expectancy, and there are immediate health and social benefits for people of any age who stop.

There are many ways for you to obtain help and advice to get you started. A recent survey showed many smokers felt uncomfortable seeking help; it's important to understand that you are much more likely to be successful if you do seek help - either from your doctor, your pharmacist, or a support organisation such as the NHS Smoking Helpline (see below for more contact details).

The survey also highlighted a common misconception - that 'nicotine replacement' products, such as nicotine gum or patches, were harmful in themselves; some people even thought these products caused cancer or heart disease. Bear in mind that cigarette smoke contains over 4000 chemicals, at least 50 of which are known to cause cancer; nicotine replacement products contain only one active ingredient - nicotine - the only ingredient you're addicted to.

Smoking is an addiction

When stopping smoking, it's important to understand that smoking is an addiction - not just to the nicotine in the cigarette, but there is also an element of psychological addiction (where certain places or situations make you want to smoke), and a strong habit to the action of smoking - usually of holding the cigarette in your hand. So you have to rid yourself not only of the chemical addiction, but of the psychological addictions too. That's why most people find some kind of support helps to make them successful - such as a nicotine-replacement product, advice from a health professional, and/or taking part in a structured quitting plan with realistic targets.

Nicotine replacement therapies

Since the early 1990s, nicotine replacement therapies have become available from UK pharmacies, starting with nicotine patches and chewing gum. Many people will think that these are still the only forms of nicotine replacement available - but infact there are now lots more, including the following, which will be described in more detail below.

• Nicotine Gums, Lozenges, and Sublingual Tablets
• Nicotine Patches
• Nicotine Nasal Spray
• Nicotine Inhalator
• Prescription-Only Medicines for smoking cessation

The right product for you will depend on your smoking habit and personal preferences.

When you smoke a cigarette, nicotine is delivered to the body very quickly; blood levels peak after only 15-30 seconds. Nicotine replacement products do not deliver nicotine this quickly, because their purpose is not to give you a 'hit' of nicotine, but to provide your body with a steady and predictable level of nicotine making your withdrawal easier.

As a general rule, if you smoke more than 20 cigarettes a day, and have your first cigarette within 20 minutes of rising in the morning, you should start on a higher strength preparation - for example, the 4mg gum, or a 16mg or 21mg patch.

Click here to see the range of smoking cessation products available from Pharmacy2U.

Nicotine Gums, Lozenges, and Sublingual Tablets
These are available in strengths ranging from 1mg to 4mg, to allow for individual variations in the amount of nicotine that will be required. Their main advantage is that they give you control over how much nicotine is released and at what times of the day - so if you mostly smoke in the evening, you could just use one of these products at that time, rather than having to wear a patch all day.

With the gum, nicotine is released when the gum is chewed and is absorbed through the inside surface of the cheek. It should be chewed until the taste become strong, and then ?parked' between the teeth and gums until the taste fades, at which point it can be chewed again. Each piece of gum should last for around 30 minutes.

Lozenges are sucked, and release nicotine into the saliva, which is also absorbed through the cheek; they last for around 20 minutes. If you smoke within 30 minutes of waking, you should use the 4mg lozenges, otherwise use the 2mg ones; the number of lozenges sucked daily should be gradually reduced over a period of weeks.

Sublingual tablets (also called 'Microtabs') are held under the tongue and release nicotine in a similar way. Their advantage is that they do not need to be sucked or chewed, making them more suitable for people who do not wish to be seen chewing - at work, for instance.

Click here to see nicotine gums, lozenges and sublingual tablets available from Pharmacy2U.

Nicotine Patches
Patches release nicotine at a steady rate, which is absorbed through the skin. They are a good option for people who smoke throughout the day. The main choice is between a 16-hour patch (eg. Nicorette) or a 24-hour patch (eg. Niquitin, Nicotinell); 16-hour patches are applied in the morning and taken off at bedtime, whereas 24-hour patches are kept on overnight, making them especially helpful if you experience early morning cravings.

Patches are available in three strengths; depending on how many cigarettes you smoke each day, you would start on either the strongest or medium patch. They are recommended to be used for a period of 12 weeks, during which time you would reduce down to the smallest patch, and then stop completely.

Click here to see nicotine patches available from Pharmacy2U.

Nicotine Inhalator
The Nicorette Inhalator is a pen-shaped plastic device, which takes cartridges that release nicotine into the mouth when the device is sucked. This makes it especially suitable for people who have a high dependence on the physical act of holding a cigarette; however none of the inhaled nicotine is taken into the lungs - it's absorbed in the lining of the cheek, in the same way as the nicotine gums and lozenges.

Each cartridge lasts for around 20 minutes, and a 12-week course is suggested, using 6-12 cartridges daily for the first 8 weeks, then gradually reducing to zero.

Click here to see the Nicorette Inhalator products available from Pharmacy2U.

Prescription-Only Medicines
As well as the nicotine replacement therapies available without a prescription, there are medicines available with a prescription from your doctor that are very effective at helping you to stop smoking. The most effective of these is called champix (varenicline). This medicine is taken orally and works by binding to receptors in the brain to reduce the craving and withdrawal associated with smoking cessation. It also removes the pleasure of smoking. A course normally lasts 12 weeks, and is started whilst you are still smoking; a 'stop date' should be set for the second week of treatment. For information on Pharmacy2U's private prescription services, including our online doctor consultation service, Click Here.

Availability on the NHS

As well as being available to buy from pharmacies, nicotine replacement preparations and champix are now available to be prescribed by your doctor on an NHS prescription; however there may be local guidelines for your doctor to follow, so you'll need to check which preparations are available to you on the NHS.

Motivation

• Make a pledge to family or friends that you'll quit by a certain date - perhaps an important date, such as a birthday or anniversary.
• Think about times when you know it'll be hard - for example, during breaks at work, or when you're out with friends. Think about how you will deal with these situations - perhaps eat a healthy snack instead of lighting up, or avoid the pub for a few nights.
• Think how much money you'll save once you have stopped smoking. Smoking is an expensive as well as an unhealthy habit, and it gets more expensive every year.
• Bear in mind that you might feel a little worse before you start to feel better. You're likely to develop a cough as your lungs recover from the smoke inhalation and begin to clear away some of the tar; you may also experience stomach upsets, mood changes, and difficulty sleeping. This is all perfectly normal and will go away in time - it's just your body adjusting. If you know about it beforehand, you can think about how to manage it and stay strong.