Podcast: Yes, You Can Quit Smoking
Bhavna Sharma, MD
About 14% of U.S. adults smoked in 2017, according to the U.S. Centers for Disease Control and Prevention (CDC).
That was a record low. But there were still 34 million people smoking. And surveys show that the vast majority of them want to quit.
In recognition of World No Tobacco Day, May 31, we recently spoke with Bhavna Sharma, MD, a pulmonary and sleep specialist at Einstein Medical Center Philadelphia. In this podcast, she offers information about the many negative effects of smoking and advice about the best ways to quit.
Below is a transcript of the podcast conversation.
Dr. Sharma: Nicotine is a very, very powerful substance that your brain gets addicted to.
Bill Fantini: Have you tried to quit smoking cigarettes but failed several times? You are not alone. In fact, you are the rule rather than the exception. I’m Bill Fantini with Einstein Perspectives. For more information and some suggestions that could pave the way to smoking cessation success, we’re joined by Bhavna Sharma, MD, pulmonary critical care and sleep medicine specialist at Einstein Medical Center, Philadelphia. We’ve all heard that smoking can cause lung cancer, but that’s hardly the only hazard. What are the other main threats?
Dr. Sharma: A lot of my patients, I would say most of my patients, are current or ex-smokers and when I do question them about what do they think are some of the health effects of smoking, as you mentioned, most of them bring up lung cancer. But it surprises them when I tell them that lung cancer is not nearly as common as some of the other things that smoking can lead to especially heart disease. One of the most common reasons smokers die is because of increased cardiovascular disease, which means heart attacks as well as stroke, which is very strongly related to the amount and years of smoking in the books. There are many other health problems related to smoking, especially breathing problems like COPD. People who have underlying asthma, it can be triggered by smoking and even worsened by smoking.
Dr. Sharma: Smoking is especially harmful for women, especially women who are young trying to get pregnant. It reduces their fertility and increases many of the problems that are associated with pregnancy, including preterm labor, small birth weight, et cetera. Smoking is also related to many other cancers other than lung cancer, including cancer of the esophagus, which is our food pipe; cancer of the mouth and oral cavity; the larynx, which is our voice box; bladder cancer; cervical cancer; etc. Smoking is so bad for you that right now cigarette smoking is the leading cause of preventable death in the United States and more people die each year of smoking-related conditions than HIV, illegal drug use, alcohol use, motor vehicle injuries and firearm-related incidents together.
Bill Fantini: Well, clearly there are health benefits to quitting, but it is a serious addiction, yes?
Dr. Sharma: Yes. So that’s another point that I always bring up with my patients, that smoking is not just a habit. Nicotine is a very, very powerful substance that your brain gets addicted to. More smokers become addicted to nicotine, which is a drug that’s naturally found in tobacco. And right now we’re all talking about the opioid epidemic, but there are more people in the United States who are addicted to nicotine than any of the other drugs, way more people than the opioid epidemic has affected. When people smoke, nicotine easily crosses the brain barrier and reaches their brain very quickly and once people attempt to quit, they may have withdrawal symptoms from nicotine, like feeling irritable, angry, anxious, cravings, and feeling hungrier than usual. And hence, they find it really hard to quit. That’s why it’s not just a habit, it’s an addiction they need to break.
Bill Fantini: Well, what are the rates of success for trying to quit on the first attempt or eventually?
Dr. Sharma: Many smokers will quit successfully, but a lot of them will relapse eventually. The chances of relapse are highest within days to weeks after initiating a quit attempt. And the risk of relapse remains high. But it does decline rapidly over the next three months, but relapses still do occur even after one year of abstinence from smoking. There are people who try to quit cold turkey, meaning quitting without any help from their physicians or other health care providers without any medications, etc. Though some of them are successful, most studies have shown that 97% of cold turkey quit attempts fail within six months, so what works best is a combination of a quitting medication and a behavioral change program available online as well as through help at your physician’s office.
Bill Fantini: What about using nicotine replacement?
Dr. Sharma: That’s a very good question and a lot of times people ask their physicians or other health care providers, nurses, respiratory therapists, etc., and thankfully we live in an era where we have quite a few FDA-approved products for nicotine replacement therapy. As we briefly spoke about, nicotine is the most addictive substance in the cigarettes and people who are trying to quit usually fail because they start undergoing withdrawal from nicotine. Currently, there are five FDA-approved nicotine replacement products on the market and these include the nicotine patches, the nicotine gum, nicotine lozenges, nicotine nasal spray, and a nicotine inhaler. In addition to the nicotine products, there are also two medications which are available only by prescription but have very high success rates for quitting and these are Wellbutrin as well as Chantix by prescription.
Bill Fantini: Now, lately, e-cigarettes have become very popular. Is there research comparing them to other nicotine replacement?
Dr. Sharma: E-cigarettes have been a very popular topic in the medical community as well as in the general public in the last few years. The e-cigarette delivery system is meant to heat and vaporize liquid nicotine, and the nicotine that is vaporized is inhaled and is supposed to help with the craving. The main problem with e-cigarettes or other electronic nicotine delivery systems is that there is no regulation in the amount of nicotine available in these systems. Though there is very little data that these products may help with smoking cessation, the more concerning thing is the addiction potential of nicotine present in these e-cigarettes for a developing brain.
Dr. Sharma: Currently, there’s a lot of debate about the epidemic of underage vaping and talk about this being a gateway into nicotine addiction. What’s really worrying is the latest statistics show that about one in 20 middle-school kids have used e-cigarettes and one in five high school students have also used e-cigarettes and we are very concerned about the potential harm that nicotine addiction may have on these developing brains. Also, there’s a lot of evidence that smokers who are using e-cigarettes in attempts to quit may not be switching completely over to e-cigarettes and may be smoking regular cigarettes as well as e-cigarettes, which defeats the whole purpose of using e-cigarettes as a smoking cessation tool. So currently, the medical community does not support the use of e-cigarettes. Use other FDA-approved methods of nicotine replacement, which have shown clear benefit in quitting.
Bill Fantini: What about counseling and support groups or methods such as hypnosis? Do they help?
Dr. Sharma: Yes, so there is actually great data that counseling and group support does help. Now, everybody may not have access to counseling sessions, but there are quit lines available as well as a lot of support online. The data regarding hypnosis is very scarce and currently not recommended. We do not have enough evidence that hypnosis actually helps to quit. It’s hard to test whether it works or not, but studies suggest that it doesn’t help people quit and this may be because nicotine actually changes your brain chemistry, meaning nicotine addiction is just too powerful to overcome by suggestion of hypnosis alone. At present, there’s just not enough data for it and the same goes for other alternative methods of quitting such as acupuncture and laser therapy. We just don’t have enough data. Now, there may not be much harm to it, but by themselves they may not be a very successful mode of quitting and we encourage using additional therapy such as behavioral modification in addition to using nicotine replacement as well as prescription medication to help quitting because we have great data that it doubles the chances of abstinence from smoking in the long-term.
Bill Fantini: So then there are steps people should take to prepare if they’re planning to quit.
Dr. Sharma: Yes, that is crucial to the success. People have to come up with a plan and there is a lot of support online which helps to create a personalized quit plan. They can talk to their physician, their health care provider or the nurse to see what works best for them. The first step is picking a quit date. Usually, people choose a date a week or two away from their visit with the physician and highlight that date on their calendar or phone. If you involve your family and friends, let them know that you’re quitting, that will highly increase your chances of quitting. They can help you, provide a lot of encouragement to you when you’re trying to quit and people who smoke and stay away from you and you can try to stay away from them.
Dr. Sharma: Write down the reasons you want to quit and every time you have the urge to light up a cigarette, look at that list. Get rid of cigarettes or anything that reminds you of smoking. For example, a jacket you wear to go out and smoke every time. Get rid of that. Think about your feelings, places or situations that make you want to smoke. It’s easier to avoid them if you’ve identified them; write them down. And then have healthy strategies to fight cravings, and be prepared to fail. That’s the most important thing. Most people will not succeed in their first attempt to quit. Mark Twain said, “Smoking cessation is really easy. I’ve quit smoking a hundred times.” It’s hard. It’s an addiction. If you fail, don’t lose hope. Many people will take more than five or six attempts to quit smoking. Learn from your mistakes. Identify your triggers. Write down what made you go back to it and start all over again.
Bill Fantini: Well, I quit three times myself, but the last time was about 40 years ago, so it can work in the end.
Dr. Sharma: Oh, that’s awesome.
Bill Fantini: Now, do you have any information comparing the number of former smokers, people who have successfully quit versus the number of current smokers, people still lighting up in the US?
Dr. Sharma: The encouraging thing is the number of smokers in U.S. Who have picked up a cigarette recently is down to an all-time low. Since 2002, the number of former smokers has been greater than the number of current smokers. So the trend is quite encouraging, but we’re not there yet. We still need to stop every new cigarette that’s being lit and encourage people to give up. I’d like to conclude by letting everyone know there is hope and there are many reasons why they need to give up smoking, not just for themselves, but also as role models for their children and for the future of this country. There is help available. Talk to your physician, talk to your health care provider, and keep trying. It’s never too late to quit. It doesn’t matter if you have COPD already. It doesn’t matter if you have heart disease already. We have a lot of data to show that every person who quits ultimately benefits from it, no matter how long they’ve smoked. So today is your day to quit.
Bill Fantini: Dr. Sharma, thank you so much for sharing your time and expertise with us. It’s been a pleasure speaking with you. That was Dr. Bhavna Sharma, pulmonary critical care and sleep medicine specialist at Einstein, Philadelphia. To request an appointment with a doctor who can help you quit smoking visit our website at www.einstein.edu or call 1-800-EINSTEIN. I’m Bill Fantini for Einstein Perspectives.
Taking the Next Step
Make an appointment to ask your doctor for advice or medications to help you quit smoking.
