Difficult but required; quit or it may get worse

Smoking klls. Image courtesy Wikimedia Commons

There is clear evidence that shows that cessation of smoking has substantial health benefits and drugs have demonstrated reduction of nicotine withdrawal symptoms which makes it easier to stop smoking (as nicotine in cigarettes creates dependency). All of the available first-line therapies are reasonably safe and have proved to be efficacious in various studies.

Nicotine replacement therapy(NRT)

Nicotine is the addictive substance in cigarettes and so for people who want to quit smoking, these replacement therapies help them with the unwanted and disturbing psychological symptoms that are otherwise experienced when they abstain from tobacco.

It comes in various forms – patch, gums, lozenges, inhalers, nasal or mouth spray and sublingual tablet. They are available over the counter and most commonly used and backed up by robust scientific evidence in a combination of a transdermal (applied on skin) patch and gum. The dosing of NRT depends on a number of cigarettes smoked by a person each day. Patch works as a long-acting agent and has effect for 24 hours, so is replaced every morning and applied on a non-hairy skin site.

To control the cravings over the day commonly used and available is gum, and one can use up to 24 pieces of gum per day for the first six weeks of treatment. “Chew and park” is the technique recommended for its proper usage: chew the gum until the nicotine taste appears, then “park” the gum against the buccal mucosa until the taste disappears, then chew a few more times to release more nicotine. Repeat this for 30 minutes, then discard it and you can use it every 2-3 hours or whenever there is an urge. The therapy has to be used for at least 3 months and after 4-6 weeks of treatment, gradually its use is reduced.

Varenicline (marketed by Pfizer as Chantix or Champix): It works by blocking nicotine receptors in the brain, reducing cravings and nicotine withdrawal effects. It interrupts the reinforcing effects of nicotine that lead to its dependence and thereby reduces the rewarding aspects of a cigarette when a person smokes while on this drug.

It has been found to be the most effective out of all the first-line treatment options available and is usually combined with a nicotine patch for a greater benefit.

Bupropion (marketed by GlaxoSmithKline as Zyban): It is an antidepressant and enhances the release of dopamine, the chemical in the brain that makes people feel good. It reduces irritability and cognitive issues that are experienced by someone who quits smoking. It is cheaper as compared to varenicline.

E-cigarettes (vaping): E-cigarettes are nicotine delivery devices that uses a battery to aerosolize nicotine. Many brands and varieties are available that vary in the rate and amount of nicotine delivery. Trials have shown increased rates of smoking abstinence at 6 and 12 months with the use of E-cigarettes but experts still don’t know about the long term health effects of this product.

When it was launched it was thought to be a safer option as tobacco isn’t burned in them but their safety is uncertain as recent data has shown that there is a possibility of severe adverse effects such as acute lung injury which causes severe lung damage in some. Even though many E-cigarettes might contain less nicotine than regular cigarettes, this does not mean they are harmless. In addition to the possible health effects, vaping can lead to nicotine dependence or addiction.

To date, no e-cigarette has been evaluated or approved by the FDA as a medical product for smoking cessation and its use is banned in India.

Non-medical interventions:Combination of pharmacological and non-pharmacological therapy is the most effective and useful strategy to help someone achieve abstinence from smoking.

Behavioural therapy: it is a form of counselling which helps and guides someone to quit an addictive and harmful habit.

There are speciality clinics run by various multi-speciality hospitals, or brief face-to-face counselling by the physician can also aid with external support provided by telephone or support groups.

The government has established a National level tobacco cessation Quitline with a toll-free number (1800-112-356) and the services are available in regional languages. There are trained counsellors and coaches that walk you through the quitting phase and help you with a quit date and plan, regular follow-ups, support to get medicines, and tackling cravings and withdrawals.

Acupuncture: Although less effective than medical therapies but research has shown its beneficial effect on long term abstinence and is a reasonable additional therapy to aid smoking cessation. Hormones like endorphins are released when one stimulates some specific points in the body and this help to reduce the urge to smoke and make the withdrawal symptoms milder.

Yoga, meditation or tai chi: When practised at least 2-3 times a week have been shown by research to help people either stop smoking or reduce the number of cigarettes. They help in improving overall mental health, blood pressure and perseverance required to quit smoking.

Mobile apps: These days there are apps available that help you with quitting plan and support and help to keep track of your progress.

Impact on oral health from smoking:

The various and common oral problems affecting people who smoke are:

• Staining of teeth- due to nicotine and tar in tobacco. It can make teeth yellow to brown in heavy smokers.
• Bad breath (halitosis) and bad taste
• Reduced taste sensations
• Higher chances of tooth loss and decay- as it causes damage of tissue surrounding the tooth (periodontitis)
• Gum diseases, bacterial plaques – gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums don’t heal properly and are a good nidus for infection.
• Mouth cancer – Chewing tobacco and snuff can cause cancer in the cheek, gums, and lips. Just as with a pipe, cancer often occurs where the tobacco is held in the mouth. Smokers are at a 10 times higher risk for oral cancer compared to non-smokers.
• Slow and delayed recovery after gum or mouth surgery

The author is a Consultant, Pulmonary Medicine at Sir HN Reliance Foundation Hospital. Views are personal.

Read all the Latest News, Trending News, Cricket News, Bollywood News,
India News and Entertainment News here. Follow us on Facebook, Twitter and Instagram.