Smoking Cessation – Diagnosis, Symptoms and Treatment

What is Cigarette Smoke?

Cigarette smoke is composed of toxic fumes and carcinogens created due to the combustion of hydrocarbons and other cigarette chemicals.  Cigarettes also contain nicotine, a highly addictive stimulant that causes heart rate elevation, agitation, euphoria, and gastrointestinal symptoms in naïve individuals.  These symptoms typically resolve in long-term nicotine users.

Cigarette smoke irritates the lining of the nose, oral passage, bronchi, and lungs – this acutely leads to inflammation.  Long-term smoking often results in scarring and destruction of lung tissue, frequently leading to chronic obstructive pulmonary disease (COPD).  COPD is characterized by difficulty breathing, wheezing, and cough and is considered a leading cause of death in the United States.

Other complications of cigarette smoke include oral cancer, esophageal cancer, stomach cancer, pancreatitis, urothelial cancer (bladder and kidneys), and colon cancer.  It is also a leading risk factor for the development of heart disease and stroke.  Smoking is considered the number one cause of preventable death.  Due to this condition's importance, patients must understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions

•         What are the harms of Cigarette Smoke?
•         How common is Cigarette Smoking?
•         What are the symptoms and signs of long-term Cigarette Smoking?
•         How is Smoking Cessation managed?

What are the Harms of Cigarette Smoke?

Cigarette smoke is the leading cause of preventable death in the United States.  The more and longer you smoke – the more pack-years you have.  The more significant number of pack-years, the higher the risk of developing complications from cigarette smoking.  Smoking is associated with the following medical problems:

•         Chronic obstructive pulmonary disease (COPD)
•         Asthma exacerbation
•         Lung cancer
•         Gingivitis & oral cancer
•         Gastroesophageal reflux disease (GERD)
•         Esophageal & stomach cancer
•         Pancreatitis – inflammation of the pancreas
•         Urothelial cancer – bladder, ureteral, or kidney cancer
•         Colon cancer
•         Heart disease – coronary artery disease, myocardial infarction
•         Peripheral vascular disease
•         Stroke
•         Osteoporosis & hip fractures

The increased risk of a heart attack generally decreases after 1 year of smoking cessation.  COPD is a chronic disorder characterized by shortness of breath, cough, and wheezing.  Cigarette smoke is the most common risk factor for the development of COPD.  Smoking leads to progressive destruction and breakdown of lung tissue – when you stop smoking, the lung deterioration rate decreases, but the lungs cannot repair themselves back to normal.  Long-term COPD leads to pulmonary hypertension, which may eventually cause heart failure.

How Common is Cigarette Smoking?

Cigarette smoking is exceedingly common in the United States and responsible for frequent complications evaluated in primary care clinics.  Primary care doctors generally manage smoking cessation.  Patients with severe COPD or lung cancer typically require referral to pulmonary medicine and oncology specialists.

About 2/3rds of smokers want to quit, and approximately 50% say they have previously tried to quit.  About 30% of adult smokers who try quitting seek the guidance of a medical professional.  Approximately 25%-35% of smokers who abstain from smoking can succeed for ≥6 months.

Signs and Symptoms

Symptoms and signs of cigarette smoking may include:

•         The unpleasant smell of cigarette smoke
•         Symptoms of gastrointestinal disease – acid reflux, difficulty or pain with swallowing, abdominal pain, blood in the stool
•         Symptoms of lung disease – coughing, hemoptysis, difficulty breathing, wheezing
•         Symptoms of heart disease - chest pain, angina, orthopnea, swelling in the legs
•         Symptoms of kidney/bladder cancer - blood in the urine, abdominal/flank pain

Smoking Cessation Medications

Smoking cessation management depends on the stage at which the individual is ready to make a behavioral change.  If they have not yet contemplated quitting, it is generally recommended that the patient be provided with educational brochures.  Patients that are contemplating smoking should receive positive feedback and encouragement.  They may be further educated about the risks of smoking and the health benefits that smoking cessation affords. Some individuals are sure they want to quit and are immediately interested in treatment.

Treatment of smoking cessation may include psychological strategies such as biofeedback and participation in smoking cessation groups.  Patients with nicotine dependence often benefit from nicotine gums, lozenges, or patches that gradually help them wean off nicotine.  These include Nicorette gum and NicoDerm patches.

Pharmacologic therapies can also be useful in patients that are motivated to quit smoking.  These often include:

•       Zyban (Bupropion)
•       Pamelor (Nortriptyline)
•       Chantix (Varenicline)

Often, a combination of psychological treatment, nicotine supplementation, and psychoactive medications is the most effective management strategy.

References:

1.     Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 2013; 368:341. - https://www.nejm.org/doi/full/10.1056/NEJMsa1211128
2.     Rigotti NA. Strategies to help a smoker who is struggling to quit. JAMA 2012; 308:1573. - https://www.ncbi.nlm.nih.gov/pubmed/23073954