Your guide to smoking cessation

Congratulations!

YOU’VE DECIDED TO QUIT SMOKING?

You’ve just taken the first and foremost important step towards a more healthy life: making the decision to quit. This brochure will guide you through the process which should be both progressive and decisive. It will provide you with explanations and simple tips that have proven useful! However, bear in mind that there are no miracle solutions. Live one day at a time and you will succeed!

You can change the statistics...

 

Each year in Quebec, over 13 000 people die prematurely because of smoking. An even greater number of people are condemned to live at a snail’s pace, with damaged lungs and a worn-out heart. Even though the trend has weakened considerably over the past 15 years, more than 20% of Quebecers continue to smoke. Young people in the 20 to 24 year-old age group remain the greatest consumers and among these, one out of three will die of a smoking-related illness. (Source: Health Canada 2004)

Did you know that... One teenager in five smokes. Male smokers outnumber female smokers. (Source: Health Canada 2004)

Does smoking affect your health?

 

Did you know that... Second-hand smoke affects 55%-70% of non-smokers? (Source: CQTS)

Cigarette smoke contains thousands of chemical products. The most harmful are nicotine, tar, benzene, formaldehyde, hydrogen cyanide and carbon monoxide. The effects of nicotine occur in the smoker’s brain and nervous system. Numerous studies indicate that nicotine is the active element in tobacco that triggers and maintains the need to smoke.

Smoking is recognized to be the main cause in many cases of:

• COPD (chronic bronchitis and emphysema)
• lung cancer
• cardio-vascular disorders

COPD is the acronym for Chronic Obstructive Pulmonary Disease. It includes emphysema and/or chronic bronchitis. Ninety percent of COPDs are caused by tobacco smoke.

Furthermore, smoking increases the risk of respiratory infections by altering, among other things, the function of the cilia that line your lungs. These tiny hairs work like brushes, expelling dust particles, mucus and microbes from the lungs. The longer you smoke, the greater the risk to your health and life. Bear in mind that it takes very little time for the effects of smoking to manifest themselves.

Two types of dependence

Smoking causes two kinds of dependence in smokers:

• psychological or behavioural dependence
• physical or pharmacological dependence

Psychological or behavioural dependence

Smoking causes psychological dependence, as the smoker associates the act of smoking with a pleasant moment during the day (coffee at the end of a meal, a social activity, a telephone conversation or a leisure break).

Nicotine may give the impression of reducing anxiety, boredom and stress. As a result, nicotine dependence combined with the psychological pleasure of smoking makes it a habit that is difficult to break. As a matter of fact, abruptly quitting without proper treatment may cause the body to manifest symptoms of nicotine withdrawal. Smokers will often use these symptoms as an excuse for going back to smoking.

Watch out for withdrawal symptoms...

 

Smoking cessation is often accompanied by “withdrawal” symptoms. Generally, the body has totally eliminated the nicotine within a few days after quitting. However, the withdrawal symptoms may persist for weeks, or even months. Learn to recognize these symptoms but do not panic if they appear. And above all, be patient! The effects of withdrawal will dissipate more quickly than the number of years you have spent smoking...

Smoking-related lifestyles need to be modified.

The most common symptoms are :

Irrepressible urge to smoke Dizziness Lack of concentration Tremors Variable appetite Mood swings, irritability

Trouble sleeping Anxiety Lower heart rate Headaches Gastrointestinal problems Abnormal craving for sweets

PROPER PREPARATION IS CRUCIAL!

Remember: the craving will pass, whether or not you smoke...

Proper preparation entails not merely deciding to quit, but also doing one’s research and homework in an effort to be properly prepared to embark on this wonderful adventure leading to wellness.

1 - Review the medications that can help you quit smoking

Whether or not you intend to use them, being aware of the medications that are available will help you make a wise choice.

Your pharmacist is the ideal person to consult for information regarding these medications. (Refer to page 11 for product explanations)

2- Set a date

The risk of a heart attack starts to diminish 24 hours after smoking cessation. At the end of one year, the risk has decreased by half

Once you have made the firm decision to quit smoking, it is important that you set a date that will mark your first day without a cigarette. Make a personal pact to give up smoking completely on that day. Choose a day that is relatively stress-free, when your daily routine will allow you to devote your efforts to kicking the habit. By doing so, you will be less exposed to the influences that compel you to smoke.

Once you have selected a date, create a couple of posters indicating this date. Use your imagination and put some energy into it!

3- Identify the reasons that are prompting you to quit smoking

Jot down these reasons on your progressive calendar and keep it close at hand. Read them out loud regularly, especially when you get the urge to smoke.

A FEW SIMPLE TIPS...

The following are some simple tips that will help carry you through the quitting process.

1. Do it for yourself
   No one can force you to quit smoking. Smoking cessation, and all the benefits associated with it, is a gift that only you can give yourself.

Why am I quitting? To reduce the risk of pulmonary and cardiovascular diseases To set an example for my children To exercise self-control To have more energy...



2. Identify the factors that prompt you to smoke
   For some people, having a drink or feeling stressed triggers a craving to smoke. Learn to recognize these triggers and make a list of them, along with their substitutes. You will then be able to develop new habits and thus resort to these substitutes when you get the urge to smoke.
3. Visualize
   Imagine yourself without a cigarette between your fingers, and performing some other activity.
4. Be positive
   Avoid perceiving the smoking cessation process as a form of hardship. Instead, think of all the benefits associated with kicking the habit.
5. Drink water
   Drink plenty of water in order to flush the nicotine and other chemicals from your system more rapidly. Adding some cracked ice to your water suppresses the urge to smoke for a while. Drinking 8 glasses a day is recommended.
6. Breathe deeply
   

   You have to build a new lifestyle.

   Most people fail to make full use of their lungs. Breathing deeply while thinking about something pleasant promotes relaxation. Inhale through the nose as slowly and deeply as possible. Hold your breath and slowly count to 4. Exhale softly through the mouth until your lungs are empty. Repeat this exercise 5 times, but be careful of dizziness!
7. Eat healthy
   

   Different people have different food requirements.

   Eat when hungry, not because you are bored. Eat fruit, vegetables, bread and pasta. Incorporate lean meats, chicken and fish in your diet. Eat skim or low-fat dairy products. Make a habit of eating slowly.

8. The benefits of exercise Better health Improves posture and balance Weight management Strengthens muscles and bones Raises the level of energy Relaxes and relieves stress Builds selfesteem (Source: Health Canada)

   Keep in shape
   Physical activity is a must. Start improving your fitness by adopting a moderate exercise program. Get plenty of rest and avoid overtiredness.


9. Manage your weight
   Immediately after you quit smoking, you might just gain a little bit of weight. The average is about 2 kilos. It is therefore important that you manage this situation. Remain active, keep an eye on your diet and avoid replacing your tobacco dependence by over consuming food.
10. Plan some healthy activities
    When you go out, focus on healthy outdoor activities and hang out in places where smoking is prohibited.
11. Avoid people who smoke, as well as places where smoking is allowed
    During the next few weeks, you will be very vulnerable. Bear in mind that it’s just for a while, time enough to build up your self-confidence.
12. Inform your family, friends and associates
    

    Une forte envie de fumer ne dure que de 2 à 3 minutes.

    It is crucial that you inform your family, friends and associates of your firm decision to quit smoking, to avoid giving in to your mood swings, and to draw empathy from those who are close to you. They should avoid often-expressed comments like: “You’re really losing it! Go and buy some cigarettes!”, because subconsciously, this is what you want to hear. It’s just your mind tricking you into not feeling guilty.
13. Fill out your progressive calendar
    The Lung Association’s progressive calendar is one more tool designed to help you quit for good. It highlights the value of your commitment to a better respiratory health. During the year, add a stamp every month so that you can monitor your progress (document attached).
14. Calculate your savings
    Figure out the amount of money you spend each week on cigarettes, and then calculate the amount for a full year.
15. Pledge and rewards
    Smoking cessation is an accomplishment that deserves to be underscored and rewarded. Fill out a pledge (document attached) and list the ways in which you plan to reward yourself.
16. Discard all your cigarettes, lighters and ashtrays
    Avoid giving your cigarettes to a friend. You will not be doing him or her a favour, and to avoid making them the first person you turn to for a cigarette the next time you get a serious urge to smoke. Taking such a step confirms your commitment to quit smoking!

RELAPSE

Don’t throw in the towel!

Smokers often fear a relapse, which they perceive as a failure. Bear in mind that relapses are often part of the long cessation process. Rather than viewing it as a failure, think of it as an opportunity to learn and broaden your experience.

The material used to smoke is the leading cause of residential fires in Canada.

There are no easy solutions. In time, the body adjusts on its own and things return to normal. Anyone who wishes to quit smoking for good has to be deeply motivated. Family members, friends and work associates can provide moral support and avoid creating useless stress.

Give some thought to the situations where you doubt your ability to resist smoking, and work on these.

A helping hand!

Smoking cessation is also a learning process in itself. It is a good idea to self-evaluate by jotting down one’s strengths and weaknesses.

Quitting is not easy but bear in mind that many people have managed to do so. There are no miracle solutions, but there are some simple time-tested techniques. Above all, you must truly want to quit, and want to do so for yourself.

For assistance, the Lung Association encourages you to consult the health professionals available through its free and unique Poumon-9 smoking cessation help line, designed to provide information and advice regarding the various approaches, methods, pharmaceutical aids and available literature, all based on your experience as a smoker.

Contact the POUMON-9 line toll-free by dialling 1-888-768-6669, ext. 232, or in Montreal, dial (514) 287-7400, ext. 232.

MEDICATION THAT CAN HELP YOU QUIT SMOKING

Some drugs are designed to help alleviate the withdrawal symptoms associated with smoking cessation, or to simply suppress the urge to smoke. These include: patches, nicotine gum and inhalers, and Zyban.®

Nicotine patches (Nicoderm® – Habitrol®)

Nicotine patches can help alleviate withdrawal symptoms like irritability, anger, anxiety, difficulty concentrating, frustration and agitation. Each cigarette you smoke produces a rise of nicotine in your brain. It takes 7 seconds for nicotine to make its way to the brain. The level of nicotine drops when you finish your cigarette, only to climb swiftly back up as soon as you light up another one. Dependence is therefore reinforced each time you smoke and your brain reacts to any sudden drop in the level of nicotine.

Nicotine patches are designed to satisfy this craving by continuously releasing nicotine into the bloodstream through the skin. As a result, the brain becomes accustomed to receiving weaker doses of nicotine at a constant rate, and the urge to smoke gradually fades.

Warning

Some people cannot use nicotine patches. Check the contraindications before using them, and make sure you have the proper dosage (the patches are available in 3 different doses, depending on the quantity of cigarettes you normally smoke). It’s very important that you refrain from smoking while wearing a nicotine patch.

If you smoke while wearing a patch, you may experience a nicotine overdose. Nicotine patches are available over-the-counter in drugstores, and if supported by a prescription, 80% of the cost is covered by the Quebec Drug Insurance Plan or by your personal insurance plan.

Nicotine chewing gum (Nicorette® – Nicorette Plus®)

Just like the patches, nicotine chewing gums deliver a certain amount of nicotine, which can help prevent the symptoms of craving. Chewing the gum slowly, gradually releases the nicotine.

You have to quit smoking completely before you start using nicotine chewing gum.

Recommended dosage

Nicotine chewing gums are available in 2 dosage strengths: 2 mg for those who smoke their first cigarette more than 30 minutes after waking up and 4 mg for those who smoke their first cigarette within 30 minutes of waking up. You can get nicotine chewing gum without a prescription; it is sold over-the-counter in drugstores, and if supported by a prescription, 80% of the cost is covered by the Quebec Drug Insurance Plan or by your personal insurance plan. Read the directions carefully and use as directed.

Nicotine inhaler (Nicorette®)

The nicotine inhaler looks somewhat like a cigarette and satisfies the hand-to-mouth ritual.

The 8 cm-long plastic cylinder in which 10 mg cartridges of nicotine are inserted releases a 4 mg dose of nicotine that is absorbed through the mouth and throat. The nicotine is non-toxic and alleviates the symptoms of withdrawal. Recommended use is 6 to 12 cartridges a day during the first three months, followed by a gradual dosage reduction, if necessary, during the subsequent 6 to 12 weeks. The nicotine inhaler is available over-the-counter in drugstores, without a prescription. The cost is not covered by the Quebec Drug Insurance Plan.

Adverse effects

Treatment may cause temporary irritation of the mouth and throat, coughing or stomach discomfort. To avoid overdosing, it is very important to refrain from exceeding the recommended dosages and smoking during the treatment.

Medication to help you quit smoking (Zyban®)

Your doctor may prescribe a bupropion hydrochloride tablet (Zyban®) to help you quit smoking, if you match the profile of smokers for whom this drug is intended.

This sustained-release tablet contains no nicotine. It can help alleviate the symptoms of withdrawal and the urge to smoke. It is usually prescribed for a period of 7 to 12 weeks.

The cost is covered by the Quebec Drug Insurance Plan at a rate of 80%, or by your personal insurance plan.

Side effects and contraindications

This drug has side effects that vary among users. The side effects most commonly associated with bupropion hydrochloride tablets are dry mouth and insomnia. These side effects are usually mild and temporary. Use of Zyban® is specifically contraindicated in persons with convulsive disorders, as well as those who are taking Wellbutrin® or any other drug containing bupropion. It is also contraindicated for persons with a current or prior diagnosis of bulimia or anorexia, as well as anyone taking monoamine oxydase inhibitors (MAOI).

Consult your doctor and pharmacist for more information regarding any of these four drugs designed to alleviate the withdrawal symptoms associated with smo- king cessation.

Varenicline tartrate (Champix®)

Champix®  (varenicline tartrate) is a new prescription drug that, when combined with counseling, may reduce the sense of satisfaction you get from smoking. It can reduce cravings and withdrawal symptoms.

Varenicline tartrate works differently than nicotine replacement therapies. The drug works by binding to nicotine receptors ("targets" for nicotine) in the brain. Varenicline tartrate greatly weakens nicotine's chemical reactions in the brain that cause pleasure and reinforce the addiction.

Do I need a doctor's prescription?

Yes. A doctor must prescribe varenicline tartrate (usually for 12 weeks). It is not recommended for people who:

• Are pregnant
• Are breastfeeding
• Are allergic to varenicline tartrate
• Are using nicotine replacement therapy, such as patches, gum or inhalers

Talk to you doctor if you:

• Take other medicines, including over-the-counter drugs. Varenicline tartrate may alter the way other drugs work.
• Take insulin, asthma medication (theophylline) or blood thinner (warfarin) as your dose may need to be adjusted once you are smoke-free.
• Have any kidney problems, as you may need a lower dose.
• Have experienced depression or other mental health problems as these symptoms may worsen.

Do not drive or operate heavy machinery when using Varenicline tartrate unless you are sure that this drug does not affect your mental alertness or physical coordination.

Pros of varenicline tartrate:

• It's easy to use because it comes in a pill.
• It's not addictive because it doesn't contain nicotine.

Cons of varenicline tartrate:

• Some people may have side effects: nausea, strange dreams, constipation, flatulence (gas) and vomiting, etc.
• A number of patients have experienced unusual feelings of agitation , depressed mood, hostility, changes in behavior or suicidal ideation.

All patients, families and caregivers should know about and monitor for such symptoms. They should be instructed to stop taking Champix® and contact their healthcare provider immediately. 

Non-pharmacological methods

There are several alternative methods capable of helping you to quit smoking. Hypnosis, laser therapy, acupuncture, homeopathic products, as well as group or individual motivational sessions all fall into this category. These methods can sometimes reinforce your will to quit smoking, but be wary of people who claim them to be “miraculous”.

External link :

Reference : Health Canada. 2008. New safety information regarding Champix (varenicline tartrate).