Smoking Cessation: Overview and Practice Questions (2023)

Smoking remains one of the most significant public health challenges worldwide. Despite the well-documented risks associated with tobacco use, millions still find themselves trapped in the grip of nicotine addiction.

The journey to quit smoking is neither easy nor uniform, with each individual facing a unique set of challenges.

This article breaks down the best strategies for smoking cessation, emphasizing evidence-based approaches and providing insight into the myriad of factors that can support or hinder a person’s path to becoming smoke-free.

What is Smoking Cessation?

Smoking cessation refers to the process of discontinuing tobacco smoking. It’s a challenging journey due to the addictive nature of nicotine, but with support, many can overcome this habit. Quitting reduces the risks of numerous health issues, from respiratory problems to cardiovascular diseases, ultimately leading to improved overall health and increased lifespan.

Nicotine Replacement Therapy

Nicotine replacement therapy (NRT) is a medically-approved approach to help people quit smoking. It provides the body with controlled doses of nicotine, without the harmful chemicals found in cigarettes.

The aim is to alleviate withdrawal symptoms and cravings by gradually reducing the nicotine dosage over time. When used as directed, NRT can significantly increase the chances of successfully quitting smoking.

Types

Nicotine replacement therapy (NRT) is available in various forms to cater to individual preferences and needs.

The primary types of NRT include:

• Nicorette Gum: This is a form of chewing gum that releases nicotine into the bloodstream through the lining of the mouth. It helps to reduce the intensity of cravings and withdrawal symptoms. Users gradually decrease the number of pieces they chew daily until they no longer need it.
• Nicotrol Inhaler: This device allows the user to inhale a vaporized form of nicotine through the mouth, mimicking the hand-to-mouth action of smoking. It delivers nicotine through the lining of the mouth and throat rather than the lungs.
• Nicotine Transdermal Patches: These are adhesive patches applied to the skin which release a steady, controlled amount of nicotine throughout the day. They come in different strengths, allowing the user to reduce the dose gradually over time.
• Nicotine Nasal Spray: Administered through the nose, this spray delivers nicotine directly to the nasal membrane, providing rapid relief from cravings. It’s prescribed for those who require immediate nicotine release.
• Prescription Medications: There are certain medications not based on nicotine that help with smoking cessation. Bupropion (Zyban) is an atypical antidepressant that reduces withdrawal symptoms and cravings. It doubles the chances of quitting successfully. Varenicline (Chantix) is a medication that works by reducing cravings and withdrawal symptoms. It also diminishes the pleasure derived from smoking, making relapse less rewarding.
• Behavioral Counseling: This involves working with trained counselors or therapists to identify triggers and develop coping strategies. It aims to address the psychological aspect of the addiction, providing smokers with skills and tools to manage cravings, stress, and potential relapse situations. Combining behavioral counseling with NRT can significantly increase the chances of quitting successfully.

Note: Each type has its own advantages, and the best choice often depends on the individual’s smoking habits, preferences, and any underlying health conditions. It’s essential to consult with a healthcare professional before starting any form of NRT to ensure its appropriateness and effectiveness for the individual.

How to Calculate Pack-Years for Smokers

Pack-years is a term used to measure the cumulative exposure a person has had to cigarettes over time.

It’s a simple calculation that provides valuable information for healthcare professionals when assessing risks for diseases like lung cancer or COPD.

Here’s how to calculate pack-years:

Formula:

Pack-years = (Number of packs smoked per day) × (Number of years smoked)

Steps:

1. Determine the Number of Cigarettes Smoked Daily: If someone smokes 20 cigarettes (equivalent to 1 pack) a day, then they smoke 1 pack per day. If they smoke 10 cigarettes a day, they smoke 0.5 packs per day, and so on.
2. Determine the Number of Years: This is simply the duration for which the person has maintained the smoking habit at the rate determined in step 1.
3. Multiply the Two Figures: Take the number of packs smoked daily (from step 1) and multiply it by the number of years the person has smoked (from step 2).

Example:

Suppose a person has smoked 1 pack (20 cigarettes) a day for 20 years.

1. Number of packs smoked per day = 1 pack/day (since they’re smoking 20 cigarettes or one full pack every day)
2. Number of years smoked = 20 years
3. Pack-years = 1 pack/day × 20 years = 20 pack-years

This person has a 20 pack-year smoking history.

Knowing the pack-years can help clinicians assess the risk and make recommendations about screenings or interventions.

If a person’s pack-year history changes (e.g., they smoke more or less over time), the calculation can be adjusted accordingly by segmenting the years and then summing up the results.

What is a Respiratory Therapist’s Role in Smoking Cessation?

A respiratory therapist plays a vital role in smoking cessation, particularly given their expertise in lung health and respiratory care.

Their role encompasses several key areas:

• Education: RTs educate patients about the adverse effects of smoking on the respiratory system, emphasizing diseases like chronic obstructive pulmonary disease (COPD) and lung cancer. By providing tangible information about how smoking directly harms the lungs, they can motivate patients to consider quitting.
• Assessment: RTs can assess a smoker’s readiness to quit and determine the level of nicotine addiction. This assessment can help tailor specific cessation strategies for each individual.
• Recommendation: Based on the assessment, RTs can recommend various smoking cessation aids, including nicotine replacement therapy (NRT) or medications, always ensuring they are appropriate for the patient’s respiratory health.
• Behavioral Counseling: While it may not be their primary role, some RTs are trained in behavioral counseling techniques to help smokers identify triggers and develop coping strategies.
• Follow-Up and Support: Once a patient decides to quit, regular follow-ups by RTs can provide much-needed support. These check-ins can help address any challenges, track progress, and adjust strategies as needed.
• Lung Function Monitoring: RTs can conduct regular lung function tests, like spirometry, to show patients the tangible benefits of quitting over time, such as improved lung capacity and reduced symptoms.
• Referrals: If a patient needs more specialized help, an RT can refer them to other professionals or support groups dedicated to smoking cessation.

Note: Respiratory therapists provide a unique blend of clinical expertise and patient support in the smoking cessation journey, making them instrumental in guiding smokers toward a healthier, smoke-free life.

Smoking Cessation Practice Questions

1. What are the two types of support that can be provided by a respiratory therapist during a smoking cessation program?
Physical and emotional support

2. In a smoking cessation program, how can the respiratory therapist physically assist a patient?
They can ask the patient about their smoking history, educate the patient about the benefits of quitting smoking, assess their willingness to attempt to quit, discuss helpful medications, and arrange a follow-up meeting to begin the quitting process.

3. What are the four treatment types of smoking cessation?
1) Nicotine inhaler, 2) Nicotine gum, 3) Nicotine patch (Transdermal), and 4) Nicotine nasal spray.

4. What does a nicotine MDI do?
It works just like a regular MDI, it’s very portable, and it has titratable dosing.

5. How does oral nicotine gum work?
It’s chewing gum that supplements a patient’s nicotine intake, so they do not need to obtain it by smoking tobacco.

6. How does a nicotine transdermal patch work?
It’s a patch that is applied directly to the skin and delivers a steady dose of nicotine over a 24-hour period. Over time, the dose is gradually reduced until the patient no longer has nicotine cravings.

7. How does the nicotine nasal spray work?
It’s a medication that includes a nicotine solution, which is sprayed into the nose through the nose and is absorbed into the bloodstream. It has very fast delivery and is portable to use on the go.

8. After a person quits smoking, when can they expect shortness of breath and coughing to decrease?
Usually, within 1 to 9 months of quitting

9. What are bupropion and varenicline?
They are medications for the brands Zyban and Chantix.

10. How long does it take for carbon monoxide levels to return to normal after a person quits smoking?
Usually, within 12 hours

11. One of the most immediate benefits of smoking cessation is that the heart rate drops in approximately how many minutes?
20 minutes

12. What are two helpful things to know about cigarette smoke?
1) It has over 1,000 toxic agents that damage lung tissue, and 2) it causes short and long-term health problems.

13. The 1964 Surgeon General’s Report of the Advisory Committee on Smoking and Health concluded that smoking can cause what four illnesses?
1) Lung cancer, 2) laryngeal cancer, 3) emphysema, and 4) cardiovascular disease.

14. What did Mark Twain say that can be applied to smoking?
“Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.”

15. Who is involved in smoking cessation?
Medical professionals, including the patient’s therapist, doctor, nurses, and respiratory therapist.

16. What percentage of adults smoke in the United States?
According to the CDC, 12.5% of adults smoke in the United States.

17. What percentage of smokers have called a quit line in an attempt to stop smoking?
Only 2.3%

18. What percentage of all cancer deaths are related to smoking?
Approximately 25%

19. What are the five A’s of smoking intervention?
1) Ask if the patient smokes, 2) Advise them to quit smoking, 3)Assess their willingness to quit at this time, 4) Assist the patient by discussing helpful medications and possibly counseling, and 5) Arrange a follow-up meeting.

20. What are the five R’s to help a patient quit smoking?
1) Relevance, 2) Risks, 3) Rewards, 4) Roadblocks, and 5) Repeat.

21. What medications are used to help patients stop smoking?
Chantix and Zyban

22. What are the possible side effects of Chantix?
Nausea is the most common side effect and may persist for several months. Other side effects include stomach pain, indigestion, constipation, gas, weakness, fatigue, dry mouth, headache, insomnia, and unusual dreams.

23. What are the smoking risks for pregnant women?
Smoking during pregnancy can cause a baby to be born prematurely and with low birth weight. This increases the odds that the baby will be sick and have to stay in the hospital for a longer period after birth. It can even cause death, as smoking during and after pregnancy is a major risk factor for sudden infant death syndrome (SIDS).

24. What are two types of nicotine patches?
Nicotrol and Nicoderm

25. What is an alternative drug type that is effective in smoking cessation?
Anti-depressant drug therapy has been shown to be effective in helping patients quit smoking.

26. What are the five major steps of smoking cessation?
The five major steps of smoking cessation are 1) Preparation, 2) Setting a quit date, 3) Coping with withdrawal, 4) Staying tobacco-free (maintenance), and 5) Handling relapses.

27. What is the most effective smoking cessation program?
The most effective smoking cessation program is often a combination of behavioral counseling and pharmacotherapy tailored to an individual’s needs.

28. What are the four D’s of smoking cessation?
The four D’s of smoking cessation are: 1) Delay, 2) Deep breathing, 3) Drink water, and 4) Do something else.

29. Does drinking water help someone stop smoking?
Yes, drinking water can help reduce cravings and distract someone from the urge to smoke.

30. How long does it take to feel normal after quitting smoking?
It varies by individual, but many people report feeling better within a few weeks to a few months after quitting, though some symptoms or cravings might persist longer.

31. What is the process of smoking cessation?
Smoking cessation is the process of discontinuing tobacco smoking, which often involves stages like preparation, quitting, managing withdrawal symptoms, maintaining a smoke-free lifestyle, and addressing any relapses.

32. What is the timeline for nicotine withdrawal?
The timeline for nicotine withdrawal typically includes intense symptoms during the first 72 hours, with peak symptoms around day 3. These symptoms gradually decrease over the following 3-4 weeks.

33. What is the most successful smoking cessation method?
Combination therapy, which involves behavioral support/counseling and pharmacotherapy (like nicotine replacement therapy or non-nicotine medications), is often cited as the most successful method.

34. Does quitting smoking affect blood sugar levels?
Yes, quitting smoking can lead to changes in blood sugar levels, which might be temporary or may require adjustments in diabetes medications.

35. Will quitting smoking reverse damage to arteries?
Quitting smoking stops further damage and can lead to some improvement in the health of arteries over time, but it might not reverse all previous damage.

36. Does quitting smoking make you gain weight?
Some people may gain weight after quitting smoking due to changes in metabolism and increased appetite. However, the health benefits of quitting outweigh the risks of potential weight gain.

37. Are smoking cessation drugs covered by insurance?
Coverage varies by insurance plan and country. In many places, smoking cessation drugs are covered at least in part by insurance, but one should check with their specific provider.

38. Which smoking cessation product has the least number of reported side effects?
Individual reactions vary, but in general, nicotine replacement therapies (like patches, gum, or lozenges) tend to have fewer side effects compared to oral medications. It’s always best to consult with a healthcare provider.

39. Can quitting smoking cause depression?
Some people experience mood changes, including symptoms of depression, after quitting smoking. This can be due to withdrawal from nicotine and/or changes in brain chemistry.

40. Can quitting smoking improve kidney function?
Yes, quitting smoking can slow the progression of kidney disease and decrease the risk of kidney damage.

41. Are smoking cessation programs effective?
Yes, many people benefit from smoking cessation programs, especially when combining behavioral support with pharmacotherapy.

42. Can quitting smoking reverse diabetes?
Quitting smoking cannot “reverse” diabetes, but it can improve blood sugar control and reduce the risk of diabetes-related complications.

43. Can quitting smoking make you tired?
Yes, fatigue is a common symptom some people experience after quitting smoking due to nicotine withdrawal.

44. Do smoking cessation bracelets work?
There’s limited scientific evidence to support the effectiveness of smoking cessation bracelets. Effectiveness varies among individuals.

45. Does smoking cessation hypnosis work?
Some people find hypnosis helpful in their smoking cessation journey, but its effectiveness varies, and more research is needed to confirm its overall efficacy.

46. How long does smoking cessation last?
Smoking cessation is a lifelong process, but the intense phase of withdrawal typically lasts for a few weeks to a few months.

47. Is smoking cessation primary or secondary prevention?
Smoking cessation is considered secondary prevention because it aims to prevent the progression or recurrence of disease in people who have already started smoking.

48. Will quitting smoking help with back pain?
Quitting smoking can improve blood flow and oxygen to the tissues, which might help with some types of back pain.

49. Will quitting smoking increase testosterone?
Some studies suggest that smoking can lower testosterone levels, so quitting might lead to a normalization or slight increase.

50. Can smoking cessation cause constipation?
Yes, constipation is a common symptom some people experience after quitting smoking.

51. Is smoking cessation free?
The cost of smoking cessation varies. Some resources, like community support groups, may be free, while medications or professional programs might have associated costs.

52. What are smoking cessation drugs?
Smoking cessation drugs include nicotine replacement therapies (patches, gums, lozenges, inhalers, and nasal sprays) and non-nicotine medications like bupropion (Zyban) and varenicline (Chantix).

53. Does smoking cessation improve COPD?
Quitting smoking can slow the progression of COPD and improve symptoms, although it cannot reverse existing lung damage.

54. Does smoking cessation increase blood pressure?
Initially, nicotine withdrawal might lead to temporary changes in blood pressure, but in the long run, quitting smoking generally reduces the risk of high blood pressure.

55. Which smoking cessation is most effective?
A combination of behavioral support/counseling and pharmacotherapy (like nicotine replacement therapy or non-nicotine medications) is often cited as the most effective method.

56. Can quitting smoking kill you?
While quitting smoking can lead to withdrawal symptoms, it’s not lethal. However, continuing to smoke greatly increases the risk of life-threatening diseases.

57. Is smoking cessation covered by insurance?
Coverage varies by insurance plan and country. Many insurance plans cover at least part of the costs of smoking cessation treatments.

58. Are biomarkers a useful aid in smoking cessation?
Biomarkers, like cotinine levels, can be used to verify smoking status, but their direct role in aiding smoking cessation is still under study.

59. Is action planning helpful for smoking cessation?
Yes, action planning, which involves setting specific goals and strategies for quitting, can be a beneficial component of smoking cessation programs.

60. Can someone quit smoking without really wanting to quit?
It’s possible, but motivation and desire to quit significantly increase the chances of success in smoking cessation.

Final Thoughts

The journey of smoking cessation is one that offers profound benefits for both the individual and society at large.

As we advance in our understanding of addiction and develop more effective strategies for support, it becomes increasingly possible for smokers to break free from their dependence on tobacco.

It’s imperative that individuals, communities, and health organizations work collaboratively to promote a smoke-free future, recognizing the profound impact such an achievement can have on global health.