Tips to quit smoking

The World Health Organization (WHO) estimates that by 2030 tobacco will be responsible for the death of more than 8 million people a year around the world. Currently, it is the responsible for the deaths of more than five million people per year worldwide, being the cause of 1 in 10 deaths in adulthood through various pathologies. It is also the most preventable cause of death among the 5 main factors mortality risk.

Consumption of tobacco it is one of the main risk factors for vascular diseases, being the direct cause of 30% of them. Tobacco multiplies by four the risk of suffering from cerebrovascular disease, coronary disease or peripheral vascular disease, being the nicotine and carbon monoxide (CO) present in tobacco smoke substances that exert a greater harmful effect on vascular health. Tobacco, however, is not a risk factor for the development of high blood pressure. Tobacco is obviously the cause of severe respiratory disorders, such as chronic obstructive lung diseases (), which are chronic bronchitis and. In addition, tobacco use has been linked to pulmonary fibrosis idiopathic and obliterative bronchiolitis with organizing pneumonia, and increases the risk of developing a pneumothorax.

Tobacco and cancer

Tobacco smoke is the major environmental carcinogen to which we are all actively or passively exposed. It is responsible for a third of all tumors in men and 10% of cancers in women. Their relationship is linear, that is, the higher the consumption,.

Passive smokers have a 25% higher risk of lung cancer than non-smokers. Tobacco has been clearly linked to various types of cancers, for example cancer of the oral cavity, lip, pharynx, larynx, esophagus, stomach, liver, pancreas, lung, colon, kidney, bladder and cervix. Likewise, tobacco use has also been related to the appearance of other pathologies, such as:

• Recurrent respiratory infections.
• Gastroduodenal ulcer.
• Stomatitis and periodontitis.
• Inhibition of taste and smell.
• Healing disorders.
• Low birth weight
• Previous placenta.
• Placental abruption.
• Premature abortions
• Skin dehydration

Social repercussions

In addition to the repercussions on the health of each person, at a social level smoking is a significant economic cost, not only because of public health expenditures for the treatment of diseases derived from tobacco consumption, but also because smoking contributes to premature death of people in full productive life, depriving families of a source of livelihood and reducing the working-age population of a society.

Physical and mental dependence

smoking is thus a chronic addictive disorder in which the patient has a physical and psychological dependence on tobacco. 27% of the population over 16 years of age smokers to a greater or lesser degree and it is estimated that approximately half will die from a disease related to tobacco use. However, quitting tobacco at age 30 almost completely avoids the risk caused by its use, while quitting at age 50 reduces it by half.

Quitting is not easy!

More than one 60% of smokers have tried to quit at some point or another, but not all with the same result, sometimes due to a real lack of will and in others due to lack of adequate medical, pharmacological and social means to be able to carry out the cessation. Anyone who is consulted is under the obligation to advise on those who have the tobacco cessation. As in many other cases, quitting smoking will be a task that will require a systematic and multidisciplinary intervention, not being enough (in general) the mere decision to say "I will stop smoking from tomorrow."

• It is necessary that the patient who wants to quit smoking receives advice to do so in a firm, serious and clear way, receiving information on how to achieve it and especially the benefits that quitting smoking will bring to himself and to those who will surround.
• Set date It is important mark a date for tobacco cessation in about 15 days view and stand firm on it. Likewise, to prepare for that date, it is advisable for the patient to share his intentions with his environment (family, friends, co-workers) so that they can support him and facilitate the withdrawal as much as possible.
• It is advisable for the patient not to do it alone, but to contact his or her regular general practitioner so that the professional can follow up, advise drug treatment during the process, inform him or her of withdrawal symptoms that may appear and give positive reinforcement as the quitting process progresses.
• The behavioral psychological treatment To redirect the psychic dependence of tobacco on the part of health professionals, it must be complemented by a Pharmacotherapy.

Thanks to this treatment, it is possible to achieve that up to 30% of patients who want to quit smoking continue without doing so after one year, thus tripling the chances of success with respect to spontaneous smoking cessation. The different pharmacological options can be combined depending on the degree of tobacco dependence, which can be quantified using the Fagerstöm test:

Nicotine replacement therapy (TSN) is present in Spain with three different presentations: patches, chewing gum and lozenges. In patients who have had previous failures when trying to quit smoking per se, the use of two of these presentations in combination can be recommended, patches as basal treatment and gum or tablets for acute moments. In general, NRT can be done by everyone unless there are contraindications such as serious cardiovascular diseases, the pediatric age or they are occasional smokers. Large number of CST failures It is due to an incorrect use (by default) of the same, so it is necessary to insist on the correct doses.

Help to quit smoking

Nicotine patches

They are usually 16 or 24 hours, with presentations ranging from 5 mg to 21 mg. It is estimated that 1 mg of nicotine patch should be administered for each cigarette smoked per day, that is, if a pack is smoked a day, about 20 mg of nicotine should be administered, for example two 10 mg patches. The standard treatment is usually between 6 and 14 weeks. They have to be placed in arm, trunk or thigh, in a clean, hair-free area. They can cause skin irritation, dizziness, muscle pain or headache and are contraindicated in cases of generalized dermatitis.

Nicotine gums

They usually contain 2 or 4 mg of nicotine that is released slowly as you chew. It is not advisable to chew all the time incessantly, but to chew the gum for a few minutes and then leave it in the mouth to rest, since if they chew constantly Nicotine is swallowed, not absorbed through the oral mucosa, so it is metabolized in the liver and leads to throat irritation and gastrointestinal discomfort. A chewing gum is usually recommended every two hours approximately, with a maximum of 10 a day if possible and for about 3-6 months, then reducing the dose. As mentioned, they can be used in association with patches. They can cause jaw pain, hiccups and a bad taste in the mouth, and are contraindicated in cases of temporomandibular joint disorders, throat inflammation or dental disorders.

Lozenges to suck

They contain 1 mg of nicotine that, like chewing gum, is released slowly as you suck. They usually last half an hour in the mouth and it is indicated to take at most one every hour, with a maximum of about 12-15 a day. The treatment will continue for about 3 months and then it will gradually reduce. Like gum, it can be used as an adjunct to nicotine patches. May cause throat irritation and increased salivation, and are contraindicated in case of esophagitis or oropharyngeal inflammation.

bupropion (Zyntabac®)

Is a drug oral antidepressant that favors the cessation of tobacco doubling the chances of achieving it in the long term. Its use in conjunction with NRT provides better results for the patient to quit smoking. Its effect is independent of its antidepressant power. Treatment should start approximately one week before the date chosen to stop smoking, taking 150 mg every 24 or 12 hours depending on the degree of dependence and should be maintained for 9 weeks. The side effects more common are insomnia, dry mouth and dizziness, and seizures can occur very rarely. It is contraindicated in the case of a history of seizures, anorexia or bulimia or the use of certain drugs or drugs.

varenicline (Champix®)

It is a drug that on the one hand reduces the urge to smoke and symptoms related to tobacco withdrawal and on the other hand decreases satisfaction and reward obtained from smoking. varenicline triples the chances that the patient will be able to quit tobacco use in the long term, being more effective than bupropion and NRT. Treatment is started with 0.5 mg a day and is increased over a week to 1 mg every 12 hours. The treatment usually lasts about 12 weeks, but it can be kept up to 24 weeks, being tolerated correctly even for a year, although it is not the most recommended. It can be associated with NRT and the most common side effects are nausea, headache, sleep disturbances, and changes in mood or behavior.