Smoking Cessation

Welcome to Pulmonary Rehab

Babette Parthum, RRTClinical CoordinatorRespiratory Therapy

●Why smoking is addictive.●Facts about cigarettes and electronic

cigarettes●Steps you can take to approach quitting.●How to prepare for a relapse.●Reasons for becoming tobacco free.●How to track your triggers.●Working through withdrawal

Today’s objectives:

Tobacco: main ingredient in cigarettes

Does not cause a smoker’s addiction.

The problem lies in the artificial flavorings and chemicals that are added to the tobacco.

Why is smoking addictive?

●The key ingredient that causes a smoker’s addiction is nicotine.

●Nicotine is a stimulant. ●Causes your body to release a hormone

called epinephrine (also called adrenaline).

●This release causes your body to produce a sudden release of glucose.

●This glucose release causes stimulation or “smoker’s high”.

●Once the glucose levels drop, depression and fatigue sets in, leading the user to crave more nicotine to relieve those symptoms.

●This becomes a vicious cycle because smokers begin increasing the number of cigarettes they smoke to prevent the bad feelings of withdrawal.

●There are at least 599 additives (chemicals) in a cigarette.

●Many of these additives are found in our food.

●These additives were not tested for burning. Burning changes the properties of the chemicals.

Facts about cigarettes

●More than 4000 chemical compounds are created by burning a cigarette, 69 of these are carcinogenic.

●“Light” cigarettes are just as dangerous. People who switched to light cigarettes to decrease their tar and nicotine intake tend to take longer, deeper, more frequent puffs to reach the nicotine content that their body is craving.

More Facts about cigarettes

●They do not burn tobacco, instead it is a vapor.●Although there is no smoke or noxious odor emitted, there are still toxins emitted.●They still contain nicotine, propylene glycol, and other toxins.●They are still considered toxic because they contain liquid nicotine and propylene glycol.

Facts about E-Cigarettes

●Set a realistic goal for a quit date.●Prepare your environment.

● Rid your house, car, and workplace of cigarettes and ashtrays.

● Tell your family, friends, and coworkers of your intent to quit smoking and ask that they respect your decision by not smoking in your presence.

●Seek support from a healthcare professional (pulmonary rehab team, doctor, respiratory therapist, counselor).

Preparing to Quit

● Change your routine● Switch from drinking coffee to tea● Eat meals in a different location● Take a different route to work

● Reduce Stress● Take a hot bath● Exercise● Read a book

Preparing to Quit

Talk to your doctor about medications and nicotine replacement products.

●Over the Counter Nicotine Replacement Therapy● Nicotine Patch – placed on the skin and gives

users a small and steady amount of nicotine.● Nicotine gum - chewed to release nicotine.

The user chews the gum until it produces a tingling feeling, and then places it between their cheek and gums.

●Prescription Nicotine Replacement Therapy●Nicotine inhaler – a cartridge attached to

a mouthpiece. Inhaling through the mouthpiece gives the user a specific amount of nicotine.

●Nicotine nasal spray – a pump bottle containing nicotine, which is put into the nose and sprayed.

●Oral medications can help you get through the first months of not smoking.●Zyban® (Bupropion) – helps reduce

nicotine withdrawal and the urge to smoke.

●Chantix® (Varenicline) – helps to reduce nicotine withdrawal and the urge to smoke. It also blocks the effects of nicotine from cigarettes if the user starts smoking again.

●Many people do not succeed at smoking cessation on their first attempt.

●Remember to NEVER give up!

Be Prepared for a Relapse

●Avoid situations that cause you to light up. ●Drinking alcohol●Being around other smokers●Fear of gaining weight

● Most people gain no more than 10 pounds while they are quitting

● Establish an exercise plan● Eat healthy

●Bad mood or depression

Be Prepared for a Relapse

●Health risks● More likely to develop emphysema, lung

cancer, heart disease and many other illnesses.●Causes premature aging and skin problems.●Difficulty falling asleep and inhibition of deep

sleep.●Exacerbation of snoring and sleep apnea.●Alienation from non-smoking friends, family, and

coworkers.●Cost – Smoking is expensive!

Reasons for Becoming Tobacco Free

●I want to breathe better.●I want to limit how much supplemental oxygen I use

at home.●I’ll be less at risk of lung cancer, heart attack, and

stroke.●I’ll save money.●I want to slow the progression of my lung disease.●I want my clothes, car, and house to smell better.●I want to have less mucus, shortness of breath, and

wheezing.●Add your own reasons to this list

Decide Why YOU want to quit

●Stress (Anxiety, depression)●Boredom●Eating●Certain emotions●Social Situations●Morning Coffee●Driving●Waking upFor one day, write down each time you smoke or

have the urge to smoke. Record the time of day and what you were doing just before you had the urge. Look for patterns in these smoking triggers. Find ways to avoid or deal with these triggers.

Track Your Triggers

●You may cough more and have more mucus because the lungs are cleaning themselves.

●Nicotine is a very addictive drug.● You will go through several weeks of withdrawal

and may experience mood swings, lower energy, and trouble thinking clearly. These symptoms WILL go away.

●Keep yourself and your mind busy.● Play a game● Go for a walk● Work in your garden● Exercise

Working Through Withdrawal

●Eat low fat snacks●Crunchy snacks – apple spices, carrots, celery

sticks, pretzels●Sweet snacks – angel food cake, bananas,

pineapple, low fat cookies or muffins●Creamy snacks – fat-free pudding, yogurt,

applesauce●Get lots of support

●Talk to a friend●Ask family members not to keep cigarettes in the

house●Ask a friend or family member to quit with you.●Seek support in your pulmonary rehab group

24 Hours: Anxieties have peaked in intensity and within two weeks should return to near pre-cessation levels.

48 Hours: Damaged nerve endings have started to re-grow and your sense of smell and taste are beginning to return to normal. Cessation anger and irritability will have peaked

Stop Smoking Recovery Timetable

10 Days: The "average" ex-user is down to encountering less than two crave episodes per day, each less than 3 minutes.

10 Days to 2 weeks: Recovery has likely progressed to the point where your addiction is no longer doing the talking. Blood circulation in your gums and teeth are now similar to that of a non-user.

Stop Smoking Recovery Timetable

2-4 weeks: Cessation related anger, anxiety, difficulty concentrating, impatience, insomnia, restlessness and depression have ended. If still experiencing any of these symptoms get seen and evaluated by your physician.2 weeks - 3 months: Your heart attack risk has started to drop. Your lung function is beginning to improve.

3 weeks - 3 months: Your circulation has substantially improved. Walking has become easier. Your chronic cough, if any, has likely disappeared. If not, get seen by a doctor, and sooner if at all concerned, as a chronic cough can be a sign of lung cancer.1-9 months: Any smoking related sinus congestion, fatigue or shortness of breath has decreased. Cilia have re-grown in your lungs, thereby increasing their ability to handle mucus, keep your lungs clean, and reduce infections. Your body's overall energy has increased.

1 year: Your excess risk of coronary heart disease, heart attack, and stroke has dropped to less than half that of a smoker.5 years: Your risk of a subarachnoid hemorrhage has declined to 59% of your risk while still smoking (2012 study). If you are a female ex-smoker, your risk of developing diabetes is now that of a non-smoker (2001 study).5 - 15 years: Your risk of stroke has declined to that of a non-smoker.

Want to Quit?Contact the American Cancer Society Quit line for free and confidential counseling services, support and information:1-877-937-7848TTY: 1-866-228-4327You can also visit www.yesquit.org

References:American Association for Cancer Research:

Park et alAmerican Lung AssociationCenters for Disease ControlAmerican Thoracic SocietyNational Institute of HealthNational Cancer InstituteYourLungHealth.orgAmerican Heart Association