Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Several methods are available to assist those who decide to quit smoking. The
main categories of methods are:
changing the behavior that is associated with smoking;
self-help literature;
nicotine replacement therapy; and
prescription smoking cessation aids.
Each method
actually offers several different options. Moreover, combinations of the methods
usually are necessary, and no one combination will work for everyone. In fact,
it may be necessary to try several different methods or combinations of methods
before success is achieved.
Behavioral modification and self-help literature to quit
smoking
Due to the addictive nature of nicotine, some form of behavioral modification
is often necessary for successful cessation of smoking. Educational programs,
hypnosis, and aversion therapy (learning how to avoid cigarettes) are a few
options. Smokers may be counseled to avoid specific triggers or situations that
lead to smoking. For example, instead of awakening and grabbing a cigarette at
the bedside or smoking immediately after a meal, people may be encouraged to
replace the urge to smoke with another activity, such as, taking a walk or
reading a book.
Numerous associations and societies, for example, the American Cancer
Society, American Heart Association, and the American Lung Association, have
developed brochures to help smokers quit smoking.
Nicotine replacement therapy to quit smoking
Nicotine replacement therapy (NRT) became available over
the counter in the 1990's. The purpose of nicotine replacement therapy is to substitute another source of
nicotine while cigarettes are discontinued. By this means, the habit of smoking
is eliminated, even though the addiction to nicotine remains intact. But at the
same time, nicotine replacement therapy eliminates the symptoms of withdrawal that can trigger more smoking. In
addition, behavioral counseling to change smoking-related behavior usually is
necessary. Once cigarettes have been replaced during nicotine replacement
therapy, the amount of nicotine
is then gradually reduced.
Currently, there are different forms of nicotine replacement therapy available over-the-counter
and include:
nicotine transdermal systems or patches (Nicoderm CQ and Nicotrol),
nicotine
polacrilex resin or gum (Nicorette), and
nicotine lozenges (Commit).
The nicotine patch (Nicoderm CQ and Nicotrol)
contains nicotine that is stored within a specially designed support or matrix.
Once applied, the nicotine transdermal system steadily release nicotine that is
absorbed across the skin and into the blood stream. The gum contains nicotine
that is released slowly upon chewing and "parking". Parking refers to the action
of shifting the gum to one side of the cheek after chewing in order to speed the
absorption of nicotine. Nicotine lozenges contain
nicotine within a hard candy that allows for slow release of nicotine as the
candy dissolves in the mouth. A program for slowly weaning users from nicotine
replacement products is provided by each product's manufacturer.
The nicotine
patch, Nicoderm CQ, is available in three strengths; 21, 14, and 7 mg. People
are advised to begin with the 21 mg patch if they smoke more than 10 cigarettes
per day or the 14 mg patch if they smoke less than 10 cigarettes per day. After
six weeks of wearing the initial patch strength, the next lowest patch strength
is worn for two weeks. If therapy was started with the 21 mg patch, an
additional two weeks is required for the 7mg patch. A maximum of eight or 10
weeks, depending upon the strength of the first patch used, is recommended for a
successful quitting program. The Nicoderm CQ patch can be worn for 16 hours
(from awakening until bedtime) or 24 hours if the urge to smoke is great upon
awakening.
Nicotrol is available as a 15 mg patch, and should be worn no more
than 16 hours per day. Nicotrol may be worn for up to six weeks.
The gum, Nicorette, is
available in a variety of flavors in 2 strengths; 4 and 2 mg. Patients are advised to begin with the 4
mg piece of gum if they smoke more than 25 cigarettes per day or the 2 mg piece
if they smoke fewer than 7 cigarettes per day. No more than 20 pieces of the 4
mg strength or 30 pieces of the 2 mg strength should be chewed in one day.
Initial weaning from treatment should begin after 2 to 3 months and be completed
by 4 to 6 months. The most common side effects with
Nicorette are aching jaws or soreness of the gums, changes in taste, abdominal
(gastrointestinal)
discomfort, hiccups, nausea, vomiting, and
belching.
Commit nicotine lozenges are available
in 2 or 4 mg doses. One dose consists of one lozenge, and no more than 20 doses
should be consumed in one day. The manufacturers of Commit recommend choosing
the proper dosage based upon when you usually have the first cigarette of your
day. According to the manufacturer's instructions, if you smoke within 30
minutes of getting up in the morning, you should use the stronger 4 mg dose. If
not, you should use the 2 mg lozenges.
Biting or chewing nicotine lozenges
instead of allowing them to dissolve can lead to indigestion or
heartburn. You should
not eat or drink anything while the lozenge is in your mouth. The lozenges will
last for about 20-30 minutes when allowed to dissolve in the mouth. The most
commonly reported side effects with nicotine lozenges are indigestion, throat
irritation, soreness of the teeth or gums, insomnia, nausea,
hiccups, coughing, heartburn, headache, and
flatulence.
How effective is nicotine replacement therapy?
Approximately 25% of patients successfully stop smoking with nicotine patch
therapy. The success rate with nicotine gum is similar. There have not yet been
studies to compare the effectiveness of nicotine lozenges to the patch or gum.
The rate of success for nicotine replacement therapy increases 35% to 40% when intensive behavioral counseling is added.
Lung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due
to tobacco smoke. Lung cancers are classified as either small cell or non-small
cell cancers.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Bronchitis is a disease of the respiratory system in which the bronchial passages become inflamed. There are two types of bronchitis, acute and chronic. Symptoms of acute bronchitis include frequent cough with mucus, lack of energy, wheezing, and possible fever. Treatment may require medication such as bronchial inhalers and predinsone. Supportive treatment is focused on relieving the symptoms with fever reducers, cough suppressants, and rest. Treatment may be more aggressive in patients with pre-existing conditions such as empyema, COPD, or cigarette smoking.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
In the U.S., more than 2,000 people are diagnosed with bone cancer every year. There are many types of bone cancer. The most common forms of bone cancer are osteosarcoma, Ewing's sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma. Pain is the most common symptom. Treatment usually involves surgery, chemotherapy, and radiation therapy.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Though the cause of stomach cancer is unknown, risk factors for stomach cancer include diet, H. pylori infection, smoking age, gastritis, stomach surgery, family history, and pernicious anemia. Symptoms include stomach discomfort, feeling full after a small meal, nausea and vomiting, and weight loss. Treatment depends upon staging and may involve surgery, radiation therapy, or chemotherapy.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Thrush is an infection of the mouth caused by the candida fungus. Symptoms of Thrush include pain or difficulty swallowing, a feeling that food gets stuck in the throat, and fever.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Treatment for bladder cancer depends on the stage of the disease, the grade of the tumor, and the type of bladder cancer. Options for treatment include surgery, radiation therapy, chemotherapy, and biological therapy.
Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold. Occurring as a result of spasm of blood vessels, the cause is unknown. Symptoms of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Treatments include protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
The term oral cancer includes cancer of the mouth (oral cavity) and the back of the mouth (oropharynx). Red and white patches inside the mouth, bleeding, loose teeth, pain upon swallowing, a lump in the neck, earache, and a sore on your lip or in your mouth that won't heal are all symptoms of oral cancer. Treatment for oral cancer depends upon the staging of the disease and usually involves surgery, radiation therapy, or chemotherapy.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. Miscarriage usually occurs before the 13th week of pregnancy. The cause of a miscarriage cannot always be determined. The most common causes of a miscarriage in the first trimester are collagen vascular disease (lupus), hormonal problems, diabetes, chromosomal abnormalities, and congenital abnormalities of the uterus.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Impotence, also known as erectile dysfunction, is a common
problem among men characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to achieve
ejaculation, or both. Impotence can have emotional causes but most often it is
due to a physical problem.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Laryngitis is an inflammation of the voice box (vocal cords). The most common cause of acute laryngitis is infection, which inflames the vocal cords. Symptoms may vary from degree of laryngitis and age of the patient. Common symptoms include croup, hoarse cough, fever, cold, runny nose, dry cough, and loss of voice. Chronic laryngitis generally lasts more than three weeks. Causes other than infection include smoking, excess coughing, GERD, and more. Treatment depends on the cause of laryngitis.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
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