Available [8,9] To explore the subject, I

Available options for smoking
cessation and their effectiveness

 

-Abstract?

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Introduction

Smoking is largely accepted as the leading preventable cause of cancer worldwide.
1,2 In the UK, smoking has been discovered to directly cause about
20% of all cancer as well as 28% of cancer mortalities. 3,4 This
is significant because non-smokers on average live about decade longer as
oppose to smokers. 1,3,5–7 As a medical student it is intriguing
to understand why people smoke and what is available to help them quit because
of the cancer risk and the effects on morbidity and mortality related to
smoking, as well as this smoking currently costs the English society 12.9
billion a year, of which 2 billion pounds a year from the NHS as well as
costing a smoker about £3600 a year to smoke. 8,9 To explore the
subject, I will first delve into ‘why people smoke?’ to gain insight, then I
will explore self-motivations and their effectiveness on quitting on their own
and thereafter I will proceed to discuss the use and effectiveness of drugs
such as varenicline (Champix) and bupropion(zyban) as well as nicotine replacement
therapy(NRT) and its combined use. To gain a deeper understanding of a smoker’s
point of view I have conducted an interview with an ex-smoker that has tried
varenicline on his latest quite attempt, this has enlightened my understanding
of the position of a smoker and I will be using this case study coupled with
research, guidelines and my NCSCT training to shed light on a smoker’s options
with regards to helping them quit smoking and their effectiveness as well as
any drawbacks or barriers that might hinder their quit attempt and discuss ways
that these can be overcome.

 

Discussion

Firstly, in exploration to the question as to ‘Why people smoke?’, I
asked my case study subject appendix 1 why did he start smoking
and in summary his reasons where: social/peer pressure, seeming older and
stress of exams. My subject like a lot of young people today did not think
about the long-term health penalties associated with tobacco smoking when he
started smoking, and the fact that nicotine is a highly addictive substance
that can lead to deadly outcomes. 10 The social aspect of smoking
entails role models such as tv/movies actors that were payed to advertise a
brand of tobacco, a study was conducted into this matter and it was found that
“Movie smoking exposure significantly predicted progression to established
smoking in long-term follow-up. “with an estimate of 34.9% of smoking can be
attributed to movie/tv smoking exposure within their test 11. Other
types of role models may involve the influence of friends that may use peer
pressure to encourage the habit of smoking using social exclusion as an
alternative on a risk-taking vulnerable adolescence 12. Smoking not
only make you seem socially older it also affects your skin, 13, appendix
1 Where twin studies show indicators of the physiological ageing caused
by smoking such as: wrinkles on the upper and lower lips, the face becomes more
wrinkled especially between mouth and nose, and sagging chins appear; bags
under the eye, lower eyelids baggie and upper eyelids sagging. 57% of the time
the smoking twin was identified in this study showing that smoking has some significance
to your perceived age. 13,14 Stress is another contributor to why people smoke, and smoking
has been shown to decrease the arousal level of a subject and possibly stress
level it is possible that smoking in an unpleasant state could facilitate a reduced
arousal level sooner than with non-smoking. 15 One third of
young smokers will quit, one third of young smokers will not be affected and one
third of young smokers will retain the habit of smoking and which will lead to
their premature death. 10

 

Secondly, in exploration of what is self-motivation/ efficacy I found
that quitting smoking is hard in of its own due the dependency of the addictive
drug namely nicotine and quitting smoking can involve several attempts.
16,17 Nicotine dependency opposes self-motivation to quit through nicotine
withdrawal symptoms consisting of: trouble concentrating, desire for products
that contain tobacco, the feelings of easily irritable, quick to anger as well
as being hungrier than usual. 16,18 Moreover, Individuals who may
want to stop smoking because of: family & friends, the finical cost of smoking
or physical cost of smoking (illness secondary to smoking); whom stop smoking
for a time frequently start again due to these withdrawal symptoms, weight gain
as well as stress. 16-18 My case study had 2 failed quit attempts
and where factors such as stress overcame his self-motivation to quitting smoking,
appendix 1 he used a method called going ‘cold turkey’ where by you
stop smoking all together suddenly (as oppose to cutting down) but he did not
have any help and Scientific research has shown treatments such as: counselling,
a doctor’s advice and Behavioural therapies can help a quit attempt. 18,19
Social support is the second most important ingredient of smoking cessation
after self-motivation, a good way that this can be achieved is by getting
family and friends to be proactive in the quit attempt or joining a support
group. 19 using a new, healthy way to relieve
day to day stresses because for many people Smoking is a stress reliever,
Replacing cigarettes as a default stress-management tool with something else is
critical to quit attempt seceding and being sustained; Exercise is an effective
alternative for stress relief as well as this it can help improve your mood,
and reduces concerns with gaining weight once you quit as you are burning the
increased food intake.19 ,20 appendix 1 Changing habits that are
related to smoking such as chewing gum or having a healthy snacks when urge to
smoke arises suggestions include toothpicks, celery, cinnamon sticks, or straws
to keep you occupied. 19,20 Additionally, it is estimated that 55%
of adult smokers have tried to quit smoking and about a 75% (2012) rebound rate
through going ‘cold turkey’. 19,21

 

One of the first line treatments options given for smoking cessation is
nicotine replacement therapy. 18 Nicotine replacement therapy is
used to decrease withdrawal symptoms discussed earlier by replacing nicotine
taken from smoking with other forms of nicotine such as: gum, inhaler, lozenge,
nasal spray or a patch patches to be placed on skin that contain nicotine. The
slow release of patches dissociates smoking and getting a hit of nicotine as
well as lacking tar that is found in cigarettes that can cause cancer.
22 Research of 40,000 subjects found that the use of nicotine
replacement therapy in all forms made it more likely that quit attempt is
successful by 20%. 22 There is no advantage of using NRT patches
beyond the time of 8 weeks. 22 Moreover, NRT is effective when
mixed with counselling or when used in isolation, and there is no need for NRT
to be prescribed by a doctor which may mean more people have access to NRT from
just using their pharmacy but smokers who smoke more frequently may need higher
doses of nicotine. 22 Nicotine replacement therapy may be more
effective if given using a combination of slow acting patches and faster acting
product such as nasal spray. 22 Side effects from NRT may include
skin irritation or mouth irritation but these are minimal in comparison to side
effects of smoking. 1,2,22 more?

 

Another option for smokers is varenicline (Champix), Also given as a
first line treatment for smoking cessation. 18 Varenicline is a
very effective smoking cessation drug, it can increase the probability of
stopping smoking by two folds. 23,24 Varenicline is a full against
of ?7 nicotinic acetylcholine receptors and partial against of other subtypes
such as ?4?2. 25 The activity of varenicline on ?4?2 receptors
creates less effect of dopamine release as compared to nicotine but this
competitiveness on ?4?2 means that nicotine would bind and fully stimulate ?4?2
receptor to a less extent as the receptor is saturated with varenicline. 26
Research found that varenicline is more effective than the use of 1 NRT product,
but results are not as clear for the use of combination NRT. 27 My
case study subject heard about this drug through a friend and requested it
after being referred to the smoking cessation program by his GP after he was
found to have problems with his heart and he felt that the drug worked as he
had no desire to smoke within the first few weeks, but he stopped taking
varenicline earlier that recommended because he felt uncomfortable that it was
building a sheath around his brain. Varenicline is more costly than other
alternative for smoking cessation but also more effective and research shows by
measure of quality adjusted life year gained (QALY), varenicline is at least as
cost effective as bupropion or NRT. 28-30 Common side effects may include nausea,
headache, abnormal dreams, insomnia and nasopharyngitis, 31
there has been some evidence that varenicline increases risk of cardiovascular disease
32 but because once a smoker stops smoking the risk of a
cardiovascular disease decreases by a half in the first year and returns to
same risk as a non-smoker within 3 years, this makes the risk of cardiovascular
disease a result of varenicline is negligible but there is advice to stop
taking varenicline after a cardiovascular event and to report to a doctor. 31,33,34

 

Alternatively, bupropion (Zyban) can be used as a smoking cessation aid
that is a first line option for patients willing to stop smoking. 18
Bupropion acts to decrease the severity of withdrawal symptoms and nicotine
cravings. 35 Bupropion also has anti-depressant effects, so it may
be difficult to ascertain its effectiveness as a smoking cessation drug in
people with history of depression; taking this into account it is approximated
that bupropion doubles the chances of quitting smoking. 35
Bupropion has been found to have less effectiveness when compared with
varenicline but similar effectiveness as nicotine replacement therapy. 35
Side effects may include epileptic seizures which caused bupropion to be
withdrawn from the market for a time, but it was later found that this was a does
issue and seizures occur in overdosing, also having epilepsy is a
contraindication to taking bupropion. 36 more?

 

-Vaping -?
Effective,? Evidence,? Uptake,? Quit smoking all
together 

 

 

 

 

Summary

In summary, a smoker has 3 different type of drugs as first-line
treatment 18 to help them quit smoking if they are unable to
achieve and maintain the change themselves through self-motivation alone, these
include: nicotine replacement therapy(NRT), which may be in the form of gum,
inhaler, lozenge, nasal spray or a patch; bupropion and varenicline.
Varenicline seems more effective than bupropion or single NRT 27,35
while being at least as cost effective to deliver 28-30 and I
think that means that this should be the recommended therapy because of
effectiveness.

 

Conclusion

Conclusion/merge
with summary not yet finalised as some aspects of this essay are subject to
change

 

 

 

 

 

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