House Calls / Dr. Michael Schwartz

Cigarette smoking is the No. 1 preventable cause of death. Every year, more than 400,000 people die from smoking related illnesses. Smoking can lead to lung cancer, esophageal cancer, heart disease, stroke and vascular disease. Quitting is hard. Fortunately, several aids have been developed to help smokers kick the habit.

Electronic cigarettes are the new smoking cessation craze. These electronic devices, which resemble cigarettes, create water vapor with nicotine to simulate the act of smoking. The patient inhales on the "cigarette" which delivers a set amount of nicotine and water vapor smoke satisfying the smoking urge. No heat or tobacco biproduct is contained in this device, making it a safer alternative to actual smoking. Many of these products are rechargeable and nicotine cartridges can be replaced. There are also disposable products available. Side effects may include muscle pains and tremors. Early studies show some promising results, however more research needs to be performed. Finally, many of these cigarettes may come with a card stating that this product is approved for indoor use in restaurants and bars. Use caution; laws may still pertain to prohibiting use of these devices in public establishments.

Varenicline (brand name Chantix) is a nicotinic receptor partial agonist. This drug works by simulating the effect of smoking by binding to receptors in the brain. This in turn reduces the need for tobacco while creating the same pleasurable effect of smoking without having to have a cigarette. The patient slowly increases the dose of the medication while continuing to smoke for the first seven to 14 days. After this initial period, the desire to smoke a cigarette decreases and eventually disappears. Chantix must be used with caution in patients with heart disease, kidney disease or circulation disorders. Finally, the drug may increase depression and anxiety in patients who have a history of these disorders. Suicidal risk may be increased as well.

Bupropion (brand name Welbutrin or Zyban) is an antidepressant used to decrease one's craving for smoking. Although its mechanism is not well understood, most patients will not desire a cigarette while taking this medication. A patient generally will start this medication about two weeks prior to attempting to quit smoking. They may remain on this drug for several months (or longer) depending on the effectiveness of the treatment. This medication is not recommended in patients who have had seizures or may be on other antidepressant drugs. Side effects include dry mouth and dizziness.

Nicotine replacement (Nicorette gum, Nicoderm patches, Commit lozenges) is used to deliver nicotine to the patient in order to reduce the urge to have a cigarette. Although the results vary, it has proven efficacious when used with behavioral modification programs. Rare side effects include a rapid heart rate, fatigue and nausea.

Acupuncture is a traditional form of Chinese medicine used to treat many ailments. Auricular acupuncture has been used to help smokers quit. Several small needles are placed around the ear according to a predetermined distribution. This is believed to simulate neurochemicals in the brain that reduce the urge to smoke. Several treatments may be necessary and results have varied.

More Information
Fact box

Hypnosis the art of placing a person into a state of relaxation (or a "conscious sleep"). It is believed that patients undergo an increased sense of alertness during hypnosis allowing for the introduction of suggestive communications. The hypnotist may suggest some of the adverse qualities of smoking such as smell or taste which may be interpreted by the patient as overwhelmingly real ultimately enhancing this perception. Randomized studies do suggest better success when hypnotism is combined with nicotine patches.

Behavior modification includes planning a strategy for smoking cessation. The patient may keep a diary of every cigarette smoked, avoid places where they are more likely to have a cigarette, purchase a limited amount on a limited basis or even cut the actual cigarettes down to half size before smoking them. Deciding on a day to quit is very helpful. Additionally, behavior modification works best when applied with any of the above techniques.

Cold turkey is still the most successful way to stop smoking. Although very difficult, patients who are very motivated seem to have a higher long term success rate. The most difficult part is the "hand to mouth" addiction of cigarette smoking. Many patients will chew gum, lick on lollipops or even use a toothpick. The first three to four weeks are the most difficult, but it gets easier as time goes by. Exercise helps as well.

Health care costs from smoking exceed $100 billion -- much of which is paid out of taxpayer dollars. Most smokers want to quit, but like any addictive habit, it is very difficult. Physicians and family members can and need to help. There are many treatments available with more on the way. Make certain to discuss smoking cessation with your doctor. Most smokers claim they feel remarkably better within a few days of quitting. Today is the first day of the rest of your life. Make it a smoke-less one.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, please visit his web site at