Electronic Cigarettes and Smoking Cessation Strategies | Cecilia Pham, PharmD | RxEconsult
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Electronic Cigarettes and Smoking Cessation Strategies Category: Cancer by - December 21, 2012 | Views: 8946 | Likes: 0 | Comment: 0  

Some Facts About Cigarette Smoking and Cessation

  • Cigarette smoking is one of the top leading preventable causes of death.
  • Every year, approximately 6 million deaths worldwide and over 400,000 deaths in the United States are due to smoking.
  • Smoking is a major risk factor for heart disease, lung cancer, and chronic obstructive pulmonary disease (COPD). Some of these diseases are the top ranked causes of death.
  • Not only do smokers put themselves at risk, they put the people around them at risk (second hand smoking).
  • People who stop smoking reduce the risk of developing or worsening many life-threatening diseases.
  • Statistics show that 70 percent of smokers want to quit, but only 25 percent actually seek help to quit. Much fewer numbers have sought available effective treatments.
  • Only about 3 to 7 percent of smokers are successful in quitting and staying smoke-free for at least one year.
  • Health providers can help. They can walk smokers through a counseling process to ask about their smoking status, advise them to quit, assess their readiness to quit, assist them in quitting, and arrange for follow-up to see their progress.

What are electronic cigarettes?

At the beginning of the 21st century, electronic cigarettes were commercialized as alternatives to smoking and an option for smoking cessation. They were electronic devices that looked like cigarettes and were used in the same fashion. However, they contained much less of the traditional toxins in a cigarette and produced only vapor for inhalation. The device consists of three parts: a plastic tube, an electronic heater, and a liquid cartridge. Electronic cigarettes offer the advantage of allowing smokers to simulate smoking, yet enable them to smoke less to zero amounts of nicotine. Some brands even say that their products are fireproof because they can prevent fires that could be started from a lit cigarette.

Should everyone use electronic cigarettes?

  • Due to the lack of adequate scientific studies, it cannot be confirmed that electronic cigarettes are more beneficial or equivalent to recommended smoking cessation therapies.
  • The FDA has not encouraged electronic cigarette use, as there is not enough supporting evidence to show how safe these products are, nor how much nicotine and other chemicals are actually inhaled with these devices.
  • Traces of potential cancer causing agents like diethylene glycol and nitrosamines have been found in electronic cigarettes.
  • As an inhaled product, smokers can still experience throat irritation and airway problems such as bronchospasms.
  • Ultimately, electronic cigarettes should not be considered the first option in trying to stop smoking. Smokers should talk to a healthcare provider to see what other options are available.

What are proven alternatives for smoking cessation?

Smoking cessation can be a difficult process to endure, especially for those that have smoked for many years, where it has become an undeniably pleasurable habit. Stopping “cold turkey” can be very difficult and otherwise unsuccessful due to such strong withdrawal effects like depression, insomnia, irritability, frustration, and restlessness. There are several smoking cessation strategies with more supporting evidence that can help smokers to quit smoking. Talk to a health provider such as a physician or pharmacist for more detailed information and counseling. They may recommend the following options:

  • Nicotine gum or lozenge:

These do not require a prescription. Compared to a cigarette, it does not have all the other toxic chemicals. Unlike any smoking device, it is not inhaled directly into the lung so has no potential for causing throat irritation or airway problems like bronchospasms. Randomized trials showed that 81.3% of patients had initial cessation of at least one day compared to 69.4% on placebo. There are two different strengths: 2 mg and 4 mg dosed according to level of smoking . They are available as fruit or mint flavor. They are like candy can easy to use. Hold in the mouth for 30 minutes and repeat every few hours. This can satisfy oral cravings and delay weight gain. The treatment is done for about 12 weeks. Side effects are mild.

  • Nicotine patch:

This does not require a prescription and has the advantage of a once daily dosing. Dosing depends on level of smoking. One patch is worn every 24 hours or every 16 hours (removed at bedtime) if side effects occur. This treatment lasts for about 8 to 10 weeks. The nicotine patch approximately doubles the rate of long-term abstinence compared to placebo. The patch should be removed before bedtime as it can cause sleep disturbances such as vivid dreams.

  • Nicotine patches can be used together with the gum or lozenge.

Many times, combination strategies may give better success rates. The patches are used for long-term control, while the gum or lozenges is used to satisfy short cravings. A randomized trial showed that this combination had a higher effectiveness compared to either alone at 6 months. The combination showed 40.1% smoking cessation in participants.

  • Prescription options like Chantix or Zyban:

It is recommended that smokers should start treatment 1-2 weeks before smoking quit date. These come in the form of pills that can be taken once to twice daily. The treatment lasts about 12 weeks. Chantix can be continued for an additional 12 weeks after successful quitting. Zyban is especially recommended in smokers who have diagnosed depression. A randomized trial showed that 31.8% of participants on Zyban abstained from smoking by 6 months compared to 22.2% on placebo. The result were higher when Zyban was combine with the lozenge at 33.2%. Another randomized study showed that Chantix 2 mg had a 44% success rate compared to 18% in the placebo group and 30% in the Zyban group. However, it should be cautioned that these medications have the potential to cause major changes in mood and behavior. Chantix may also worsen heart conditions, and should be used cautiously in smokers who have heart disease. Chantix is also associated with vivid dreams.

 

REFERENCES

World Health Organization Report on the Global Tobacco Epidemic, 2011: Warning about the dangers of tobacco.

CDC. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2004.

Anthonisen, N., Skeans, M., Wise, R., Manfreda, J. Kanner, R., Connett, J. 2005 Feb 15. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 142(4): 233-9.

Treating tobacco use and dependence: 2008 update. US Department of Health and Human Services 2008.

Rigotti, N. 2002 Feb 14. Clinical practice. Treatment of tobacco use and dependence. N Engl J Med. 346(7): 506-12.

Yamin, C., Bitton, A., Bates, D. 2010 Nov 2. E-cigarettes: a rapidly growing Internet phenomenon. Ann Intern Med.153 (9): 607-9.

FDA Warns of Health Risks Posed by E-Cigarettes

Evaluation of e-cigarettes - Food and Drug Administration

Vardavas, C. et al. June 2012. Short-term Pulmonary Effects of Using an Electronic Cigarette: Impact on Respiratory Flow Resistance, Impedance, and Exhaled Nitric Oxide. Chest. 141(6): 1400-1406.

PHARMACOLOGIC PRODUCT GUIDE: FDA-APPROVED MEDICATIONS FOR SMOKING CESSATION

Piper ME, Smith SS, Schlam TR, Fiore MC, Jorenby DE, Fraser D, Baker TB. 2009. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry. 66(11): 1253.

Zyban Prescribing Information

Chantix Prescribing Information

 

This medication summary is for information only and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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