Not really a disease but the cause of many and we need to help willing patients to give up. Significant Level of addiction - First cigarette within 30 mins of waking is a poor sign, Smoke > 25/day
Pathology caused or worsened
- Cancers
- Lung, Stomach, Oral, Laryngeal
- Colon and Bladder cancer, Oesophageal, Pancreatic,
- vascular disease
- Malignant hypertension
- SAH due to Berry aneurysm
- Buerger's disease
- Abdominal aortic aneurysm
- VTE in those on OCP
- Atherosclerotic Peripheral vascular disease
- Gastrointestinal
- Clots, Dyspepsia, Peptic ulcer disease, COPD
- lung disease
- Goodpasture's syndrome - more severe alveolar haemorrhage
- Lung cancer
- COPD, Asthma
- Chickenpox lung.
- Endocrine
- endocrine disease - Eye complications of Grave's disease.
- Pregnancy
- Perinatal morbidity, mortality, Intrauterine growth retardation
- Neurology
Pathology lessened
- Osteoporosis
- Parkinson's disease
- Ulcerative colitis
- COVID 19 pneumonia
Therapies available - any /all worth trying
- Complementary can be tried - Hypnotherapy, Acupuncture
- Nicotine replacement therapies (NNTs) - gum, inhalers, nasal sprays, patches, lozenges
- Bupropion SR (Zyban) - Noradrenaline and dopamine reuptake inhibitors. May be used with patch. C/I with epilepsy
Nicotine Withdrawal
- Craving for nicotine, Anger, restlessness, anxiety
- Irritable, increased appetite, Poor concentration
- Most resolve by 30 days. Weight gain 2-4 kg
General
- Getting patients to stop smoking and keeping them off the cigarettes is one of the most useful things that you can do. It's almost never too late and patients are rarely too old to stop.
- Nicotine Withdrawal syndrome: Craving for nicotine, Anger, restlessness, anxiety, Irritable, increased appetite, poor concentration, Most resolve by 30 days. Weight gain 2-4 kg
- Always consider it, discuss it, support it. Try for a smoke-free house - will partner give up too. Complementary can be tried - Hypnotherapy, Acupuncture
- Nicotine replacement which is available on the NHS. Not immediately post MI/Stroke/Arrhythmia
- Bupropion (Zyban) - see BNF start a week before plan to stop. Then continues for 2-3 months. Not if epilepsy, bipolar, pregnant, breastfeeding
References