Dr. Ahmed
Smoking Cessation is beneficial for anyone, regardless of the age. It’s never too late to quit smoking.
However, the greatest benefits of smoking cessation are experienced by those individuals who quit smoking before the age of 40 years.
Because of the widespread smoking cessation programs, many people have quit smoking before 40 years of age in Europe and the United States.
This translated into increased survival rates and reduced smoking-related medical conditions over the decade.
Data from four national registries in the US, UK, Canada, and Norway, comprising 1.48 million people were analyzed to see the effects of smoking cessation.
Key points of the Smoking Cessation Study:
- Research says that smokers have a 3 times higher risk of mortality when compared to those who never smoked. They have also lasted around 12 to 13 years of their life in comparison to non-smokers who faced no such loss.
- Individuals who quit smoking had lower chances of death but still 1.3 times higher than non-smokers. Which shows the impact of smoking cessation on longevity.
- Even if they quit smoking for a short period of less than 3 years they still experienced significant benefits. Including reduced risk of premature death by 95% in women and 90% in men under 40 years of age.
- Smokers who quit early in life before age 40 had longer survival. Nevertheless quitting at any age can grant several benefits which were more expressed the sooner smoking was quit.
- Short-term quitting can make up for the years of life lost. For instance, quitting for less than 3 years can save 5 years of life, and quitting smoking for 10 years or more can save 10 years of life.
Why Smoking at an Early Age is Difficult to Quit?
According to the Centers for Disease Control and Prevention, over 16 million individuals in America are diagnosed with some sort of illness caused by smoking [ref].
This is enough to give a perspective about what a single cigarette can do to your body. Still, people refuse to give up this toxic habit and continue to live with it.
Not only that, the number of cigarettes smoked can also increase with their addiction, eventually leading to death.
A study from 2020 concluded that those who start smoking before 20 years of age find it much harder to quit.
They also become more addicted to it. Likewise, people who started smoking after 22 years of age were less nicotine dependent.
Just like metabolic memory, starting smoking at an early age strikes your brain so hard that it is difficult to quit. Even if you quit for a few years, a single puff of a cigarette will make you crave again.
For these reasons, smoking cessation education must be spread to help people live longer and without an illness.
Smoking is like a hub of diseases and it is the root of every lung disease. The most notorious lung cancer is mainly caused by cigarettes, in the USA almost 80% to 90% of lung cancer deaths are associated with this habit [ref]. This is because tobacco is a combination of 7000 different toxic chemicals.
To express the importance of smoking cessation a recent study showed that individuals who stopped had lower risks of death from cancers, respiratory, and vascular diseases. Even short-term cessation showed multiple benefits. [ref]
Quitting at any age will have plenty of health effects.
Methodology and analysis
The study examined adult smokers and non-smokers residing in different countries from 1974 to 2018.
Their main conclusion was; that smokers died before non-smokers in all cases. Females lost up to 12 years of their life and males lost about 13.
However, they further found out that quitting before 40 can lead to a longer life. Even if you quit for less than 3 years, it can make a huge difference.
Furthermore, cessation for over 10 years can add 10 more years to your life. Which will make their health similar to those who never smoked. This is enough to show that smoking cessation is good for both short-term and long-term benefits.
Smoking Cessation Drugs:
For those who have trouble with quitting this habit can lean towards certain drugs that help with cessation.
Nicotine replacement Therapies:
1. Nicotine patch:
These patches can deliver a controlled dose of nicotine through the skin. This will reduce the withdrawal symptoms.
These are often suggested by physicians to help you with a plan to quit cigarettes and it increases the chances of long-term cessation as there are no cravings.
2. Nicotine lozenge:
Another option, these products can dissolve in the mouth and release nicotine to reduce cravings.
They are a more convenient choice and an easy way to manage symptoms. However, taking these with counseling or a quit plan can raise your chances.
3. Nicotine gum:
This is a chewable product which helps you break this toxic habit. It does the same thing as others by delivering a small amount of nicotine.
So, whenever a smoker feels the urge, he can just pop one in his mouth and chew. It comes in various flavors and with time the dose is lowered to remove nicotine from your life without any symptoms.
Other Nicotine replacement therapies include nicotine inhalers, nicotine nasal sprays, transdermal nicotine patches, and sublingual nicotine tablets.
Non-Nicotine-Based Therapies for Smoking Cessation:
1. Bupropion:
Bupropion is an atypical antidepressant. It is also one of the FDA-approved drugs for the management of Obesity along with Naltrexone combined in a single tablet as Contrave.
The US clinical practice guidelines recommend Bupropion (Welbutrin) as one of the first-line drugs for smoking cessation in ready-to-quit smoking individuals [Ref].
Bupropion is available as a tablet, Welbutrin and Welbutrin XL, in a dose of 150 mg. The maximum dose recommended is 300 mg per day. (Sometimes a higher dose of 450 mg may be indicated).
Because of the increased risk of insomnia and dry mouth, it is best to take in the morning. However, for individuals not achieving their goals, a dose of 300 mg may be used twice daily.
Bupropion may work best when combined with Nicotine replacement therapies as mentioned above.
However, people at risk of seizures, such as those with epilepsy should avoid Bupropion.
2. Nortriptyline:
The US Clinical Practice Guidelines recommend Nortriptyline as a second-line drug for smoking cessation along with Nicotine replacement therapy.
3. Clonidine:
Clonidine is primarily a centrally-acting antihypertensive medicine. The US Clinical Practice Guidelines recommend Clonidine as a second-line drug for smoking cessation.
Clonidine may also help with opiate and alcohol withdrawal symptoms. In smokers, it is associated with an abstinence rate twice that of a placebo drug.
4. Varenicline (Chantix, Tyrvaya):
Varenicline is the latest drug approved by the FDA for smoking cessation. It acts by attaching to and activating and blocking the alpha-4, and beta-2 nicotinic acetylcholine receptors (nAChRs) in the brain.
The nicotinic receptor activation is very mild. It also prevents the binding of nicotine to these receptors.
By maintaining low levels of dopamine in the brain, it helps in reducing the withdrawal symptoms associated with nicotine.
Varenicline use is associated with an abstinence rate of 3 times that of a placebo drug and 1.6 times that of Bupropion.
Hence individuals on Varenicline are 3 times more likely to quit smoking than those not given any drug and 1.6 times more likely than Bupropion to quit smoking [Ref].
In another study, the abstinence rate at 6 months was more than twice that of a placebo drug.
However, Varenicline use is associated with serious adverse cardiovascular outcomes and should be used with caution in individuals with established heart disease.
Other Novel Therapies for Smoking Cessation:
A nicotine vaccine, administered intramuscularly is currently being investigated as a treatment for smoking cessation. NicVax is another vaccine that failed to show any benefits.
Mecamylamine is a nicotine antagonist and may reduce the pleasures associated with smoking resulting in smoking cessation.
Other therapies being tried by smoking rehabs are Hypnotherapy (Hypnosis) and Acupuncture for smoking cessation. However, these methods have not been scientifically proven.
Theta-burst transcranial magnetic stimulation (TBS) is another method being tested as a treatment for smoking cessation.
Hazards of Second-hand Smoke Effects:
SHS or passive smoking is when you inhale smoke exhaled by a smoker. This is lethal enough to cause premature deaths in 34,000 people in the USA.
It can harm the cardiovascular system and lead to heart attacks in people who don’t even smoke.
So much so that it increases their chances of getting coronary heart disease by 25% to 30% and stroke by 20% to 30%.
These effects are more pronounced in people who are already suffering from heart disease which is why they need to take special precautions to stay away from SHS.
This is a good example to show why smokers need to quit because they are causing significant harm to others as well.
Even if you are exposed to second-hand smoke for a brief minute, it is sufficient to damage your blood vessels and make your platelets sticky.
So, take extra measures and stay away from those who smoke. If you are consistently in an environment where exposure is evident then wear masks and get your lungs occasionally to rule out any severe issues.
