Online Health Chat with Iyaad Hasan, DNP (c)

November 9, 2010

Introduction

Cleveland_Clinic_Host: If you're ready to quit smoking or chewing tobacco - or even if you're just thinking about it – then this web chat is for you. Learn why you got hooked, and find the motivation to help yourself quit for good. Discover ways to get over the hump. You know what makes it all worthwhile? Understand which medications and techniques can help.

Cleveland Clinic's Tobacco Treatment Center has a support program that makes it easier to stop than you think. All you need is the desire to quit and a little willpower.

Cleveland Clinic's Tobacco Treatment Center dramatically increases quitting success rates by providing participants with a personalized treatment program. With their knowledge and expertise, our tobacco cessation specialists will:

• Develop an individualized treatment plan based on your medical history, dependence on nicotine, how ready you are to quit and your preferred method  of learning.
• Combine the appropriate medications and behavioral therapies to help you  cope with the physical and emotional cravings you experience as you quit.
• Follow-up with you on a regular basis to check on your progress, offer tips and  advice  and celebrate your successes.

Iyaad Hasan, MSN, DNP(c), Director of Cleveland Clinic’s Tobacco Treatment Center, self-proclaimed “quit-ologist” and former smoker, knows first-hand what it’s like to quit tobacco:

“I used to smoke four or five cigars a day. Whenever someone commented on that, I’d say, ‘No, I’m not addicted. I don’t smoke cigarettes, I smoke cigars. I don’t even inhale. I can stop smoking anytime.’ “One night while playing poker with my friends, I smoked five cigars. When I woke up the next morning, my mouth felt awful. Dry and painful. I spit into a handkerchief and saw red phlegm. I looked in the mirror and my gums were bright red. Bloody red. I washed my mouth out and kept spitting blood. At that moment, I knew I had an addiction to tobacco and I had to quit. I went cold turkey and it was tough, but I did it.”

Iyaad Hasan, DNP (c) specializes in pediatric and adult tobacco treatment and is a locally and nationally recognized expert in the field assisting with groups through the media and other venues.  He has helped thousands of smokers and tobacco chewers find their way to a nicotine-free life. He can help you, too. It is time to change your life, and snap the habit!

To make an appointment with Iyaad Hasan, DNP(c) or to learn more about how our Tobacco Treatment Center can help you, please call 216.444.8111 or visit clevelandclinic.org/tobaccotreatment

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Iyaad Hasan. We are happy to have him here today for our chat on Ready to Snap Your Tobacco Habit? Let’s begin with the questions.

Basic Facts about Tobacco

smokers_kid: What are the chances that smoking will kill you?

Speaker_-_Iyaad_Hasan_DNP_c_: About four million people die worldwide each year as a result of smoking. In the United States, tobacco use is responsible for nearly one in five deaths, killing more than 400,000 Americans each year. This is more than the number of people who would die every year if three jumbo jets crashed each day with no survivors. Smoking is the single most preventable cause of death in our society. Statistically, smokers die 10 - 12 years younger than non-smokers.

school2: How many people smoke cigarettes?

Speaker_-_Iyaad_Hasan_DNP_c_: In 1998, the latest year for which figures are available, 24.1% of adults --about 48 million people-smoked cigarettes. Approximately 26% of men and 22% of women reported being smokers in 1998, reflecting a continuing decline in the percentage of Americans who smoke. African-Americans smoke about the same as whites, 24% and 25%, respectively. Ethnic groups with the lowest smoking rates are Hispanics (19.1%) and Asians/Pacific Islanders (13.7%). Education level seems to affect smoking rates as shown by a consistent decrease in the smoking rate in groups with a higher level of education. About 37% of those with less than a high school education smoke, while only about 11% of those with a college education or more smoke.

school2: Why do people begin to smoke?

Speaker_-_Iyaad_Hasan_DNP_c_: Most people begin smoking between the ages of 10 and 18. Peer pressure and curiosity are the major influences that encourage them to experiment with smoking. Also, people with parents who smoke are more likely to begin smoking than those who have nonsmoking parents. Those who begin to smoke at a younger age are more likely than late starters to develop long-term nicotine addiction. Another prevalent influence in our society is the tobacco industry's advertisements for its products. The tobacco industry spends nearly $6 billion annually to develop and market ads that depict smoking as an exciting, glamorous, healthy adult activity.

smokers_kid: Can quitting really help a lifelong smoker?

Speaker_-_Iyaad_Hasan_DNP_c_: Yes. It is never too late to quit. The sooner smokers quit, the more they can reduce their chances of getting cancer and other diseases. Within 20 minutes of smoking the last cigarette, the body begins a series of regenerating changes. After 20 minutes, blood pressure drops to normal. After 8 hours, the carbon monoxide level in the blood drops to normal. After 24 hours, the chance of heart attack decreases. After one year, the risk of coronary heart disease is half that of a smoker. In 1 to 9 months, coughing, sinus congestion, fatigue, and shortness of breath decrease and cilia regrow in the lungs. After 10 years, the lung cancer death rate decreases by almost half. After 15 years, the risk of coronary heart disease is that of a non-smoker. It is important to note that the extent to which these risks fall depends on the total amount the person smoked, the age the person started smoking, and the amount of inhalation.

school2: Is smoking common among young people?

Speaker_-_Iyaad_Hasan_DNP_c_: Yes. Tobacco use, including smoking cigarettes, chewing tobacco, and dipping snuff, remains common among American youth. About 35 percent of high school students and about 13 percent of middle school students surveyed in 1998 and 1999 reported being users of some form of tobacco, with about 8 percent reporting they smoked their first cigarette before age 11. About 80 percent of adult smokers started smoking when they were 17 or younger.

school2: If you smoke but don't inhale, is there any danger?

Speaker_-_Iyaad_Hasan_DNP_c_: Yes. Wherever smoke touches living cells, it does harm. Even if smokers don't inhale - including pipe and cigar smokers - they are at an increased risk for lip, mouth, and tongue cancers. Because it is virtually impossible to avoid inhaling smoke totally, these smokers are also increasing their risk of getting lung cancer.

school2: Suppose I smoke for a while and then quit?

Speaker_-_Iyaad_Hasan_DNP_c_: Smoking begins to cause damage right away and is highly addictive. Several studies have found nicotine to be as addictive as heroin, cocaine, or alcohol; it is the most common form of drug addiction in the United States. Therefore, it is obviously better never to start smoking cigarettes and become addicted to nicotine than it is to smoke with the intention of quitting later. And like alcohol, heroin, and cocaine, nicotine creates a permanent tolerance in the body. When an ex-smoker smokes a cigarette, even years after quitting, the nicotine reaction may be triggered, quickly hooking the person on the old habit.

Tobacco Addiction

Larkin: Is cigarette smoking really addictive?

Speaker_-_Iyaad_Hasan_DNP_c_: Yes. The nicotine in cigarette smoke is what causes an addiction to smoking. First, when taken in small amounts, nicotine produces pleasurable feelings that make the smoker want to smoke more. Second, smokers usually become dependent on nicotine and suffer both physical and psychological withdrawal symptoms when they stop smoking. These symptoms include nervousness, headaches, irritability, and difficulty in sleeping. Third, because nicotine affects the chemistry of the brain and central nervous system, it can affect the mood and temperament of the smoker.

intersect: Who is most likely to become addicted?

Speaker_-_Iyaad_Hasan_DNP_c_: Anyone who starts smoking is at risk of becoming addicted to nicotine. Studies show that among addictive behaviors such as the use of alcohol and other drugs, cigarette smoking is most likely to become an established habit during adolescence. Therefore, when young people become cigarette smokers they are more likely to become addicted and more likely to suffer from the variety of health problems caused by cigarette smoking.

harding: What in cigarette smoke is harmful?

Speaker_-_Iyaad_Hasan_DNP_c_: Cigarette smoke is a complex mixture of organic and inorganic compounds generated by the combustion (burning) of tobacco and additives. Cigarette smoke contains tar, which is made up of over 4,000 chemicals, including the 43 known to cause cancer. Some of these substances cause heart and respiratory diseases, all of which are disabling and can cause death. You might be surprised to know some of the chemicals found in cigarette smoke. They include: cyanide, benzene, formaldehyde, methanol (wood alcohol), acetylene (the fuel used in torches), and ammonia. It also contains the poisonous gases nitrogen oxide and carbon monoxide. Its main active ingredient is nicotine, an addictive drug.

chuck: Is there a safe way to smoke?

Speaker_-_Iyaad_Hasan_DNP_c_: No. All cigarettes can cause damage to the human body and even a small amount is dangerous. Cigarettes are perhaps the only legal product whose advertised and intended use is harmful to the body and is a proven cause of cancer.

Although some people try to make their smoking habit safer by smoking fewer cigarettes, most smokers find that difficult. Some people think that switching from high tar and nicotine cigarettes to those with low tar and nicotine content makes smoking safer, but this is not always true. When people switch to lower tar and nicotine brands, they often smoke more cigarettes or more of each cigarette to get the same nicotine dose as before. A low-tar cigarette can be just as harmful as a high-tar cigarette when a person takes deeper puffs, puffs more frequently, or smokes cigarettes to a lower butt length. Even if smokers who switch to lower tar brands do not make these changes to compensate, the health benefits are insignificant when compared to the benefits of quitting completely.

The Side Effects of Tobacco

connor2: What are some of the short- and long-term effects of smoking cigarettes?

Speaker_-_Iyaad_Hasan_DNP_c_: Smoking causes cancer, which may not develop for years. Regardless of how many smokers are lucky enough to escape cancer, the truth is inescapable: cigarette smokers die younger than nonsmokers. In fact, smoking decreases a person's life expectancy by 10 - 12 years. Smokers between the ages of 35 and 70 have death rates three times higher than those who have never smoked.

There are many more short-term effects of smoking. A major consequence of smoking is decreased lung function which is why smokers often suffer from shortness of breath, nagging coughing, or tiring easily during strenuous physical activity. Smoking also diminishes the ability to smell and taste and causes premature aging of skin.

bryce: What does nicotine do?

Speaker_-_Iyaad_Hasan_DNP_c_: Nicotine is a poison and taken in large doses could kill a person by paralyzing breathing muscles. Smokers usually take it in small amounts that the body can quickly break down and get rid of, which is why the nicotine does not kill instantly. The first dose of nicotine causes a person to feel awake and alert, while later doses result in a calm, relaxed feeling. Nicotine can make new smokers, and regular smokers who get too much of it, feel dizzy or nauseous. The resting heart rate for young smokers increases 2 to 3 beats per minute. It also lowers skin temperature and reduces blood flow in the legs and feet. Evidence shows that nicotine plays an important role in increasing smokers' risk of heart disease and stroke.

school2: Are menthol cigarettes safer than other brands?

Speaker_-_Iyaad_Hasan_DNP_c_: Menthol cigarettes are not safer than other brands and may even be more dangerous. About 28% of all cigarettes sold in the United States are menthol. About 76% of African-American cigarette smokers smoke menthol cigarettes as compared to 23% of whites. These brands contain enough menthol to produce a cool sensation in the throat when smoke is inhaled. People who smoke menthol cigarettes can inhale more deeply or hold the smoke inside longer than smokers of non-menthol cigarettes. This may explain why African-Americans, who statistically smoke fewer cigarettes a day (but more menthol cigarettes), are more likely than whites to die from smoking-related diseases like lung cancer, heart disease, and stroke.

school2: Why do smokers have "smoker's cough?"

Speaker_-_Iyaad_Hasan_DNP_c_: Cigarette smoke contains chemicals that irritate the air passages and lungs. When a smoker inhales these substances, the body tries to protect itself by coughing. The well-known "early morning" cough of smokers happens for a different reason. Normally, cilia (tiny hair like formations lining the airways) beat outward and sweep harmful material out of the lungs. Cigarette smoke, however, decreases the sweeping action, so some of the poisons in the smoke remain in the lungs. When a smoker sleeps, some cilia recover and begin working again. After waking up, the smoker coughs because the lungs are trying to clear away the poisons that built up the previous day. Unfortunately, prolonged exposure to smoke completely destroys the cilia's ability to function. Then the smoker's lungs are even more exposed and susceptible than before, especially to bacteria and viruses in the air.

wunderdog: How does tobacco use affect the economy?

Speaker_-_Iyaad_Hasan_DNP_c_: The tobacco industry is one of the most profitable businesses in the country; in 1998 tobacco manufacturers' revenue was $50 billion. Nevertheless, the costs of smoking are far higher than the income from cigarette sales. Medical costs alone caused directly by smoking total between $50 billion and $73 billion each year. Lost economic productivity caused by smoking also costs the US economy more than $50 billion each year. This totals more than $100 billion lost each year to health care costs and lost productivity due to smoking. Of course these numbers represent only the financial costs. No statistic can express the devastation of pain and suffering caused by cigarette smoking.

changes: Does cigarette smoking affect the heart?

Speaker_-_Iyaad_Hasan_DNP_c_: Yes. Smoking cigarettes increases the risk of heart disease, which is America's number one killer. Almost 180,000 Americans die each year from cardiovascular disease caused by smoking. Smoking, high blood pressure, high blood cholesterol, and lack of exercise are all risk factors for heart disease, but smoking alone doubles the risk of heart disease. Among those who have previously had a heart attack, smokers are more likely than non-smokers to have another.

Tobacco & Cancer

bryce: Does smoking cause cancer?

Speaker_-_Iyaad_Hasan_DNP_c_: Yes. Tobacco smoke contains at least 43 carcinogenic (cancer-causing) substances. Smoking causes many kinds of cancer, not just lung cancer. Tobacco use accounts for 30%, or one in three, of all cancer deaths in the United States. Smoking is responsible for almost 90% of lung cancers among men and more than 70% among women, about 83% overall. Cancer of the mouth, larynx, pharynx, esophagus, kidney, bladder, pancreas, and uterine cervix also have in common cigarette smoking as a major cause.

harding: How does cigarette smoke affect the lungs?

Speaker_-_Iyaad_Hasan_DNP_c_: Cigarette smoking causes several lung diseases that can be just as dangerous as lung cancer. Chronic bronchitis - a disease where the airways produce excess mucus, which forces the smoker to cough frequently - is a common ailment for smokers. Cigarette smoking is also the major cause of emphysema - a disease that slowly destroys a person's ability to breathe.

flashing_lights: When someone gets lung cancer, can it be shown to be attributed to smoking? My sister smoked 20 years ago, for about 5 years. People are saying it is because she once smoked. How can you tell?

Speaker_-_Iyaad_Hasan_DNP_c_: You really cannot distinguish - but given history of smoking it may be attributed to smoking. Fact: Females who smoke are 12x more likely to get lung cancer than a non-smoker.

Environmental Tobacco Smoke (ETS)

heady: What are the dangers of environmental tobacco smoke (ETS), or passive smoking, or second-hand smoke?

Speaker_-_Iyaad_Hasan_DNP_c_: Passive smoking occurs when nonsmokers inhale the tobacco smoke created by smokers (environmental tobacco smoke). ETS, also known as second-hand smoke, includes mainstream smoke, which is smoke drawn through the mouthpiece of a cigarette, pipe, or cigar that is then exhaled into the air by smokers, and side stream smoke, the smoke that comes directly from the burning tobacco before it reaches the smoker. ETS contains the same harmful chemicals as the smoke that smokers inhale. In fact, because side stream smoke is formed at lower temperatures, it gives off even larger amounts of cancer-causing substances. At least 43 of the chemicals taken in by those breathing ETS are known cancer-causing substances, and ETS is now classified by the US Environmental Protection Agency (EPA) as a Group A carcinogen (known to cause cancer in humans).

ETS causes lung cancer in healthy nonsmokers. A nonsmoker who is married to a smoker has a 30% greater risk of developing lung cancer than a nonsmoker living with a nonsmoker. Children whose parents smoke are more likely to suffer from pneumonia or bronchitis in the first two years of life than children who live in smoke-free households. Several studies have also established a link between parental smoking and the occurrence of sudden infant death syndrome (SIDS). Children of parents who smoke have a twofold increased risk of dying of SIDS. Mounting evidence in recent years has also made it clear that children of mothers who smoke have higher than normal risks of developing asthma, especially if the mother smokes during pregnancy. It is well known that second-hand smoke also makes a child’s asthma more severe than it would be otherwise, and increases the child’s risk of pneumonia, bronchitis, and fluid in the middle ear.

ETS can also affect nonsmokers by causing eye irritation, headaches, nausea, and dizziness.

grandma: How does smoking affect pregnant women and their babies?

Speaker_-_Iyaad_Hasan_DNP_c_: Pregnant women who smoke endanger the health and lives of their unborn babies. Babies of smoking women average 6 ounces less at birth than babies of nonsmoking women. When a pregnant woman smokes, she really is smoking for two because the nicotine, carbon monoxide, and other dangerous chemicals in smoke enter her bloodstream and pass directly into the baby's body. Statistics show a direct relation between smoking during pregnancy and spontaneous abortions, stillbirths, death among newborns, and sudden infant death syndrome (SIDS). Research shows that the risk of SIDS triples for babies of mothers who smoke during pregnancy; two-thirds of SIDS deaths among babies of women who smoked during pregnancy can be attributed to smoking. Mounting evidence in recent years has also made it clear that children of mothers who smoke have higher than normal risks of developing asthma, especially if the mother smokes during pregnancy. Exposure to second-hand smoke also makes a child’s asthma more severe than it would be otherwise, and increases the child’s risk of pneumonia, bronchitis, and fluid in the middle ear.

Tobacco Options: Snuff,Chew, Cigars & Pipes

jack: Are chewing tobacco and snuff safe alternatives to cigarette smoking?

Speaker_-_Iyaad_Hasan_DNP_c_: No. Smokeless tobacco contains nicotine, the same addictive drug found in cigarettes. Snuff dippers consume on average more than 10 times the amount of cancer-causing substances (nitrosamines) than cigarette smokers. In fact, some brands of smokeless tobacco contain as much as 20,000 times the legal limit of nitrosamines permitted in certain foods and consumer products, such as beer, bacon, and baby bottle nipples.

The juice from the smokeless tobacco is absorbed directly through the lining of the mouth. This creates sores and white patches which often lead to cancer of the mouth. Smokeless tobacco users greatly increase their risk of other cancers including gum, pharynx, larynx, and esophagus. Other consequences of smokeless tobacco use include halitosis (chronic bad breath), discoloration of teeth and fillings, gum disease, and tooth loss.

Since nearly 25% of adult smokeless tobacco users also smoke cigarettes, their risk of developing cancer is higher.

kutup: What are the health risks of smoking pipes or cigars?

Speaker_-_Iyaad_Hasan_DNP_c_: Smoking cigars or pipes alone is not a healthy alternative to smoking cigarettes. The risk for lung cancer is higher among smokers who smoke cigarettes and cigars or pipes, and for smokers who switch to cigars or pipes after years of cigarette smoking. Overall cancer deaths among men who smoke cigars are 34% higher than among nonsmokers. Cigars and pipes also release ETS, which is harmful to anyone who breathes it.

The Decision to Quit

Barrie: Why should I quit?

Speaker_-_Iyaad_Hasan_DNP_c_: You will live longer and feel better. Quitting will lower your chances of having a heart attack, stroke, or cancer. The people you live with, especially children, will be healthier. If you are pregnant, you will improve your chances of having a healthy baby. And you will have extra money to spend on things other than cigarettes.

ken-strop: What is the first thing I need to do once I’ve decided to quit?

Speaker_-_Iyaad_Hasan_DNP_c_: You should set a quit date-the day when you will break free of your tobacco addiction. Then, consider visiting your doctor or other health care provider before the quit date. She or he can help by providing practical advice and information on the medication that is best for you.

putter: How will I feel when I quit smoking? Will I gain weight?

Speaker_-_Iyaad_Hasan_DNP_c_: Many smokers gain weight when they quit, but it is usually less than 10 pounds. Eat a healthy diet, stay active, and try not to let weight gain distract you from your main goal—quitting smoking. Some of the medications to help you quit may help delay weight gain.

casey: I smoke a lot. I don’t believe I could quit all at once, so I have been trying to cut down a little at a time, on the way to quitting. Does this method work?

Speaker_-_Iyaad_Hasan_DNP_c_: Fading or tapering which it what you are describing is a method that we recommend. First - as I have mentioned - it decreases the nicotine concentration which in turn deceases the desire. Also, by you tapering you may begin to eliminate "filler cigarettes." These are cigarettes that are triggered from behavioral or psychological events - like having a cup of coffee and cigarette as a habit. SO - take note of the emotional, habitual and mental reasons why you smoke and you begin to take charge. It works!

The Benefits of Quitting

the_end: I have smoked for many years. I have tried quitting and can go days without smoking without a lot of “physical” issues, at least nothing I really noticed or couldn’t handle. In my opinion, my problem is psychological. How do I deal with this?

Speaker_-_Iyaad_Hasan_DNP_c_: At the Tobacco Treatment Center we see nicotine addiction in 4 components. The components are: physical, habitual, emotional and mental. The Tobacco Treatment Center utilizes medication to help you deal with the physical symptoms of withdrawal.

The remaining three components really are internal and need you to take control and make the change.

nystrom: What happens to my body when I quit?

Speaker_-_Iyaad_Hasan_DNP_c_: Within 30 minutes of quitting smoking, your pulse rate slows down and blood pressure drops toward normal.

• Within hours of stopping, the level of carbon monoxide in your blood drops, enabling the blood to carry more oxygen.
• Two days after quitting, nerve endings begin to recover and your sense of smell and taste begin to return. 
• Within 72 hours of quitting, your lungs’ bronchial tubes expand and lung volume increases.
• Months after quitting, shortness of breath diminishes. 
• In the first year, the risk of heart attack attributed to smoking declines for both men and women.
• Two to three years after quitting, the risk of heart attack attributed to smoking is virtually gone. 
• After 10 years, the risk of developing cancer is about the same as for nonsmokers.

Strategies for Quitting

school2: How do people successfully quit?

Speaker_-_Iyaad_Hasan_DNP_c_: There is no one right way to quit. Successful cessation may include one or a combination of methods including using step-by-step manuals, attending self- help classes or counseling, or using a nicotine replacement therapy (nicotine patch or nicotine gum). Anything that is legal, ethical, and effective is worth trying; this could include chewing sugarless gum, eating carrot sticks, hiding ashtrays, taking long walks, asking others not to smoke around you, and spending time in places where smoking is prohibited.

Each year about 17 million people try to quit for at least a day during the American Cancer Society's Great American Smokeout. Of these quitters, more than 4 million still aren't smoking after three months. About 90% of those who have tried to quit have done so on their own by either stopping "cold turkey" or using other methods.

jbs: What medication would work best for me?

Speaker_-_Iyaad_Hasan_DNP_c_: Different people do better with different methods. You have five choices of medications that are currently approved by the U.S. Food and Drug Administration:

• A non-nicotine pill (varenicline and bupropion SR).
• Nicotine gum.
• A nicotine inhaler.
• A nicotine nasal spray.
• Nicotine patch.

The gum, lozenges, and patches are available at your local pharmacy, or you can ask your health care provider to write you a prescription for one of the other medications. The good news is that all seven medications have been shown to be effective in helping smokers who are motivated to quit.

platypus: Can you tell me about the electronic cigarette? Do they really work in helping you quit, and how?

Speaker_-_Iyaad_Hasan_DNP_c_: The electronic cigarette is dubbed by some companies as a cessation device. In my opinion they are not cessation devices at all.

Let me give you an example. Say you had a friend that just stopped drinking alcohol. A new product came out that looks, tastes and goes down like scotch. Would you let your friend still try this product? Chances are not.

Therefore the electronic cigarette should not be a substitute for cessation.

weighty: How successful is hypnosis in quitting smoking? You see things on TV about how the idea is implanted in your head and that’s it, you are done. How does it really work?

Speaker_-_Iyaad_Hasan_DNP_c_: There is no evidence to support hypnosis for smoking cessation. However, hypnosis is about behavioral change which is a key component in cessation.

In order for oxygen to reach the blood, it must move across large surfaces in the lungs. Normally, thousands of tiny sacs make up about 100 square yards of surface area in the lungs. When emphysema occurs, the walls between the sacs break down and create larger but fewer sacs, significantly decreasing the amount of oxygen reaching the blood. Eventually, the lung surface area can become so small that a person with emphysema has to spend most of the time gasping for breath, with an oxygen bottle near or with oxygen tubes inserted into the nasal cavity.

Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, kills about 81,000 people each year; cigarette smoking is responsible for more than 65,000 of these deaths.

lilnonna: Used CHANTIX™ (Varenicline)  successfully over a year ago and was smoke free for 15 months. Started again in July and now am on second round of Chantix™. I've cut way back but still 4-5 a day. Help.

Speaker_-_Iyaad_Hasan_DNP_c_: First - congrats on your multiple attempts! You are on the right road.

The first thing I would recommend is to set a 'Quit Date.' From there I would continue to take your CHANTIX™ (Varenicline) as prescribed by your health care provider. Begin spacing out your cigarettes further and further apart as you get closer to the quit date.

Remember, the faster you drop your nicotine concentration or intake, the better the Chantix ™
will work.

believeme: What is nicotine replacement therapy?

Speaker_-_Iyaad_Hasan_DNP_c_: Nicotine replacement therapies are medications that provide nicotine without the other harmful components of cigarette smoke. To be most effective, nicotine replacement therapy should be used with a cessation program that addresses a person's psychological dependence on smoking. By chewing gum containing nicotine or wearing a transdermal patch from which the skin absorbs nicotine, a smoker's withdrawal symptoms are significantly decreased or eliminated.

Not everyone can use nicotine replacement therapy. People with certain medical conditions and pregnant women should not use it. When using the patch, it is very important that users do not smoke cigarettes or use tobacco in any form.

peaches: Some of my friends and family are smokers. What should I do when I’m with them?

Speaker_-_Iyaad_Hasan_DNP_c_: Tell them that you are quitting, and ask them to assist you in this effort. Specifically, ask them not to smoke or leave cigarettes around you.

Quitting Successfully

tsax: What kinds of activities can I do when I feel the urge to smoke?

Speaker_-_Iyaad_Hasan_DNP_c_: Talk with someone, go for a walk, drink water, or get busy with a task. Reduce your stress by taking a hot bath, exercising, or reading a book.

jaded: How can I change my daily routine, which includes smoking a cigarette with my breakfast?

Speaker_-_Iyaad_Hasan_DNP_c_: When you first try to quit, change your routine. Eat breakfast in a different place, and drink tea instead of coffee. Take a different route to work.

QB3: I like to smoke when I have a drink. Do I have to give up both?

Speaker_-_Iyaad_Hasan_DNP_c_: It’s best to avoid drinking alcohol for the first 3 months after quitting because drinking lowers your chances of success at quitting. It helps to drink a lot of water and other nonalcoholic drinks when you are trying to quit.

tryinghard: I’ve tried to quit before and it didn’t work. What can I do?

Speaker_-_Iyaad_Hasan_DNP_c_: Remember that most people have to try to quit at least 2 or 3 times before they are successful. Review your past attempts to quit. Think about what worked—and what didn’t—and try to use your most successful strategies again.

casey: I asked the question about tapering off my smoking. My son (who has asked me to quit) said that he learned in school that this isn't necessarily better as when you start smoking less, you inhale more or harder and are getting the same amount of nicotine etc. Is this true?

Speaker_-_Iyaad_Hasan_DNP_c_: It is not that it better, but an option. It is a technique to help you quit.

Need Help?

quarterhorse: What should I do if I need more help?

Speaker_-_Iyaad_Hasan_DNP_c_: Get individual, group, or telephone counseling. The more counseling you get, the better your chances are of quitting for good. Programs are given at local hospitals and health centers. Call your local health department for information about programs in your area. Also, talk with your doctor or other health care provider.

job: Why use a program such as yours, instead of going at it on my own?

Speaker_-_Iyaad_Hasan_DNP_c_: Research shows that going at it alone gives you a 5% success rate. Entering a program like ours increases your chances by 3-6 times.  Please refer to the chart below. 

Conclusion

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Iyadd Hasan is now over. Thank you again Dr. Hasan for taking the time to answer our questions about Ready to Snap Your Tobacco Habit?

Speaker_-_Iyaad_Hasan_DNP_c_: Thank you all for spending your lunch hour with me today. I hope what you learned today helps in reaching your goal of quitting smoking. This was a great first step! Remember, we are here to offer all the help that you need!

Cleveland_Clinic_Host: To make an appointment with Iyaad Hasan, DNP(c) or to learn more about how our Tobacco Treatment Center can help you, please call 216.444.8111 or visit clevelandclinic.org/tobaccotreatment.

More Information

The Tobacco Treatment Center is located at the following Cleveland Clinic facilities:

Independence Family Health Center
5001 Rockside Road, Crown Center II, Independence, Ohio 44131

Cleveland Clinic Lyndhurst Campus
1950 Richmond Road, Lyndhurst, Ohio 44124

Cleveland Clinic's Main Campus
9500 Euclid Avenue, Cleveland, Ohio 44195

Medina Hospital
1000 E. Washington Street, Medina, Ohio 44256

Strongsville Family Health & Surgery Center
16761 South Park Center, Strongsville, Ohio 44136

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