The Cleveland Clinic Smoking Cessation Program is a comprehensive, multifaceted program that can be tailored to your individual needs. We offer a variety of services designed to help you throughout the process, including office visits, distance health visits (virtual or telephone), and the eCoach program or pharmacy consultations.
Why Choose Cleveland Clinic's Respiratory Institute
At Cleveland Clinic's Respiratory Institute, we provide world-class patient care by combining our strengths in clinical care, research and education. With more than 300 providers in Pulmonary, Allergy and Immunology, Infectious Disease, and Critical Care Medicine specialties, the Respiratory Institute staff diagnose and treat a wide spectrum of disorders in our outpatient offices, inpatient hospital floors, and intensive care units. We treat over 100,000 patients annually in our outpatient clinics. Cleveland Clinic is ranked as one of the nation’s top hospitals by U.S. News & World Report.
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Respiratory Advanced Practice Providers
- Jenna Kaufman, PA-C
- Sarah Micklewright PA-C
- Nichole Williams, CNP
- Pat Curtis-Mccarthy, PA-C
- Jennifer Barone, PA-C
- Kelly Kuenzle, CNP
- Ruslan Zakharchuk, PA-C
- Danielle Summers, PA-C
- Jason Dean, PA-C
- Madeleine Lochan, CNP
Chronic Care Advanced Practice Providers
Tobacco Cessation Navigation Health Coaches
- Therese Reymann-Kerns
- Rachel Sray
Tobacco Cessation eCoaches
- Zach Scott
- Karlo Dieron
- Teresa Moser
- Ruth Llewellyn-Stanger
Primary Care Clinical Pharmacists
- Sandra Axtell, PharmD, BCPS
- Elisa Baddour, PharmD, BCACP
- Anna Bondar, PharmD, BCPS
- Keti Dubow, PharmD
- Emily Fargo, PharmD, BCPS
- Anna Grabowski, PharmD, BCPS
- Taylor Hermiller, PharmD, BCACP
- Morgan Jones, PharmD, BCACP
- Alayna Kehr, Pharm D
- Katie Kish, PharmD, BCACP
- Nicole McCorkindale, PharmD, BCPS
- Sarah Milkovich, PharmD, BCACP
- James Montgomery, PharmD, BCACP
- Marcie Parker, PharmD, BCACP
- Giavanna Russo-Alvarez, PharmD, BCACP
- Amanda Soric, PharmD, BCACP, CTTS
- Rachel Stulock, PharmD, BCACP
- Neil Turco, PharmD, BCPS
- Lindsey Wiegmann, PharmD, BCACP
- Lauren Wolfe, PharmD, BCACP
- Elizabeth Zeleznikar, PharmD, BCACP
Benefits of Quitting
We all know smoking is bad for your health, so here’s a look at the positive aspects of quitting.
Timeline of Health Benefits
Kicking the smoking habit has health benefits that start right away and keep on building the longer you stay smoke-free. Here’s what happens when you quit:
- Immediately: Your body begins repairing itself.
- Within 20 minutes: Your heart rate and blood pressure begin to decrease.
- Within 12 hours: The level of carbon monoxide in your blood drops to normal and the level of oxygen increases to normal.
- Within 2 weeks to 3 months: Your lung function and circulation start improving, lowering your risk of having a heart attack.
- Within 1 to 9 months: You’ll notice that your smoker’s cough and shortness of breath are getting better. Your risk of lung infection also begins to decrease thanks to increased lung function.
- Within 1 year: Your risk of developing coronary artery disease is half that of someone who smokes, which also greatly lowers your risk of having a heart attack.
- Within 2 to 5 years: Your risk of having a stroke may be similar to that of a non-smoker.
- Within 5 years: Your risk of developing mouth, throat, esophagus and bladder cancer is cut in half.
- Within 10 years: Your risk of dying from lung cancer drops to half that of a smoker, and your risk of developing cancer of the voice box (larynx), kidney and pancreas is also lower.
- Within 15 years: Your risk of developing coronary artery disease is similar to that of a nonsmoker.
Whole Body Benefits
Our bodies are amazing machines with incredible restorative capabilities. Here’s how smoking cessation affects different parts of your body:
Brain: When you smoke, your brain creates extra nicotine receptors so that it can deal with the large amounts of nicotine you’re putting into your body. About a month after you stop smoking, these nicotine receptors will go back to normal levels.
Heart: When you stop smoking, your risk of heart disease and heart attack continues to drop the longer you’re smoke-free. The chance of developing dangerous blood clots that can lead to stroke, heart attack or blockage of your blood vessels will be lower. Your heart won’t have to work as hard both because your blood will be thinner and because you’ll be getting more oxygen. Your cholesterol levels will go down too.
Lungs: You’ll notice that your shortness of breath is better within the first 1 to 9 months. The sooner you quit smoking, the more you can protect yourself from developing chronic obstructive pulmonary disease (COPD) when you’re older and from further lung damage and scarring. Additionally, your cilia, the tiny hairs that line your airways and lungs, will begin to grow back and start working again fairly quickly. Cilia help to keep your lungs clear by getting rid of dirt and mucus, so you may also notice that you get fewer respiratory infections than you did when you were smoking.
Head: Smoking cessation stops damage to your hearing and sight that cigarettes cause, improving your night vision and keeping your hearing intact. Your teeth will also stop getting so yellow from smoke.
Stomach: Your risk of diabetes will be lower and your belly fat reduced when you quit smoking. If you have diabetes, not smoking will make it much easier to keep your blood sugar levels under control.
Hormones: Smoking causes estrogen levels to be lower in females, so quitting will help your levels get back to normal.
DNA: Inhaling nicotine causes damage to your DNA, the part of the cell that carries genetic instructions, and this damage leads to changes, which can lead to cancer. When you stop smoking, you prevent more changes from being made to your DNA, as well as potentially heal some of the damage that has been done already.
Immune System: White blood cells work to fight off infection. When you smoke, your white blood cell count is always high because your body is constantly fighting the damage smoking creates. This also leads to less of an ability to fend off other illnesses and infections, including cancer. Once you stop smoking, your white blood cell count will go back to normal. This means they will be able to work on repairing the damage from smoking and your immune system will be able to better fight off other infections.
Muscles and Bones: More blood and oxygen will start flowing to your muscles once you stop smoking, helping them to get stronger. You’ll likely notice that you aren’t experiencing the fatigue, aches and pains that you may have when you smoked.
Skin: Quitting the smoking habit can help protect your skin from premature wrinkles and aging and clear up blemishes.
There are a multitude of lifestyle and personal benefits that you can expect when you quit smoking as well:
- You’ll save money. Buying cigarettes adds up fast. Consider investing or saving that money each year instead and you’ll be much further ahead.
- You’ll feel better. Not only will you be able to breathe more easily, but your muscles won’t feel so tired, your physical stamina will pick up, and your body will be able to fight off infections much more easily, resulting in fewer sick days.
- You’ll smell better. And so will your house and belongings. You most likely can’t smell the smoke that lingers on your body, hair, clothing and everything you own, but other people can.
- It’s getting less and less convenient to smoke. There aren’t many places in the United States where you can smoke indoors anymore, which makes it a lot more difficult to get through those times when you are unable to get outside. Not having to go outside into the cold or bad weather for a smoke is amazingly freeing.
- You won’t have to worry about your family and friends being exposed to secondhand smoke. Even the smoke on your clothes, hair and skin can expose your loved ones to harmful chemicals.
- You’ll sleep better. Although quitting may interfere with your sleeping at first, once your body is used to the lack of nicotine, your sleep quality will likely improve noticeably. This is because smoking can cause insomnia, make it difficult to fall asleep, contribute to waking up often during the night, prevent deep sleep, and increase the risk of sleep apnea, all of which make you feel less than refreshed in the morning.
- Your food will taste better, plus you’ll be able to literally smell the roses. Since smoking causes your taste buds and sense of smell to be less sensitive, these senses will start to become sharper. You may even notice a difference in the first few days after quitting.
What to Expect
Kicking the smoking habit is challenging, but knowing how your body and mind might react when you quit can help you plan and prepare. You may also find it motivating to understand all the health benefits you’re reaping the longer you stay smoke-free. Remember that quitting takes time, so try to take it one day at a time rather than worrying about how you’re going to get through the next weeks and months.
Here’s what you can expect as you journey through the beginning days without cigarettes.
The first week to 10 days are usually the toughest in terms of withdrawal symptoms. Most people feel much better after a month, though some people continue to have symptoms for several months.
Common physical symptoms that can occur when you quit include:
- Cravings: You will most likely have physical cravings because your brain is trained to expect nicotine. Each craving should last only 15 to 20 minutes, and the more of them you overcome, the less powerful they will get. Nicotine replacement therapy can help lessen these, as can prescription medications.
- Weight gain: For the first few weeks, you may notice that your appetite increases, or you may start reaching for food instead of cigarettes, both of which can lead to weight gain. Keep lots of fruits, vegetables and nutritious snacks on hand when you quit so you can keep your mouth busy when you want to smoke to avoid gaining weight.
- Restlessness: You may feel restless and have trouble concentrating during this time.
- Sleeping problems: As your body adjusts to decreased nicotine levels, you may find that you have difficulty getting to sleep or that you’re sleeping more than normal at first, but eventually, your sleep will regulate itself and may even be noticeably better than it was when you were smoking. You’ll wake up fewer times during the night, fall asleep more easily and be able to sleep more deeply.
- Cough: Though you’ll find that your smoker’s cough begins to go away within 1 to 9 months after quitting, some people develop a different type of cough soon after smoking that last cigarette. This is usually due to your cilia, the tiny brush-like hairs that line your lungs and airway, coming back to life and doing their job of sweeping out dirt and mucus. Your lungs are likely working to remove toxins, so these two factors can lead to a cough for the first couple months as your cilia fully recover. Cilia restoration will likely eventually lead to fewer colds and other respiratory infections.
- Headaches: The nicotine withdrawal may cause headaches in some people.
- Dizziness: Some people feel dizzy when they quit smoking.
- Discomfort: Getting over a nicotine addiction may cause general discomfort, which can feel like you have a mild case of the flu.
- Constipation: This can be an effect of nicotine withdrawal, but it may also be due to changes in your diet or a side effect of a smoking cessation treatment you’re using.
Common emotional symptoms that can occur when you quit include:
- Cravings: These cravings aren’t the same as physical cravings; they’re the urges you get to smoke when you’re under stress, in certain situations, or involved in an activity that you associate with smoking such as driving, eating or drinking alcohol. It will take time to break these patterns and habits, but with conscious effort, you can replace lighting up a cigarette with a healthier alternative like drinking a glass of water, calling a friend, going for a walk, chewing sugarless gum, eating a healthy snack, deep breathing or engaging in a distraction like a crossword puzzle or a game on your smartphone.
- Mood changes: You may feel irritable, depressed, anxious, angry, frustrated or any combination of these emotions for the first 2 to 4 weeks. Remember that these feelings are temporary and a normal part of withdrawal.
Tips for Success
A quit plan is an essential component for the majority of people who are successful former smokers. It’s extremely difficult to stop smoking without one. Planning for how you’re going to cope with cravings, urges and symptoms of nicotine withdrawal boosts your chances of success. Our eCoach can help you come up with your own quit plan and decide on a quit date.
Many people slip up and have a few puffs or a cigarette or two while they’re working to quit smoking. Don’t beat yourself up about it if this happens. Keep working at quitting for good and with time, determination and support, it will happen.
If you end up smoking again, don’t give up. For many people, it can take multiple tries to quit smoking. By looking at what factors may have tripped you up, you can take steps to implement different coping mechanisms the next time.
Ready to quit?
Call 216.448.8247 to schedule an appointment or request an Office Visit online.
Medications & Treatments
Medications & Treatments That Can Help You Quit Smoking
Depending on your individual situation and needs, one or more medications or treatments can be used to help you quit smoking. Treatment options that we use include nicotine replacement therapy, prescription medications and acupuncture.
Nicotine Replacement Therapy
Nicotine replacement therapy helps reduce your withdrawal symptoms by giving your body the nicotine it craves. It should be used in conjunction with a smoking cessation program in order to get optimal results. You’ll need to use these exactly as instructed for the maximum benefits and to help avoid any unpleasant side effects. It’s also important that you stay away from cigarettes completely while you are on any of these products to avoid nicotine overdose. If you experience a racing heart while on any of these products, you should talk to your healthcare provider. This may indicate that your dose is too high.
Nicotine replacement therapy options include:
- Nicotine patch: You can get a nicotine patch with or without a prescription and they’re available in a variety of strengths and doses to help you gradually wean your body off of nicotine. The patch is applied to your skin once a day and can cause side effects like irritated skin, dizziness, headache, nausea, vomiting and diarrhea. If these side effects don’t go away or become worse, talk to your healthcare provider. Some states offer free or low cost nicotine patches to eligible adults through 1-800-QUIT-NOW (1-800-784-8669).
- Nicotine gum: Chewing nicotine gum helps satisfy the need to do something with your mouth when you feel an urge to smoke. If you experience any side effects, they’re typically mild. You can buy nicotine gum over-the-counter.
- Nicotine lozenges: Similar to gum, nicotine lozenges can help with the oral cravings you may feel while quitting. Side effects include heartburn and sore throat, but if these don’t go away or become severe, talk to your healthcare provider. These are also available over the counter.
- Nicotine nasal spray: A liquid that you spray once in each nostril, nicotine nasal spray is a prescription-only medication. It tends to have more side effects than gum or lozenges, such as irritated throat, watery eyes, runny nose, coughing, sneezing and a hot feeling in your throat. These side effects should go away with continued use, but if they don’t or they’re severe, contact your healthcare provider.
- Nicotine inhaler: Available only with a prescription, a nicotine inhaler comes with cartridges that fill your mouth with pure nicotine when you inhale. This option may also help satisfy the urge to put something in your mouth. Side effects may include mouth and/or throat irritation, coughing, runny nose, changes in taste, stomach upset and headache. If these don’t go away or they’re severe, contact your healthcare provider.
Prescription medications don’t contain nicotine, but they can also help you get through the withdrawal symptoms and the cravings. Some of them can be used along with nicotine replacement therapy. Usually, you will need to start taking a prescription medication for some time before you quit smoking.
There are two medications that have been approved by the U.S. Food and Drug Administration (FDA) for smoking cessation:
- Varenicline: Also known by its brand name of Chantix®, this prescription medication was developed specifically to help people quit smoking by blocking the effects of nicotine that make you feel good. This helps lessen your withdrawal symptoms and decreases the enjoyment you get from smoking. Your healthcare provider may have you start taking varenicline anywhere from a month to a week before you quit smoking. Potential side effects include nausea, diarrhea, constipation, gas, heartburn, abdominal pain, vomiting, headache, seizures, mood or behavior changes, taste changes, rash, sleeping problems and dry mouth.
- Bupropion: A prescription antidepressant, bupropion affects the chemicals in your brain that cause you to crave nicotine, which helps reduce withdrawal symptoms. Bupropion works best if you start taking it one to two weeks before you quit smoking. Side effects can include drowsiness, anxiety, mood changes, dry mouth, stuffy nose, fatigue, sleeping problems, headache, nausea, seizures, constipation and weight loss. Brand names include Zyban®, Wellbutrin®, Aplenzin® and Forfivo XL®.
Acupuncture may also be an option to curb your cravings for nicotine. Not only is it safe, it’s natural and can be used in conjunction with nicotine replacement therapy and/or prescription medications. Acupuncture can be especially helpful when you first quit smoking. Other integrative and lifestyle medicine services such as holistic psychotherapy, meditation, yoga, and more are also treatment options.
Appointments & Locations
You can come in for a one-on-one appointment with a provider who will talk to you about your quitting options, answer your questions, and discuss what plan may work best for you. This option is recommended particularly if you have underlying health issues such as diabetes, chronic obstructive pulmonary disease (COPD) or another chronic illness.
Office visits are available at these locations:
No matter where you live, if you have a webcam and an internet connection, you can participate in an online virtual visit using your smartphone, tablet or computer to discuss your quitting options with a provider. We’ll answer your questions and help you come up with a plan.
Whether you prefer email or phone, our eCoaches can help talk you through quitting options, schedule a quit date, formulate a quitting plan, and give you support throughout the process as needed. From questions about smoking cessation medication side effects to problems with relapses, your eCoach can help. This option is available to anyone in the United States who is a Cleveland Clinic patient.
You may have questions about smoking cessation medication like potential side effects, interactions with other medications you’re on, and when and how you should take them. Our pharmacists can answer your questions, as well as provide smoking cessation counseling. You can come in for an office visit or do an online virtual visit.
You only need to be an active smoker to be eligible to participate in our smoking cessation program. We welcome everyone, and offer payment options for people with or without insurance. You may also want to visit with your primary care provider about your next steps. If you’re not sure which option is right for you, call 216.448.8247 for more information.
If you’re looking for more resources to help you quit, here are some good places to get started.
Cleveland Clinic Lung Cancer Screening Program
Consider signing up for our comprehensive Lung Cancer Screening Program if you’re 50 to 77 years old and have a smoking history of at least 20 pack years (for example, 1 pack per day x 20 years or 2 packs per day x 10 years). The screening test involves a CT scan with low radiation dose to detect early lung cancer in individuals who are at high risk for developing it but who have no signs or symptoms. The purpose is to find, treat and potentially cure early-stage lung cancer, which responds better to treatment the earlier it’s found.
Centers for Disease Control and Prevention on Vaping
Centers for Disease Control and Prevention (CDC) provides key facts about the risks of e-cigarette use or vaping, their recommendations and the latest outbreak information.
Find Helpful Articles on Cleveland Clinic Health Essentials
- Vaping: Risk & Illness on the Rise
- Even Smoking ‘Just’ One or Two Cigarettes a Day Increases Your Risk of Lung Disease
- Parents, Could Your Teens Be Juuling?
- 8 Reasons to Quit Dipping Tobacco
- The American Cancer Society (ACS) has a section devoted to quitting tobacco with information on where to get help, interactive tools, the relationship of tobacco and cancer, how to keep your kids smoke-free, smoke-free communities and the ACS’s annual Great American Smokeout.
- The American Lung Association has tools, tips, support and fact sheets to help you stop smoking or to help a loved one quit. There’s also more information about Freedom From Smoking®, the program we use in our smoking classes at Cleveland Clinic.
- The National Cancer Institute’s site, Smokefree.gov, has an abundance of free and accurate resources to encourage smokers to stop:
- Smokefree apps for your smartphone offer individualized guidance once you input your information
- You can sign up for the SmokefreeTXT text messaging program, which sends you daily text messages with encouragement, tips and advice to help making quitting easier
- Create a personalized Quit Plan by choosing a quit date and answering seven questions
- Take a quiz on your withdrawal symptoms
- See how you can prepare to quit
- US News provides frequent health articles on men's, women's health, and children's health issues.
- Everyday Health inspires and empowers people to live their healthiest lives, every day, through trusted, medically reviewed information and expert health advice.
- Low-dose CT Screening Program May Influence Smoking Behavior
You can get a nicotine patch with or without a prescription and they’re available in a variety of strengths and doses to help you gradually wean your body off of nicotine. The patch is applied to your skin once a day and can cause side effects like irritated skin, dizziness, headache, nausea, vomiting and diarrhea. If these side effects don’t go away or become worse, talk to your healthcare provider. Some states offer free or low cost nicotine patches to eligible adults through 1-800-QUIT-NOW (1-800-784-8669).
For Medical Professionals
Refer a Patient
If you’re a caregiver who is part of the Cleveland Clinic health system, simply place an electronic order for “Consult to Smoking Cessation.” This order will be sent to our eCoach navigators who will then contact your patient to discuss which service is the most appropriate.
Providers are able to schedule the smoking cessation visit at the time of placing the consult using the order up feature. Patients will also have the ability to schedule their appointment via MyChart once consult is placed.
If you’re a provider who is outside Cleveland Clinic and you’d like to refer a patient, either you or your patient can fill out our web registration form. An eCoach will then contact your patient to review treatment options.