In 2007, 19.8 percent of adults in the United States were cigarette smokers, which is the lowest percentage ever recorded. Although it’s a great achievement, it still means 43.4 million U.S. adults smoke. Cigarette smoking is the most important preventable cause of morbidity, mortality and excess health care costs in the United States.
From 2000 to 2004, cigarette smoking caused an estimated annual average of 443,595 deaths and cost $193 billion dollars per year in smoking attributable costs. Smoking is responsible for 95 percent of lung cancer, the vast majority of chronic lung disease and is a significant risk factor for heart disease, as well as other cancers. At $4 per pack, the cost of the cigarettes alone can easily be more than $2,500 a year.
Preventing smoking and providing effective treatment to help smokers quit will remain a public health priority for the foreseeable future. In support of this goal, the U.S. Department of Health and Human Services recently published the clinical practice guideline entitled, “Treating Tobacco Use and Dependence: 2008 Update.”
The new guidelines present evidence that counseling by a physician, even lasting three minutes or less, increases the odds for prolonged abstinence. Higher intensity counseling lasting greater than 10 minutes doubles the abstinence rate compared to minimal counseling. Tobacco cessation treatments are cost-effective and have been shown to reduce health-care costs. The number of effective medications for tobacco dependence treatment has increased to seven approved medications: Chantix, Wellbutrin SR, and Nicotine replacement therapy in the form of patch, gum, lozenge, inhaler and nasal spray.
If you smoke, when you see your physician, he should ask you two questions. The first is, “Are you willing to make a quit attempt now?” If the answer is no, he should offer to help at another time when you are more motivated. If the answer is yes, you and your doctor should set a quit date and move on to the second question: “What worked or did not work when you tried to quit before?” If you have no idea, your doctor should offer advice about strategies that generally do work. This likely will include the use of one or more of the approved medications for treatment.
Recent studies show that Chantix appears to have the greatest efficiency after three to six months. The most common adverse effect of Chantix is nausea, which at the maximal dosage occurs in about one-third of treated individuals. However, most of the nausea reported was mild and treatment discontinuation due to nausea occurred in only 3 percent of patients.
If your attempt at quitting is unsuccessful, don’t give up. Less than 40 percent of smokers try to quit each year and among those who make a quit attempt, few remain abstinent after one year. The true nature of tobacco use is that of a chronic disorder similar to other diseases such as diabetes and COPD. Relapse is expected.
Successful treatment should take a long-term view of the relationship between you and your physician and should incorporate encouragement, counseling and effective drug therapy at every opportunity. Permanent abstinence is the goal of treatment but is usually achieved only after multiple cycles of remission and relapse. If after reading this article you feel that now is the time for you to make a quit attempt, call your physician RIGHT NOW. You might have saved your own life.
Richard J. Wilbur, M.D. is Board Certified in Internal Medicine. Dr. Wilbur practices at
Safecare Medical Center’s Hollywood office, located at 4050 D Sheridan St., Hollywood, FL 33021. For an appointment with Dr. Wilbur, contact his office at 954-989-7441 or
online at www.safecare.com.
