Abu Dhabi, UAEWednesday 22 May 2019

Rise from the ashes: effective ways to quit smoking

We investigate the various methods available that can help smokers to kick the unhealthy habit – from medication and patches that curb nicotine cravings, to alternate methods such as yoga and acupuncture.
Most vaping devices consist of an e-liquid tank, battery and atomiser, which has a coil on top that is used to vaporise the e-liquid. Dan Kitwood / Getty Images
Most vaping devices consist of an e-liquid tank, battery and atomiser, which has a coil on top that is used to vaporise the e-liquid. Dan Kitwood / Getty Images

By now, everyone knows that smoking kills, it has been drummed into us in so many ways for years. Global statistics show that six million people die from the habit every year. Of these, 500,000 die as a result of second-hand smoke inhalation, according to the World Health Organisation (WHO).

Half of those who live by the cigarette will eventually die by it. Despite these facts, smoking remains endemic around the world.

Health Authority – Abu Dhabi statistics from 2012 show that almost a quarter of the capital’s population smoke. About 5 per cent smoke shisha, 6 per cent smoke medwakh and 12 per cent smoke cigarettes. Statistics from a 2009 Dubai Health Authority publication showed that more than 20 per cent of men and more than 4 per cent of women in the emirate were also smokers.

Abdulaziz Al Zarooni, the deputy director of Dubai Medical District, says that since signing the WHO’s Framework Convention on Tobacco Control, the UAE Ministry of Health and Prevention has been “keen on implementing and making people more aware of its antismoking policies”.

He says it hopes to limit the spread of tobacco use among the younger generation and plans to do this by providing support services and facilities to curb, and eventually stop, smoking. Six new specialised clinics have been opened to help people quit smoking by way of appropriate treatment.

When it comes to quitting smoking, there are many options, says Dr Samah Ahmed, a pulmonology specialist at Burjeel Medical Centre.

“We have medications like nicotine replacement therapy, and we have varenicline and bupropion,” she says, referring to two prescription medicines that are known to help with giving up the habit.

The Journal of the American Medical Association published a study last year showing that cigarette smokers were far more successful at quitting when on varenicline. However, both varenicline and bupropion can lead to strong side-effects, such as stomach or bowel problems, nausea, ­abnormal dreams and mood changes.

A more flexible option is nicotine replacement therapy (NRT), which can take many forms.

“In general, we have gum, patches, lozenges, the ­inhaler or nasal spray,” says Ahmed.

NRT usually lasts between eight and 12 weeks, and has been shown to work best in combinations – for example, using a patch alongside faster acting forms, such as lozenges, to reduce cravings.

Another Journal of the American Medical ­Association study, published this year, compared varenicline with nicotine patches and combination NRT. It revealed negligible differences in the success rates between the various methods, with roughly a fifth of patients managing to remain abstinent for a year. Another study showed that an eight-week course of varenicline yielded higher three-year abstinence rates compared with the nicotine transdermal patch.

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Ahmed says some patients’ choices will be determined by medical conditions.

“If a patient has dermatitis or allergic skin reactions, it is better to avoid nicotine patches,” she says, adding that hay fever or nasal irritation may push others away from nasal spray, which requires a prescription.

“Vaping” with electronic nicotine delivery systems (Ends), such as e-cigarettes, e-hookahs and e-cigars, should be a last resort; only when “the patient insists this is the only way, like if they have a history of seizures, and can’t take bupropion, and they tried nicotine replacement several times without any effect”. However, users must set a time when they will stop vaping, she adds.

From 2008 to 2012, the number of adults and adolescents using vaping devices doubled. Figures show that in 2014, US$3 billion (Dh11bn) was spent on them. Users advocate them as healthier, cheaper and more socially acceptable alternatives to cigarettes, but WHO points out that most brands, which number more than 450, have not been tested by independent scientists. There is a huge discrepancy in the safety and efficiency of these delivery systems – ranging from low to comparable with smoking. Nicotine itself is the addictive component of tobacco – one that can lead to cardiovascular disease, may function as a tumour promoter and can adversely affect women during pregnancy.

An Environmental Science and Technology study, published in July, revealed that three different types of e-liquids used in vaping devices contained various compounds that were potential carcinogens and irritants. The increased heat produced more carcinogens. Most vaping devices consist of an e-­liquid tank, battery and atomiser, which has a coil on top that is used to vaporise the e-­liquid. The study found that such ­single-coiled devices produced significantly higher toxicants than ­double-coiled ones.

The coil is the heating element in a vaping device. A single coil device has only one element, while a dual coil has two, which allows for a larger amount of vapour to be produced.

Another paper, published in the New England Journal of Medicine, claimed that long-term vaping was associated with an incremental lifetime cancer risk that was five to 15 times higher than the risk ­associated with smoking.

How­ever, Clive Bates, former director of the UK’s Action on Smoking and Health, calls this calculated cancer risk a “work of ­fiction”.

Gregory Conley, president of the American Vaping Association, elaborates: “In brief, aldehydes are only produced above trace levels when you burn the ­wicking material inside the device’s coil. A human can tell you whether the testing set-up is resulting in what are known as ‘dry puffs’, an acrid, burning taste that results from overheating the coil. No human can withstand a dry puff for more than a couple seconds and they certainly can’t use it throughout their daily life.”

Aldehydes such as formaldehyde, a by-product of tobacco combustion, are known to be carcinogenic and genotoxic.

Even though researchers will find high levels of aldehydes, he says such results are “worthless”, because “no human is actually vaping that way”.

Alex Clark, legislative coordinator at the ­Consumer Advocates for Smoke-Free Alternatives Association, expresses a similar view.

“Smokers who experiment with vapour products often find they enjoy the unique flavours, lower cost and convenience, “ he says. Even if they don’t quit ­completely, there are considerable health benefits to replacing as many combustible ­cigarettes as possible.” Clark adds that The Royal College of Physicians and Public Health England found that e-cigarettes are unlikely to exceed 5 per cent of the harm of ­traditional combustible cigarettes.

Even so, the UAE’s Ministry of Health and Prevention has opted to restrict vaping products such as e-cigarettes, which, Al Zarooni explains, “are not allowed as the UAE is committed within the WHO framework and guidelines that it signed along with other participating countries”.

He says the devices are subject to the same controls as regular cigarettes, and it is forbidden to use them in public or promote them, due to “a lack of verifiable research and studies to back its claim as a safer alternative”.

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“There are also non-medical, or alternative ways of stopping smoking, such as acupuncture, hypnosis, therapy, and yoga,” notes Ahmed, adding that yoga seems to be the most successful among these options as “it helps people to cope with nicotine cravings, because the most distressing obstacle in quitting smoking is nicotine craving”.

A Journal of Women’s Health study found that yoga enhanced the effects of cognitive behavioural therapy on short-term smoking cessation outcomes.

It revealed that yoga had the potential to lower stress and cravings, while improving both mood and perception of quality of life. However, when it comes to quitting smoking, there are no hard and fast rules – it is about finding a healthy solution that is right for you – whether it be hypnosis, acupuncture or aromatherapy.

New-York based psychologist Kalman Khodik, says: “Addictions are clearly related to those variables that significantly disrupt functioning.”

One tool he cites is cognitive-behavioural therapy, which he says can help to decouple substance abuse from its social, environmental, emotional, and physiological cues.

Regular meditation, he adds, has been shown to reduce anxiety, depression and irritability, while boosting learning abilities, creativity, and emotional self-regulation.

A 2001 study, published by the American Health Foundation and Press, showed that adequate acupuncture treatment motivated smokers to reduce their smoking, or even quit smoking completely. And it reduced the subjects’ taste for tobacco and desire to smoke.

halbustani@thenational.ae

Updated: August 29, 2016 04:00 AM

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