|
OUR GROUP
OF COMPANIES
|
|
|
|
 Search Site
|
|
|
| Newsletter Subscription
|
|
|
|
|
|
Medicare / Health Articles / Articles
|
|
|
 |  |
|
|
| |
Beat the Smoke: Smoking Cessation
Cigarette smoking is an addiction. The nicotine in cigarettes causes both physical and psychological dependence. It is no wonder that cigarette smoking is such a difficult behaviour to give up. Today, many smokers already know the dangers of smoking and want to quit, not only because of the health risks to themselves, but also to those around them.
Most smokers while trying to quit smoking will experience some form of withdrawal symptoms. These symptoms include irritability, frustration, anxiety, difficulty in concentrating, restlessness, craving for cigarettes, increased appetite or weight gain, headaches or sleep disturbances. Smokers who are more addicted to nicotine may experience more intense withdrawal symptoms. The first few days will be difficult, but withdrawal symptoms are really good signs that your body is undergoing self-healing from the harmful effects of cigarette smoking and will usually disappear in one or two weeks.
To help smokers reduce and better cope with their withdrawal symptoms, nicotine replacement aids have been made available without prescription in all leading pharmacies in Singapore. Nicotine replacement therapy (NRT) helps the smoker to focus on combating psychological dependence and change of habit while the acute physical effects of nicotine withdrawal are addressed. Basically, NRT provides the body with just enough nicotine to help reduce cravings and relieve some withdrawal symptoms. You also eliminate harmful tobacco smoke which contains tar, carbon monoxide and irritants, which are the primary causes of cancer and heart diseases.
Every smoker has different needs, and a wide range of NRT is now easily available to suit individual smoking patterns. The Fagerstrom Tolerance Questionnaire (Table 1) assesses the smoker's dependence on nicotine and provides a guide as to which NRT is most suitable. Talk to your pharmacist or doctor to find out more about the approach that suits you best.
Figure 1: Fagerstrom Tolerance Questionnaire
| Questions | Answers | Points |
1. How many cigarettes do you smoke per day?
| (A) 10 or less
(B) 11-12
(C) 21-30
(D) 31 or more | 0
1
2
3 |
2. How soon after you wake up do you smoke
your first cigarette? | (A) 0-5 min
(B) 6-30 min
(C) 31-60 min
(D) After 60 min | 3
2
1
0 |
3. Do you find it difficult to refrain from smoking in
places where smoking is not allowed (e.g. hospitals,
government offices, cinemas, libraries, etc)? | (A) Yes
(B) No | 1
0 |
4. Do you smoke more during the first hours after
waking up than during the rest of the day? | (A) Yes
(B) No | 1
0 |
5. Which cigarette would you be the most unwilling
to give up? | (A) First in the morning
(B) Any of the others | 1
0 |
| 6. Do you smoke even when you are very ill? | (A) Yes
(B) No | 1
0 |
Score 0-3: Low nicotine dependence
Score 4-6: Medium nicotine dependence
Score 7-10: High nicotine dependence
Nicotine Patches
Nicorette? 16 hours Patch in 15mg, 10mg 5mg strengths
Nicotinell? 24 hours Patch in 21mg (TTS 30), 14mg (TTS 20), 7mg (TTS 10) strengths
Type of user, behavioural pattern best used in:
Nicotine patches are placed directly over the skin, very much like a plaster, and they work by delivering nicotine through the skin into the body. The patches can be placed underneath your clothing so that it discreetly controls your cravings by giving continued relief throughout the day. The 16-hour patches provide nicotine while you’re awake, not when asleep. This mimics the smoking pattern and addresses cravings in the daytime and helps avoid delivery of nighttime nicotine which, for some people may cause sleep disturbance. On the other hand, the 24-hour patches gives a continuous effect throughout the day and is able to control morning cravings better. It is useful for smokers who need to smoke their first cigarette within 5 to 30 minutes after waking up, and for those who tend to smoke more frequently during the first hours after waking than during the rest of the day.
The low to moderate strength patches (5mg/16hr and 10mg/16hr patches or TTS 10mg/24hr and TTS 20mg/24hr patches) are suitable for light smokers (those who used to smoke fewer than 10 cigarettes per day) or those who have medium nicotine dependence, scoring 4-6 on the Fagerstrom Questionnaire. This form of NRT is recommended if you smoke regularly throughout the day, as opposed to just smoking only on periodic basis.
The moderate to high strength patches (10mg/16hr and 15mg/16hr patches or TTS 20mg/24hr and TTS 30mg/24hr patches) are suitable for heavy smokers (those who used to smoke 10 or more cigarettes per day) or those who have high nicotine dependence, scoring 7-10 on the Fagerstrom Questionnaire.
Side effects
Nicotine patches are generally well tolerated and free of side effects. For some, you may notice a slight redness or itching of the skin at the site of application. This usually disappears within 2 days. Nausea, vomiting and headaches may occur in some people but these side effects are rare. The 24-hour patches deliver nicotine even when the person is asleep and may cause some sleeping disturbances like insomnia and nightmares in some people.
Counselling points
To ensure optimum therapeutic effect, patches should be applied onto a clean, dry, hairless skin such as the side of chest or upper arm or hip and pressed on with the palm of the hand for 10 seconds. Do not apply to broken or inflamed skin. To minimize skin irritation, rotate application sites. If mild rashes develop, consult your pharmacist or doctor as topical steroids or oral antihistamines can easily be given to resolve the problem. Should your skin develop severe hypersensitive reactions to the patches, stop using immediately and consult your pharmacist or doctor.
Duration of treatment
A step-down approach is used, based on the response to the Fagerstrom Questionnaire, usually over a 3 month period. Use of patches beyond 6 months is generally not recommended.
Nicotine inhaler
Nicorette 10mg inhaler
Type of user, behavioural pattern best used in:
Nicotine inhaler is shaped to resemble a cigarette stick, so that you use it the same way as you would with a cigarette, but without the need to light it. The inhaler is made up of a mouthpiece and a replaceable nicotine cartridge.
The nicotine inhaler is a unique form of NRT that addresses both the physical and behavioural (habitual) dependence associated with smoking. Smokers who exhibit greater behavioural dependence typically find themselves smoking but can’t remember lighting up. They enjoy the process of lighting up a cigarette e.g. tapping the cigarette and flicking the lighter. Very often, they feel uncomfortable without a cigarette in the hand. When using an inhaler, puffing on the mouthpiece releases nicotine from the cartridge, which helps to relieve your cravings and at the same time keeps your hand occupied.
Nicotine inhalers allow smokers to control their cravings with a flexible dosage and are particularly useful for relapse prevention. This form of NRT is also useful for intermittent smokers who have the tendency to smoke after lunch, during break time, or stress- and situation-induced circumstances.
Side effects
Most side effects reported e.g. cough, headache, irritable or sore throat, mouth ulcers or dry mouth, resemble those seen when one smokes too much and may be due to overuse of the inhaler.
Counselling points
Each cartridge should be used for about 20 minutes per session of continuous inhalations or puffing. The nicotine content may last longer if the inhaler is used less intensively. Best effect is achieved if the inhalation technique which best helps the smoker is developed. It should also be noted that each cartridge used replaces 2 cigarettes.
Duration of treatment
Most smokers start with 6-12 cartridges per day, gradually tapering to 1-3 cartridges a day within 3 months. Use beyond 6 months is not recommended.
Nicotine lozenges
Nicotinell 1mg lozenges
Type of user, behavioural pattern best used in:
Nicotine lozenges provide a discreet yet flexible mean to controlling your cravings. The lozenges dissolves gradually and releases nicotine, which gets absorbed through the walls of your mouth into your body. If you do not have problems kicking the hand-to mouth action or even possess that habit at all, the lozenge is very useful in curbing sudden cravings and relapse prevention. It is also useful for intermittent smokers who have the tendency to smoke after lunch, during break time, or stress and situation induced circumstances.
Nicotine lozenges are generally suitable for smokers with low nicotine dependence, scoring 0-3 points on the Fagerstrom Questionnaire. It can be used occasionally as an aid to boost the willpower in combating psychological dependence.
Smokers with medium nicotine dependence, scoring 4-6 points on the Fagerstrom questionnaire may also benefit from the lozenges. This is especially so, if the smoker does not smoke regularly throughout the day, but only on a periodic basis.
Side Effects
Initially, slight irritation of throat and increased salivation. Symptoms usually disappear with subsequent usage.
Counselling Points
When starting treatment, 1 lozenge may be sucked every 1 to 2 hours. Do not chew or swallow nicotine lozenges. Allow the lozenges to slowly dissolve in the mouth for about 20-30 minutes. You may feel a warm or tingling sensation in your mouth. Relocate the lozenge from one side of your mouth to the other until it has completely dissolved (about 20-30 minutes). Only use one lozenge at a time and refrain from continuously using one lozenge after another. This could cause side effects, such as hiccups, heartburn, or nausea.
Most people suck 8-12 lozenges per day and the maximum daily dose is 25 lozenges. Coffee, juices and fizzy drinks may reduce the absorption of nicotine and should not be taken for 15 minutes before and during sucking.
Duration of Treatment
Use 8-12 lozenges a day for 3 months and then gradually cut down. Smokers should be encouraged to stop when dose is reduced to 1-2 lozenges a day. Use beyond 6 months is not recommended.
Nicotine chewing gum
Nicorette 2mg, 4mg gums (classic, mint)
Nicotinell 2mg, 4mg gums (mint)
Type of user, behavioural pattern best used in:
Nicotine chewing gums gives you active control over your cravings, with a flexible dosing schedule. Nicotine gums are useful for both smokers who smoke regularly throughout the day, as well as intermittent smokers. Additionally, the chewing action helps address behavioural dependence by replacing the feeling of having a cigarette in the mouth.
Nicotine chewing gums are available in different strengths to cater to various smokers. The 2mg chewing gums are generally for light smokers who smoke less than 20 cigarettes a day. On the other hand, 4mg gums are more suited for heavy smokers who smoke more than 20 cigarettes daily or those who have previously failed a quit attempt using the 2mg gum.
Side Effects
Some effects you may notice in the first few days include bitter taste, hiccups, sore throat, headache, dizziness and mild indigestion or heartburn. These are rarely serious and may be due to using too much gum, chewing it in a continuous manner, or swallowing too much nicotine.
Counselling Points
The number of chewing gum used per day will depend upon the smoker's craving, but generally, most people use around 8-12 pieces a day. The maximum number of gums allowed in a day should not exceed 24 pieces.
The method of chewing a nicotine chewing gum is not the same as for an ordinary confectionery chewing gum. The gum is chewed to release nicotine, then rested so that nicotine can be absorbed through the lining of the mouth. Nicotine swallowed in the saliva is not beneficial and in excess, may lead to side effects as described above.
When the patient feels a need to smoke, a piece of gum may be chewed. It must be chewed slowly until the taste becomes strong, then stopped with the gum rested between the gums and cheek. When the taste fades, the patient must again chew a few times until the taste gets strong and then rest the chewing gum again. The same procedure is repeated for half an hour. If the patient is wearing dentures and has difficulty chewing the gum, choose a different form of nicotine replacement therapy e.g. patch or lozenge.
Coffee, juices and fizzy drinks may reduce the absorption of nicotine and should not be taken for 15 minutes before and during chewing of the gum.
Duration of Treatment
Most smokers start with 8-12 gums per day, gradually tapering to 1-3 gums a day. Chewing gum may be used for up to 3 months during which time the smoker should have lost the habits associated with smoking. Regular use for more than 12 months is generally not recommended.
General Counselling for all Nicotine Replacement Therapy (NRT)
It is important that you are not to smoke anymore when you are on NRTs. You should also set a quit date and start using the NRT on the quit date. Always speak to your pharmacist, nurse, or doctor before using NRT, especially if you are under 18 years old or have any of these medical conditions, like systemic skin diseases, recent stroke or heart attack (within last 3 months), pregnancy or breastfeeding, peptic ulcer, high blood pressure, angina (chest pain) and diabetes as NRT may not be suitable for you.
Bupropion Hydrochloride
Bupropion hydrochloride tablets, available on prescription, are taken orally to help you quit smoking. They do not contain nicotine but can reduce withdrawal symptoms and the urge to smoke in most smokers. It is commonly used to treat nicotine dependence among moderately to highly addicted smokers, and can be used together with other forms of NRT.
Apart from using smoking cessation aids, one should always bear in mind that willpower and support from family and friends are also important key elements of quitting smoking successfully.
Back to health articles list |
|
|
|
| Membership |
 |
| Have A Question To Ask? |
Do you have a question to ask us about our products or services? Do not hesitate, we can help you with our prompt service and get your questions answered :
>> Click here for Enquiry Form |
|
