Ep02: Kicking the Habit: Tips and Strategies to Quit Smoking

Episode Transcript

Micaela Arneson: Most cases of COPD in the U. S. and other developed countries have a common cause.

Mike Hess: Smoking, tobacco smoking specifically. 

Micaela Arneson: And because COPD is often associated with smoking, many people who smoke and are diagnosed with COPD can also feel guilt and regret. If you or someone you love is struggling to quit, you are not alone, and you've come to the right place.

Welcome to this episode of the COPD podcast with me, Micaela Arneson. If you've jumped straight to this episode, welcome. We've put together this miniseries about COPD and we encourage you to listen to all the episodes to learn the most about this disease. In this episode, we're going to talk all things smoking and why it's always best to quit or not start to begin with, because: 

Dr. David Mannino: We know based on at least 60 to 80 years’ worth of experience that cigarette smoking in the US and most of the Western world is the biggest risk factor for the development of COPD. 

Micaela Arneson: That's Dr. David Mannino, a pulmonary physician based in Lexington, Kentucky. We'll hear more from him later in the episode. 

A quick note before we get started. This series was created for educational purposes only, and it is not a substitute for formal medical advice, diagnosis, or treatment. So if you have questions, talk to your qualified healthcare provider. 

So let's be frank, quitting smoking is the first and best thing that someone with COPD can do to stop the disease from progressing. But this is obviously much easier said than done, because nicotine is thought to be as addictive as heroin or cocaine.

It reaches the brain in just a few seconds, but its effects wear off in minutes, leaving a person wanting more, and quickly. It takes a lot of effort to stop. 

Stephanie Williams: The research indicates most people have to try to quit smoking about seven times before they're successful. 

Micaela Arneson: Stephanie Williams is a respiratory therapist, and she's worked with a lot of people who've tried to quit smoking.

Stephanie Williams: So if you have tried to quit smoking and you went back to it for one reason or another, then congratulations, you are one step closer to that average, you are not a failure. We just have to find interventions that are helpful for each individual. It's not a one-size-fits-all answer.

Micaela Arneson: And if someone you care about smokes, you probably know all too well that the decision to stop has to be theirs, but you can still help.

Stephanie Williams: Have conversations to help the person recognize maybe why they haven't been ready to quit, what might make them ready to quit, and what it would look like for them to quit. That is generally more helpful than trying to convince somebody one way or the other. 

Micaela Arneson: One of the biggest obstacles to overcome when it comes to COPD and smoking is guilt.

John Linnell: A lot of folks who have been diagnosed with COPD experience a lot of negative emotions like guilt and regret, and boy I wish I had done this differently, or I wish I could quit smoking, or I wish I had taken better care of my lungs.

Micaela Arneson: Research shows that more than 80% of current smokers regret ever having smoked and wouldn't choose to start up if they had the choice again. And once someone who smokes gets a diagnosis of COPD, it's common for them to feel more regret. 

Mike Hess: That is, again, an entirely normal process, not only in COPD, but in a lot of our chronic conditions that are brought on by lifestyle choices. Boy, I really wish I had made healthier decisions back in the day. But it's easy to get into that cycle of negativity, and it's important to remember that the past is kind of the past. We can't really do much about that anymore. And all we have is the present, and that's why it's a present, it's a gift. 

Micaela Arneson: We could easily do an entire series on the challenges to stopping smoking, because it's one of the hardest things anyone will ever do.

Stephanie Williams: The truth is that smoking, that nicotine, is truly addictive. I mean, it is so addictive, we can't minimize the impact it has on our brains. Dopamine gets released, and all those pleasure chemicals that your brain is feeling, those are real. So we just have to find interventions that are helpful for each individual.

Micaela Arneson: And there are lots of options out there for those trying to quit smoking. 

Stephanie Williams: Some people will say, well, I just quit cold turkey.

Micaela Arneson: Like Jan Cotton, who was diagnosed with COPD in 2000. She didn't quit smoking for another seven years, but when she did, she went cold turkey. 

Jan Cotton: On my son's birthday, January 30th of 2007 I smoked my last cigarette. I planned the date and I have not had a cigarette since. I didn't want to fall out somewhere, have to be intubated and wake up days later and say what happened. I wanted to do it on my terms. 

Micaela Arneson: This strategy worked for Jan, but as Stephanie points out:

Stephanie Williams: That's fabulous, but most people can't do that.

Micaela Arneson: And because it's so difficult to simply go cold turkey, there are lots of products to help people quit. In fact, the market for smoking cessation aids globally is worth $24 billion and rising fast. 

Stephanie Williams: Most people will find themselves on day three or day four really struggling and they would eat a pack of cigarettes if they could at that point. 

Micaela Arneson: Going cold turkey doesn't work for everyone because nicotine also has a relaxing effect. So, for some people like Jean Rommes, smoking becomes a familiar comforting ritual.

Jean Rommes: I had played around with the whole quitting thing for a while, but I always knew in the back of my mind I wasn't going to quit. That I really liked smoking. I really liked smoking, liked all of it. But then I realized that I absolutely had to quit. And it wasn't like I quit cold turkey, I used some aids and did some other kinds of things. A lot of it was just plain stubborn. I'm gonna do this by God and I did it. 

Micaela Arneson: One of the most popular smoking cessation aids is a more recent invention, the e-cigarette or vape. E-cigarettes are sometimes perceived as a healthier or at least less destructive alternative to traditional tobacco products. Many people have traded smoking for vaping, but vaping hasn't exactly been proven to be safe or effective. 

Dr. David Mannino: There is some evidence that there are some people who have been able to switch from a cigarette smoking to vaped products and then not go back to smoking. 

Micaela Arneson: That's pulmonary physician, Dr. David Mannino, and he says the science on vaping is far from conclusive.

Dr. David Mannino: Vaping, or these sort of non-burn tobacco products, have only been around for now maybe five, ten years, so we don't know what happens with long term exposure to these products. It may well be that hazards related to vaping will not be known for another 10, 15 years and people have been using these products for that long period of time may have damage to their lungs from these products.

Micaela Arneson: Dr. Mannino says one thing is clear with all smoking or vaping products. 

Dr. David Mannino: We do know that our lungs are best when they're breathing air. So anytime you introduce anything else into the lungs, such as tobacco smoke or vapors, dust, fumes, including these various vape products, that's not how our lungs were designed to work.

And the problem is, is that we're not going to have clear cut answers to these questions for many years.

Micaela Arneson: So if you're thinking of quitting cigarettes and turning to vaping as a safer alternative?

Dr. David Mannino:  The answer is that right now we simply do not know. But I think the safe approach is to not use them as opposed to use them assuming that they're safer than cigarettes.

Micaela Arneson: Of course, there are the more traditional smoking cessation aids. 

Dr. David Mannino: There are other types of nicotine replacement. There are gums and patches, for example, that can be used for people that have that nicotine addiction. And at least those have been studied and do not seem to be harming the lung. 

Parisa Vatanka: So there's seven FDA approved medications for smoking cessation, for tobacco cessation.

Micaela Arneson: This is Risa Vatanka, a pharmacist. 

Parisa Vatanka: There's nicotine replacement therapy in the form of gum, lozenge, and patches and those are available without a prescription. There's also nicotine replacement therapy in the form of an inhaler or a nasal spray, those do require a prescription. There’s also two oral medications by prescription, bupropion and Chantix.

Micaela Arneson: Your healthcare provider can help you figure out the right solution for you. And pharmacists like Risa are an excellent resource for any questions you might have about your options. 

Parisa Vatanka: I would encourage people who decide to use nicotine replacement therapy, products that are available over the counter, to talk to your pharmacist because it does make a difference how you use these and the right dose.

Micaela Arneson: A pharmacist can also help you learn how to take your medication properly. 

Parisa Vatanka: Not only is it okay to combine patch plus gum or lozenge, it's recommended because you would want to have the patch that will provide a steady amount of nicotine to keep your withdrawal symptoms at bay while you are developing these new habits of being tobacco free.

Micaela Arneson: Interestingly, Risa has found that a lot of people actually don't know how to use nicotine gum correctly, and pharmacists like her can help. 

Parisa Vatanka: I think that often people think, Oh, gum, I know how to use gum. So they don't really read the package, they just chew it. And then they get hiccups and stomach ache and they think, Oh, I don't like that medicine. So here's the proper way. When you're going to use the gum, this nicotine resin, you actually chew it until you have this peppery or tingly feeling, and then you park it in your cheek until the sensation goes away. And then you chew it again, and then you park it maybe on the other side. 

Micaela Arneson: And like with any medication, it's important to remember that what works for one person might not work for you.

Stephanie Williams: It's finding the right recipe to help you be successful with quitting. So you might try some of the nicotine guns. You might have tried that in the past. Maybe it worked for a bit, but it wasn't enough. Okay, well, maybe you need to try again, but let's try another recipe this time. Let's try something else.

Maybe we need to have your doctor prescribe something for you to help take some of that anxiety away. People have had success with those things, but it's finding the right recipe for you. So just keep in mind, there's not one answer, there's your answer. So find it. 

Micaela Arneson: There are a huge number of places to go for help and support with quitting smoking.

The best thing to do would be to speak first with your physician and see if they can help come up with a plan that works for you. If you're in the United States and trying to quit smoking, you can call the national Quitline at 1-800-QUIT-NOW or 1-800-784-8669 to get free access to resources in your area.

You can also find tips on how to quit at smokefree.gov or on the CDC's website. Links to all these resources and more are on our website at healthunmuted.com/resources. This is the COPD podcast hosted by me, Micaela Arneson. This show is part of the Health Unmuted audio library by Mission Based Media. To listen and learn more, visit healthunmuted.com and follow our show on your favorite podcast player. There are still many questions to answer about COPD, so please do keep listening.