Clearing the Air

Although research has clearly established that smoking and tobacco use are 2 of the principal causes of preventable diseases and mortality in the United States, the most recent statistics from the US Department of Health and Human Services indicate that an estimated 34 million individuals in the United States currently smoke cigarettes.¹ Data also reveal that more than 16 million adults have a disease that was caused by smoking, and smoking-related illnesses contribute to more than half a million deaths each year in the US.^1,2 Smoking is the leading cause of cancer in the US, and exposure to secondhand smoke may expand an individual’s risk of cancer and other diseases.^1,2

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Smoking eventually affects every organ system and can increase the risk of developing health-related complications such as certain cancers (eg, acute myeloid leukemia, lung, kidney, colorectal), cardiovascular disease, lung diseases (eg, chronic obstructive pulmonary disease, emphysema, chronic bronchitis), and diabetes.^2-4 Smoking can also increase the risk of certain ophthalmic diseases (cataracts and macular degeneration), periodontal disease, osteoporosis, rheumatoid arthritis, and poor wound healing.^3-6

According to the CDC, 68% of smokers have indicated that they would like to quit smoking, and each year more than 50% of these individuals attempt it. However, smoking cessation is challenging, and statistics indicate that fewer than 1 in 10 adults successfully quit.^5,6 Data also reveal that 90% to 95% of individuals who use smoking cessation techniques eventually start smoking again within 6 months.^6,7

Benefits of Smoking Cessation

According to the National Cancer Institute and the CDC, smoking cessation can have immediate and long-term health benefits.⁸ Table 1 reviews the health benefits of smoking cessation and how soon those benefits can be seen after cessation.⁸

Recent Clinical Data and News

In a study recently published in Cureus, the authors indicated that a one-size-fits-all approach is not practical for smoking cessation. Instead, strategies should be tailored to patient needs and involve shared decision-making between clinician and patient.⁴ Key considerations include unique communication styles and preferences between different sexes, cultural considerations, and age-specific strategies.⁴

According to a recent report by the World Health Organization, the risk of developing type 2 diabetes was lowered by as much as 30% to 40% in individuals who quit smoking.⁹ The report notes that smoking cessation is believed to boost the body’s ability to regulate blood sugar. Additionally, smoking cessation lowers the risk of diabetes-related complications such as cardiovascular disease, kidney failure, and blindness.⁹

A study published in JAMA Network Open reviewed data from a cohort of patients who survived lung cancer and explored the association of years since the cessation of smoking prior to diagnosis and cumulative smoking pack-years with overall survival. The findings revealed that smoking cessation earlier in life was associated with a decreased mortality rate following a lung cancer diagnosis.¹⁰ Compared with individuals who never smoked, former and current smokers had 26% and 68% higher mortality, respectively.¹⁰

Another study in JAMA Network Open revealed that there was a decline in attempts to quit smoking and significant decreases in the sales of nicotine replacement products during the onset of the COVID-19 pandemic.^11,12 The findings showed that in 2020, the annual prevalence of quit attempts within the past year decreased among smokers in the US for the first time since 2011, from 65.2% in 2019 to 63.2% in 2020. These results highlight the importance of reengaging with patients who smoke and continuing to offer resources for those who wish to quit.^11,12

Nonprescription Tobacco Cessation Products

Pharmacists are well positioned to guide patients in the proper selection and use of available nonprescription tobacco cessation products. They can also be instrumental in educating patients about the health consequences associated with tobacco smoke and identifying the large number of medications that interact with tobacco smoke through pharmacokinetic or pharmacodynamic processes. These interactions can cause diminished therapeutic efficacy or augmented risk of toxicity.⁶

Nicotine replacement products (gum, patches, and lozenges) are the most commonly used pharmacotherapy for smoking cessation. Product selection is often based on several factors, including cost, route of administration, ease of use, and patient preferences. In general, nicotine replacement products lessen nicotine cravings and withdrawal symptoms that begin after abstinence from tobacco products, which helps patients concentrate on the behavioral modifications that are also necessary for smoking cessation.⁶

Pharmacists can provide patients with recommendations for nonpharmacologic methods that can be used in conjunction with OTC smoking cessation products. Pharmacists can also encourage patients to seek assistance from their primary health care provider to improve the likelihood of successful and long-term smoking cessation.

Pharmacists can also assess whether self-care measures are appropriate and direct patients to seek medical assessment from their primary health care provider to discuss the use of prescription smoking cessation products. Patients with a history of cardiovascular disease, including recent myocardial infarction, arrhythmia, severe angina, uncontrolled hypertension, or active peptic ulcer disease, or those younger than 18 years should always consult their primary health care provider about recommended smoking cessation measures.⁶

Conclusion

Smoking cessation is not easy, but pharmacological and nonpharmacological measures can help patients achieve their goal. Pharmacists can encourage patients by providing them with information about smoking cessation measures and the various immediate and long-term health benefits associated with smoking cessation. Table 2 details valuable resources to provide patients. Pharmacists should encourage patients to discuss the issue of smoking cessation with their primary health care provider to devise a patient-centered smoking cessation plan to increase the odds of successfully quitting.

References

1. US Department of Health and Human Services. Smoking cessation: a report of the surgeon general – smoking cessation by the numbers. Updated January 23, 2020. Accessed January 23, 2024. https://www.hhs.gov/surgeongeneral/reports-and-publications/tobacco/2020-cessation-sgr-infographic-by-the-numbers/index.html

2. Healthy People 2030. Tobacco use. Accessed January 23, 2024. https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use

3. US Department of Health and Human Services. The health consequences of smoking – 50 years of progress: a report of the surgeon general. 2014. Accessed January 23, 2024. https://www.ncbi.nlm.nih.gov/books/NBK179276/

4. Onwuzo CN, Olukorode J, Sange W, et al. A review of smoking cessation interventions: efficacy, strategies for implementation, and future directions. Cureus. 2024;16(1):e52102. doi:10.7759/cureus.52102

5. Smoking cessation: fast facts. CDC. Updated March 21, 2022. Accessed January 23, 2024. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/smoking-cessation-fast-facts/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ftobacco%2Fdata_statistics%2Ffact_sheets%2Fcessation%2Fquitting%2Findex.htm

6. Martin B. Tobacco Cessation. In: Krinsky DL, Ferreri SP, Hemstreet BA, Hume AL, Rollins CJ, Tietze KJ, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 20th ed. American Pharmacists Association; 2020.

7. Shiffman S, Balabanis MH, Gwaltney CJ, et al. Prediction of lapse from associations between smoking and situational antecedents assessed by ecological momentary assessment. Drug Alcohol Depend. 2007;91(2-3):159-168. doi:10.1016/j.drugalcdep.2007.05.017

8. Benefits of quitting. CDC. Updated October 25, 2023. Accessed January 23, 2024. https://www.cdc.gov/tobacco/quit_smoking/how_to_quit/benefits/index.htm