Available drawbacks or barriers that might hinder their

Available options for smoking cessation and their effectiveness-Abstract?IntroductionSmoking is largely accepted as the single biggest avoidable cause of cancer worldwide. 1,2 In the UK, smoking has been found to cause about 28% of cancer mortalities as well as 20% of all cancer cases. 3,4 This is significant because non-smokers on average live about 10 years longer than smokers live. 1,3,5–7 As a medical student it is intriguing to understand why people smoke and what is available to help them quit because of the cancer risk and the effects on mortality and morbidity related to smoking, as well as this smoking currently costs the English society 12.9 billion a year, of which 2 billion pounds a year from the NHS as well as costing a smoker about £3600 a year to smoke. 8,9 To explore the subject, I will first delve into ‘why people smoke?’ to gain insight, then I will explore self-motivations and their effectiveness on quitting on their own and thereafter I will proceed to discuss the use and effectiveness of drugs such as varenicline and bupropion as well as nicotine replacement therapy and its combined use with other medications. To gain a deeper understanding of a smoker’s point of view I have conducted an interview with an ex-smoker that has tried varenicline on his latest quite attempt, this has enlightened my understanding of the position of a smoker and I will be using this case study coupled with research, guidelines and my NCSCT training to shed light on a smoker’s options with regards to helping them quit smoking and their effectiveness as well as any drawbacks or barriers that might hinder their quit attempt and discuss ways that these can be overcome.DiscussionFirstly, in exploration to the question as to ‘Why people smoke?’, I asked my case study subject appendix 1 why did he start smoking and in summary his reasons where: social/peer pressure, seeming older and stress of exams. My subject like a lot of young people today did not think about the long-term health penalties associated with tobacco smoking when he started smoking, and the fact that nicotine is a highly addictive substance that can lead to deadly outcomes. 10 The social aspect of smoking entails role models such as tv/movies actors that were payed to advertise a brand of tobacco, a study was conducted into this matter and it was found that “Movie smoking exposure significantly predicted progression to established smoking in long-term follow-up. “with an estimate of 34.9% of smoking can be attributed to movie/tv smoking exposure within their test 11. Other types of role models may include friends that may use peer pressure to encourage the habit of smoking using social exclusion as an alternative on a risk-taking vulnerable adolescence 12. Smoking not only make you seem socially older it also affects your skin, 13, appendix 1 Where twin studies show indicators of the physiological ageing caused by smoking such as: wrinkling of the upper and lower lips, the face becomes more wrinkled especially between mouth and nose, and sagging chins appear; bags under the eye, lower eyelids baggie and upper eyelids sagging. 57% of the time the smoking twin was identified in this study showing that smoking has some significance to how old you look. 13,14 Stress is another contributor to why people smoke, and smokinghas been shown to decrease the arousal level of a subject and possibly stress level it is possible that smoking in an unpleasant state could facilitate a reduced arousal level sooner than with non-smoking. 15 One third of young smokers will quit, one third of young smokers will not be affected and one third of young smokers will continue to smoke and will die due to causes related to smoking tobacco. 10Secondly, in exploration of what is self-motivation/ efficacy I found that quitting smoking is hard in of its own due the dependency of the addictive drug namely nicotine and quitting can involve several attempts. 16,17 Nicotine dependency opposes self-motivation to quit through nicotine withdrawal symptoms consisting of: trouble concentrating, desire for products that contain tobacco, the feelings of anger, irritability as well as being hungrier than usual. 16,18 Moreover, Individuals who may want to stop smoking because of: family & friends, the finical cost of smoking or physical cost of smoking (illness secondary to smoking); whom stop smoking for a time frequently start again due to these withdrawal symptoms, weight gain as well as stress. 16-18 My case study had 2 failed quit attempts and where factors such as stress overcame his self-motivation to quitting smoking, appendix 1 he used a method called going ‘cold turkey’ where by you stop smoking all together suddenly (as oppose to cutting down) but he did not have any help and Scientific research has shown treatments such as: counselling, a doctor’s advice and Behavioural therapies can help a quit attempt. 18,19 Social support is the second most important ingredient of smoking cessation after self-motivation, a good way that this can be achieved is by getting family and friends to be proactive in the quit attempt or joining a support group. 19 using a new, healthy way to relieve day to day stresses because for many people Smoking is a stress reliever, Replacing cigarettes as a default stress-management tool with something else is critical to quit attempt seceding and being sustained; Exercise is an effective alternative for stress relief as well as this it can help improve your mood, and reduces concerns with gaining weight once you quit as you are burning the increased food intake.19 ,20 appendix 1 Changing habits that are related to smoking such as chewing gum or having a healthy snacks when urge to smoke arises suggestions include toothpicks, celery, cinnamon sticks, or straws to keep you occupied. 19,20 Additionally, it is estimated that 55% of adult smokers have tried to quit smoking and about a 75% (2012) rebound rate through going ‘cold turkey’. 19,21One of the first line treatments options given for smoking cessation is nicotine replacement therapy. 18 Nicotine replacement therapy is used to decrease withdrawal symptoms discussed earlier by replacing nicotine taken from smoking with other forms of nicotine such as: gum, inhaler, lozenge, nasal spray or a patch patches to be placed on skin that contain nicotine. The slow release of patches dissociates smoking and getting a hit of nicotine as well as lacking tar that is found in cigarettes that can cause cancer. 22 Research of 40,000 subjects found that the use of nicotine replacement therapy in all forms made it more likely that quit attempt is successful by 20%. 22 There is no advantage of using NRT patches beyond the time of 8 weeks. 22 Moreover, NRT is effective when mixed with counselling or when used in isolation, and there is no need for NRT to be prescribed by a doctor which may mean more people have access to NRT from just using their pharmacy but smokers who smoke more frequently may needhigher doses of nicotine. 22 Nicotine replacement therapy may be more effective if given using a combination of slow acting patches and faster acting product such as nasal spray. 22 Side effects from NRT may include skin irritation or mouth irritation but these are minimal in comparison to side effects of smoking. 1,2,22 more?Another option for smokers is varenicline (Champix), Also given as a first line treatment for smoking cessation. 18 Varenicline is a very effective smoking cessation drug, it can increase the probability of stopping smoking by two folds. 23,24 Varenicline is a full against of ?7 nicotinic acetylcholine receptors and partial against of other subtypes such as ?4?2. 25 The activity of varenicline on ?4?2 receptors creates less effect of dopamine release as compared to nicotine but this competitiveness on ?4?2 means that nicotine would bind and fully stimulate ?4?2 receptor to a less extent as the receptor is saturated with varenicline. 26 Research found that varenicline is more effective than the use of 1 NRT product, but results are not as clear for the use of combination NRT. 27 My case study subject heard about this drug through a friend and requested it after being referred to the smoking cessation program by his GP after he was found to have problems with his heart and he felt that the drug worked as he had no desire to smoke within the first few weeks, but he stopped taking varenicline earlier that recommended because he felt uncomfortable that it was building a sheath around his brain. Varenicline is more costly than other alternative for smoking cessation but also more effective and research shows by measure of quality adjusted life year gained (QALY), varenicline is at least as cost effective as bupropion or NRT. 28-30 Common side effects may include nausea, headache, abnormal dreams, insomnia and nasopharyngitis, 31 there has been some evidence that varenicline increases risk of cardiovascular disease 32 but because once a smoker stops smoking the risk of a cardiovascular disease decreases by a half in the first year and returns to same risk as a non-smoker within 3 years, this makes the risk of cardiovascular disease a result of varenicline is negligible but there is advice to stop taking varenicline after a cardiovascular event and to report to a doctor. 31,33,34Alternatively, bupropion (Zyban) can be used as a smoking cessation aid that is a first line option for patients willing to stop smoking. 18 Bupropion acts to decrease the severity of withdrawal symptoms and nicotine cravings. 35 Bupropion also has anti-depressant effects, so it may be difficult to ascertain its effectiveness as a smoking cessation drug in people with history of depression; taking this into account it is approximated that bupropion doubles the chances of quitting smoking. 35 Bupropion has been found to have less effectiveness when compared with varenicline but similar effectiveness as nicotine replacement therapy. 35 Side effects may include epileptic seizures which caused bupropion to be withdrawn from the market for a time, but it was later found that this was a does issue and seizures occur in overdosing, also having epilepsy is a contraindication to taking bupropion. 36 more?-Vaping -? Effective,? Evidence,? Uptake,? Quit smoking all togetherSummaryIn summary, a smoker has 3 different type of drugs as first-line treatment 18 to help them quit smoking if they are unable to achieve and maintain the change themselves through self-motivation alone, these include: nicotine replacement therapy(NRT), which may be in the form of gum, inhaler, lozenge, nasal spray or a patch; bupropion and varenicline. Varenicline seems more effective than bupropion or single NRT 27,35 while being at least as cost effective to deliver 28-30 and I think that means that this should be the recommended therapy because of effectiveness.ConclusionConclusion/merge with summary not yet finalised as some aspects of this essay are