A presentation created for Pulmonary Rehab to help patients with smoking cessation. Overview of cigarettes, e-cigarettes, triggers, withdrawals, and nicotine replacement therapies.

1. Babette Parthum, RRT
Clinical Coordinator
Respiratory Therapy

2. ●Why smoking is addictive.
●Facts about cigarettes and electronic
cigarettes
●Steps you can take to approach quitting.
●How to prepare for a relapse.
●Reasons for becoming tobacco free.
●How to track your triggers.
●Working through withdrawal

3.  Tobacco: main ingredient in
cigarettes
 Does not cause a smoker’s addiction.
 The problem lies in the artificial
flavorings and chemicals that are
added to the tobacco.

4. ●The key ingredient that causes a smoker’s
addiction is nicotine.
●Nicotine is a stimulant.
●Causes your body to release a hormone
called epinephrine (also called
adrenaline).
●This release causes your body to
produce a sudden release of glucose.
●This glucose release causes stimulation
or “smoker’s high”.

5. ●Once the glucose levels drop,
depression and fatigue sets in, leading
the user to crave more nicotine to
relieve those symptoms.
●This becomes a vicious cycle
because smokers begin increasing the
number of cigarettes they smoke to
prevent the bad feelings of
withdrawal.

7. ●There are at least 599 additives
(chemicals) in a cigarette.
●Many of these additives are found in our
food.
●These additives were not tested for
burning. Burning changes the properties
of the chemicals.

8. ●More than 4000 chemical compounds are
created by burning a cigarette, 69 of these
are carcinogenic.
●“Light” cigarettes are just as dangerous.
People who switched to light cigarettes to
decrease their tar and nicotine intake tend
to take longer, deeper, more frequent
puffs to reach the nicotine content that
their body is craving.

9. ●They do not burn tobacco, instead it is a
vapor.
●Although there is no smoke or noxious
odor emitted, there are still toxins
emitted.
●They still contain nicotine, propylene
glycol, and other toxins.
●They are still considered toxic because
they contain liquid nicotine and propylene
glycol.

11. ● Set a realistic goal for a quit date.
● Prepare your environment.
● Rid your house, car, and workplace of cigarettes
and ashtrays.
● Tell your family, friends, and coworkers of your
intent to quit smoking and ask that they respect
your decision by not smoking in your presence.
● Seek support from a healthcare professional
(pulmonary rehab team, doctor, respiratory
therapist, counselor).

12. ● Change your routine
● Switch from drinking coffee to tea
● Eat meals in a different location
● Take a different route to work
● Reduce Stress
● Take a hot bath
● Exercise
● Read a book

13. Talk to your doctor about medications and
nicotine replacement products.
● Over the Counter Nicotine Replacement
Therapy
● Nicotine Patch – placed on the skin and gives
users a small and steady amount of nicotine.
● Nicotine gum - chewed to release nicotine.
The user chews the gum until it produces a
tingling feeling, and then places it between
their cheek and gums.

14. ●Prescription Nicotine Replacement
Therapy
●Nicotine inhaler – a cartridge attached to
a mouthpiece. Inhaling through the
mouthpiece gives the user a specific
amount of nicotine.
●Nicotine nasal spray – a pump bottle
containing nicotine, which is put into the
nose and sprayed.

15. ●Oral medications can help you get through
the first months of not smoking.
●Zyban® (Bupropion) – helps reduce
nicotine withdrawal and the urge to
smoke.
●Chantix® (Varenicline) – helps to reduce
nicotine withdrawal and the urge to
smoke. It also blocks the effects of
nicotine from cigarettes if the user starts
smoking again.

16. ●Many people do not succeed at smoking
cessation on their first attempt.
●Remember to NEVER give up!

17. ●Avoid situations that cause you to light up.
●Drinking alcohol
●Being around other smokers
●Fear of gaining weight
● Most people gain no more than 10 pounds
while they are quitting
● Establish an exercise plan
● Eat healthy
●Bad mood or depression

18. ●Health risks
● More likely to develop emphysema, lung
cancer, heart disease and many other illnesses.
●Causes premature aging and skin problems.
●Difficulty falling asleep and inhibition of deep
sleep.
●Exacerbation of snoring and sleep apnea.
●Alienation from non-smoking friends, family, and
coworkers.
●Cost – Smoking is expensive!

19. ● I want to breathe better.
● I want to limit how much supplemental oxygen I use
at home.
● I’ll be less at risk of lung cancer, heart attack, and
stroke.
● I’ll save money.
● I want to slow the progression of my lung disease.
● I want my clothes, car, and house to smell better.
● I want to have less mucus, shortness of breath, and
wheezing.
● Add your own reasons to this list

20. ● Stress (Anxiety, depression)
● Boredom
● Eating
● Certain emotions
● Social Situations
● Morning Coffee
● Driving
● Waking up
For one day, write down each time you smoke or
have the urge to smoke. Record the time of day
and what you were doing just before you had the
urge. Look for patterns in these smoking triggers.
Find ways to avoid or deal with these triggers.

21. ● You may cough more and have more mucus
because the lungs are cleaning themselves.
● Nicotine is a very addictive drug.
● You will go through several weeks of withdrawal
and may experience mood swings, lower energy,
and trouble thinking clearly. These symptoms
WILL go away.
● Keep yourself and your mind busy.
● Play a game
● Go for a walk
● Work in your garden
● Exercise

22. ●Eat low fat snacks
● Crunchy snacks – apple spices, carrots, celery
sticks, pretzels
● Sweet snacks – angel food cake, bananas,
pineapple, low fat cookies or muffins
● Creamy snacks – fat-free pudding, yogurt,
applesauce
●Get lots of support
● Talk to a friend
● Ask family members not to keep cigarettes in the
house
● Ask a friend or family member to quit with you.
● Seek support in your pulmonary rehab group

23. 24 Hours: Anxieties have peaked in
intensity and within two weeks should
return to near pre-cessation levels.
48 Hours: Damaged nerve endings have
started to re-grow and your sense of smell
and taste are beginning to return to
normal. Cessation anger and irritability
will have peaked

24. 10 Days: The "average" ex-user is down to
encountering less than two crave episodes
per day, each less than 3 minutes.
10 Days to 2 weeks: Recovery has likely
progressed to the point where your
addiction is no longer doing the talking.
Blood circulation in your gums and teeth
are now similar to that of a non-user.

25. 2-4 weeks: Cessation related anger,
anxiety, difficulty concentrating,
impatience, insomnia, restlessness and
depression have ended. If still
experiencing any of these symptoms get
seen and evaluated by your physician.
2 weeks - 3 months: Your heart attack
risk has started to drop. Your lung
function is beginning to improve.

26. 3 weeks - 3 months: Your circulation has
substantially improved. Walking has become
easier. Your chronic cough, if any, has likely
disappeared. If not, get seen by a doctor, and
sooner if at all concerned, as a chronic cough
can be a sign of lung cancer.
1-9 months: Any smoking related sinus
congestion, fatigue or shortness of breath has
decreased. Cilia have re-grown in your lungs,
thereby increasing their ability to handle mucus,
keep your lungs clean, and reduce infections.
Your body's overall energy has increased.

27. 1 year: Your excess risk of coronary heart
disease, heart attack, and stroke has
dropped to less than half that of a smoker.
5 years: Your risk of a subarachnoid
hemorrhage has declined to 59% of your
risk while still smoking (2012 study). If you
are a female ex-smoker, your risk of
developing diabetes is now that of a non-
smoker (2001 study).
5 - 15 years: Your risk of stroke has
declined to that of a non-smoker.

28. Want to Quit?
Contact the American Cancer Society
Quit line for free and confidential
counseling services, support and
information:
1-877-937-7848
TTY: 1-866-228-4327
You can also visit www.yesquit.org

30. References:
American Association for Cancer Research:
Park et al
American Lung Association
Centers for Disease Control
American Thoracic Society
National Institute of Health
National Cancer Institute
YourLungHealth.org
American Heart Association