1 What happens to smokers in the first few weeks after stopping smoking? Robert West University College London Practical Cardiology, Oxford September 2007

Quiz Indicate which of the following are true and which are false Stopping smoking... 1.causes a lasting drop in blood pressure 2.causes a temporary increase in adrenaline output 3.causes a temporary increase in heart rate 4.causes a temporary increase in coughing as the lungs start to recover 5.causes a temporary increase in weight gain 6.reduces healthcare costs within the first year 7.causes a temporary increase in tremor 8.increases hunger because of smokers’ need for an ‘oral substitute’ 9.causes a temporary increase in headaches 10.causes a temporary increase in alcohol consumption

Outline Psychological effects of stopping smoking Physiological effects of stopping smoking Health effects of stopping smoking

Psychological effects The following have not been demonstrated to be affected by stopping smoking: tiredness, headaches, alcohol consumption

Physiological effects of smoking cessation

Health effects of smoking cessation

Definition of withdrawal symptoms Physical and mental changes that occur following interruption or termination of drug use Normally temporary A product of physical or psychological adaptation to long-term drug use requiring a period of re-adjustment when drug is no longer ingested

Which effects are nicotine ‘withdrawal symptoms’? Irritability Restlessness Increased appetite (not caused by need for oral substitute) Increased depression Increased anxiety Difficulty concentrating Sleep disturbance Urges to smoke

Link between cessation effects and relapse More severe cravings and increased depression are associated with greater risk of relapse Anecdotal reports of smokers relapsing because of weight gain but on average those who gain more weight are more likely to remain abstinent

Treatment of withdrawal symptoms  Smokers should be provided with realistic picture of what to expect  Most common treatment is nicotine replacement, bupropion or varenicline  Varenicline reduces urges to smoke more than bupropion  No clear evidence that one form of nicotine replacement is more effective than others  Oral glucose acutely reduces desire to smoke  Exercise acutely reduces desire to smoke and other withdrawal symptoms

Conclusions Stopping smoking leads to a temporary nicotine withdrawal syndrome of mood disturbance, hunger and some physical symptoms The main permanent change is weight gain The mood disturbance, craving, hunger and physical symptoms can be managed by –preparing people in advance –presenting them with a coherent model of their symptoms –recommending exercise and –prescribing medication A minority of smokers experience adverse health effects –increased blood pressure –respiratory symptoms –clinicians need to be vigilant for these and monitor patients at risk

Quiz: answers Stopping smoking... causes a temporary increase in adrenaline output causes a temporary increase in heart rate causes a temporary increase in coughing as the lungs start to recover causes a temporary increase in weight gain reduces healthcare costs within the first year causes a temporary increase in tremor increases hunger because of smokers’ need for an ‘oral substitute’ causes a temporary increase in headaches causes a temporary increase in alcohol consumption False causes a lasting drop in blood pressure False

Additional reading West R and Shiffman S (2007) Smoking Cessation. Healthcare Press, Oxford