What Should Smokers Expect When Quitting?

Cigarette smoking is the leading cause of preventable death and disease in the United States, accounting for about 1 in every 5 deaths per year.¹

Conventional cigarette smoking has decreased in recent years, with nearly 21% of the US population reporting cigarette use in 2005 and 14% in 2017.²When a patient or provider makes the decision to quit smoking, it is critical to address not only the benefits of smoking cessation but the challenges that lie ahead. The better prepared the individual, the more likely he or she is to succeed at quitting.

The first consideration is how quitting smoking affects the body and its functions. Here is a rundown:

• 20 minutes after the last cigarette:Blood pressure (BP) and pulse decrease back to a normal range.³
• 12 hours after the last cigarette:Carbon monoxide levels return to normal.³
• 24 hours after the last cigarette:The risk of myocardial infarction begins to decrease. Smoking lowers high-density lipoprotein cholesterol, raising the risk of coronary artery disease. BP also continues to drop to a normal level.³
• 48 hours after the last cigarette:The sense of smell and taste begin to return, as the nerve endings damaged by smoking begin to heal. The lung’s cilia are also healing and starting to resume their function of sweeping debris and mucous out of the alveolar spaces.⁴
• 72 hours after the last cigarette:After 3 days of not smoking, the nicotine levels in the body are completely depleted. Breathing is easier, and energy levels have increased, because of the return of normal blood flow.^3,4
• 1 month after the last cigarette:Lung function continues to improve. Former smokers will notice less coughing and shortness of breath. Athletic endurance increases, and circulation continues to improve.⁴
• 9 months after the last cigarette:The cilia have completely recovered from the paralyzing toxins found in cigarette smoke, and the lungs have significantly healed themselves. Former smokers may, therefore, notice a decrease in the frequency of lung infections.⁴
• 1 year after the last cigarette:The risk for coronary artery disease has decreased by half and will continue to decrease past the 1-year mark.^3,5
• 5 years after the last cigarette:The chances of a stroke are now the same as a nonsmoker. Toxins in cigarettes cause blood vessels to constrict and increase the likelihood of developing blood clots. At this point, the former smoker’s blood vessels have dilated back within a normal range that reduces the risk for stroke. Cervical cancer risk has also decreased to the level of a nonsmoker. Risk for cancer of the bladder, esophagus, mouth, and throat have been cut in half.^3-5
• 10 years after the last cigarette:Lung cancer risk decreases by half, while the risk of laryngeal and pancreatic cancers also significantly decline.^4,5
• 15 years after the last cigarette:After 15 years of not smoking the chances of coronary artery disease are the same as someone who has never smoked. Similarly, the risk of developing pancreatic cancer has reduced to the same level as a non-smoker.^3,5

The second consideration when reviewing what to expect when a smoker quits is the pathophysiological and psychological addiction to nicotine. Nicotine addiction changes the brain landscape.⁶Smokers inhale nicotine from a cigarette, where it is quickly absorbed in the lungs and travels to the brain. Once in the brain, it binds to nicotinic cholinergic receptors. Stimulation of these receptors releases a variety of neurotransmitters, including dopamine, which signals a pleasurable experience and is critical for reinforcing the effects of nicotine. Receptor activation also results in the development of new neural circuits, also known as neural plasticity, and, in association with environmental cues, behavioral conditioning.

When a person who is addicted to nicotine stops smoking, the urge to relapse is persistent and far outlasts physiological withdrawal symptoms. With regular smoking, the smoker comes to associate specific environmental factors, moods, or situations with the rewarding effects of nicotine.⁶Too often, these cues can lead to a relapse. Educating the smoker on these conditioned pitfalls can help prepare them for successfully quitting. Print out theTable⁷for patients who want are trying to kick the habit.

Table 1. How to Manage Cravings⁷

Get Support

• Call or text someone. Lean on trusted people. You do not have to do this alone.
• Download a free application that can help track cravings and provide understanding of smoking patterns (smokefree.gov).
• Talk to an expert, such as a primary-care provider or a retail health provider.

Think About Reasons for Quitting

• Remember the reasons for quitting, such as family and health.
• Calculate the savings. Add up the money saved by not smoking, and think of something rewarding to do with it. This is a great way to stay motivated while a craving passes (smokefree.gov/quit-smoking/why-you-should-quit/how-much-will-you-save).

Stay Busy

• Chew gum, sip from a water bottle, or suck on a cinnamon stick, hard candy, or a straw to keep your mouth busy and mimic smoking.
• Go for a jog or walk. Go up and down the stairs a few times. Physical activity, even in short bursts, can help beat a craving.
• Meditate. Take 10 deep, slow breaths to calm anxiety and center yourself. Repeat 10 times or until the craving passes. Most cravings last 5 to 10 minutes. Remember this to push through.
• Switch to doing something else as soon as a craving hits. Simply changing a routine can help eliminate the craving.

Go to a Smoke-Free Zone

• Visit a public place. Most public places do not allow smoking. Go to a movie, store, or other place where smoking is not allowed.

Try Nicotine Replacement Therapy

• There are many forms, such as gum, lozenges, and patches. These can help with frequent cravings, but try to use them as a last resort. The goal is to change the behavior, so try to focus on interventions that do not use nicotine dependence as a crutch.

Do a Good Deed

• Help out a co-worker, family member, or friend. This shifts the focus to someone else and their needs instead of the craving.

Bethany Rettberg, NPC,is a family nurse practitioner at a CVS Minute Clinic in Mokena, Illinois.

REFERENCES

1. The health consequences of smoking—50 years of progress: a report of the surgeon general. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.
2. Centers for Disease Control and Prevention. Current cigarette smoking among adults—United States, 2017.Morbidity and Mortality Weekly Report.2018;67(44):1225-32.
3. CDC. Surgeon general’s report 2004: the health consequences of smoking.cdc.gov/tobacco/data_statistics/sgr/2004/posters/20mins/index.htm. Accessed November 20, 2019.
4. CDC. Enjoy benefits of being smoke free.cdc.gov/tobacco/campaign/tips/quit-smoking/guide/rewards-of-quitting.html. Updated April 1, 2019. Accessed December 3, 2019.
5. American Heart Association. Smoke-free living: benefits and milestones.heart.org/HEARTORG/HealthyLiving/Smoke-free-Living-Benefits-Milestones_UCM_322711_Article.jsp#.Xd1wadVKiUk. Updated June 2015. Accessed December 3, 2019.
6. Benowitz, N.L. Nicotine Addiction.N Engl J Med.2010;362(24):2295-303. doi: 10.1056/NEJMra0809890.
7. National Institutes of Health. How to manage cravings. Smokefree.gov website.smokefree.gov/challenges-when-quitting/cravings-triggers/how-manage-cravings. Accessed December 3, 2019.