Jennifer Mittler-Lee's COLUMN

Now Is the Time To Quit

Smokers are at increased risk of complications from coronavirus — here’s how to get help.

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We all know the health benefits of not smoking.

The toxins in smoke can affect many of our vital organ systems from the heart and lungs to the eyes. Expectant women can experience reproductive problems such as low-birth-weight babies. Smoking is also linked to developing many types of cancers.

Now there’s another reason to quit smoking.

Smokers have an increased risk of developing more serious complications from the coronavirus.

Smoking and COVID-19

When the coronavirus attacks the lungs, it can cause a mild infection characterized by a persistent cough or can progress to respiratory distress. Severe cases may require hospitalization, intubation for breathing support, and weeks spent in critical care.

Smokers and former smokers are at increased risk of developing a more severe course of infection, nearly double the rate of non-smokers.

In May, the University of California San Francisco (UCSF) analyzed 19 peer-reviewed studies on smoking and coronavirus. These studies included nearly 12,000 patients diagnosed with COVID-19.

The researchers found that the risk of disease progression in smokers or former smokers was twice that of nonsmokers. Current or former smokers also needed more support, were likely to be in critical condition, and were at higher risk of death.

“Smoking is associated with a substantially higher risk of COVID-19 progression,” said Stanton A. Glantz, Ph.D., director of UCSF’s Center for Tobacco Control Research and Education.

The use of e-cigarettes also led to further disease progression. Both vaping and cigarette smoke can damage the lungs and decrease lung function. Another study found that vaping, either with or without dual tobacco use, was associated with a five times greater chance of developing COVID-19.

A multitude of benefits

Along with hand washing and face masks, give yourself every possible means of protection — that includes quitting smoking.

By improving circulation, increasing oxygen levels, and lowering inflammation, you give the immune system a better chance to fight off not just coronavirus but also seasonal colds and flu.

In addition to improved immunity, the American Cancer Society lists the following benefits:

Screenshot/ “Health Benefits of Quitting Smoking”/ American Cancer Society

Quitting is tough

While some individuals can stop “cold turkey,” others need counseling, acupuncture, or medications to help curb the nicotine craving.

Those attempting to quit often require multiple attempts, but there are resources and help available. A solid plan involving support, strategies for battling weight gain, anxiety, and mood swings, and counseling will drastically improve the odds.

What medications can help?

While nicotine is responsible for the addictive qualities of cigarettes, there are thousands of chemicals in smoke. A large number of these, including formaldehyde, arsenic, and benzene have been linked to cancer.

Most medications help by reducing the craving for nicotine.

Currently, there are three FDA-approved products for smoking cessation: nicotine replacement products, sustained-release bupropion (Zyban), and varenicline (Chantix).

Nicotine replacement

Found over the counter in inhaler, spray, gum, patch, and lozenge forms, these agents act directly on nicotine receptors in the body. They replace the nicotine inhaled (along with those other toxins) in tobacco form.

Which product to choose?

This is mostly patient preference. However, the best results may come from combining the transdermal patch, which releases nicotine slowly over 24 hours, with a rapid-acting product such as the spray, gum, or lozenge when cravings hit.

Remember, nicotine gum is not chewed in the traditional sense. Users are instructed to bite down once and then place the piece of gum between the cheek and teeth and leave it there. A mild tingling sensation is proof that the nicotine is releasing.

Choosing the correct strength will depend on the number of cigarettes smoked per day. The product packaging should contain a guide, but if in doubt, consult with a pharmacist.

Zyban (sustained-release bupropion) and Chantix (varenicline)

These agents are available by prescription only.

Zyban was originally used as an antidepressant. Curiously, patients who took bupropion would often independently quit smoking. It was later discovered that the drug increased the neurotransmitters dopamine and norepinephrine in the brain the same way nicotine would.

Zyban is dosed at 300 mg per day for 7 to 12 weeks, but there is the possibility that up to 24 weeks would be required.

Common side effects include insomnia, dry mouth, dizziness, anxiety, and nausea.

Chantix works by preventing nicotine from stimulating dopamine receptors in the brain. By acting on dopamine itself, the drug replaces nicotine, but to a lesser degree, resulting in fewer cravings and withdrawal symptoms.

Chantix has a slight edge over bupropion, with 2mg dosing per day being effective after 12 weeks. Patients who completed the course were less likely to relapse than with Zyban.

However, patients who used either option for at least 45 days showed no difference and were the most successful at smoking cessation.

Side effects of Chantix tend to be milder and include nausea, vivid dreams, headache, and insomnia.

What if I can’t quit while taking Zyban or Chantix? Is it dangerous to keep smoking?

Chantix specifically outlines a schedule for smokers having difficulty quitting while on the medication. Recommendations are to start one week before the quit date. Then reduce smoking by half the daily amount for the first four weeks. Over the next four weeks, cut the amount by half again.

The recommendation for Zyban is to stop smoking after two weeks on the medication.

Nicotine replacement therapy may also be used with Zyban or Chantix.

What other therapies can help?

Along with smoking cessation products, counseling has proven effective. An individual plan should be drawn up for each patient desiring to quit, beginning with that person’s reason for quitting.

Remember, multiple attempts and a combination of medications may be needed. Above all, don’t be shy about asking for help.

ImageMartin Büdenbender/Pixabay

The best time to quit is now. Start now.

S: Set a quit date.
T: Tell family, friends, and others around you that you plan to quit.
A: Anticipate or plan ahead for the difficulties you’ll face while quitting.
R: Remove cigarettes and other tobacco products from your home, car, and workplace.
T: Talk to your doctor about getting help to quit.

It’s never been so critical.


Medika Life has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by Medika Life

Jennifer Mittler-Lee B.S. Pharma
Jennifer Mittler-Lee B.S. Pharma

I am a pharmacist with over 20 years in the industry. I have worked both retail and hospital and have been known to frequent the nightshift. As a pharmacist, I see how medical jargon confuses people. I like to write healthcare articles in a casual manner in order to connect. Find me on Medium @jrmittle

Jennifer Mittler-Lee

B.S. Pharma

I am a pharmacist with over 20 years in the industry. I have worked both retail and hospital and have been known to frequent the night shift. As a pharmacist, I see how medical jargon confuses people. I like to write healthcare articles in a casual manner in order to connect.





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