Smoking and COVID-19.

Did you know? Smoking increases your risk of developing serious illness due to COVID-19. Now is the perfect time to become smoke-free!

Author: Amy Zhao, PharmD. Reviewed by King Chen, PharmD.

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Currently, about 12% or 3.7 million Canadians smoke cigarettes. Smoking is one of the leading causes of early death in Canada, resulting in 100 deaths per day due to smoking-related illnesses such as heart disease, lung disease and cancer. In addition to damaging the health of the smoker, second-hand smoke can also increase the risk of heart and lung problems, lung cancer, and breathing problems in anyone who is breathing in the second-hand smoke. Second-hand smoke by itself causes more than 800 deaths in Canada each year!

Given how damaging smoking is to our health, smoking cessation is one of the best health choices you can make to improve your health. In fact, the benefits of smoking cessation are seen almost immediately!

· 20 minutes after your last cigarette, your blood pressure drops

· 24 hours after quitting, the risk of heart attack starts to drop

· 5 years after quitting, your chance of having a stroke is the same as a non-smoker

· 10 years after stopping, the chance of dying from cancer decreases by 50%

Managing Withdrawal Symptoms

Tobacco smoke contains over 4000 types of chemicals with more than 70 that are known to cause cancer. However, the most addicting chemical found in the cigarattes is nicotine. When you breathe in nicotine, it travels quickly from your lungs to your brain to make you feel alert and more energized. However, over time, the body becomes dependent on the nicotine and smokers experience withdrawal symptoms when smokers try to stop smoking. This can make smoking cessation difficult. Sometimes withdrawal symptoms can be difficult to manage if you are not prepared for them. However, most withdrawal symptoms peak within the first 72 hours and usually only last 2-4 weeks. See the table below for a list of different withdrawal symptoms and tips for managing them.

In addition to the withdrawal management tips above, nicotine replacement therapy (available in pharmacies without a prescription) and prescription medications (varenicline and bupropion) can help manage withdrawal symptoms and increase the chance of successfully quitting smoking.

Nicotine Replacement Therapy (NRT)

Nicotine replacement therapy helps to manage withdrawal symptoms and cravings by providing the brain with nicotine without the other harmful chemicals found in cigarettes. Using NRT can increase the chance of successfully quitting by at least 50%! There are two types of NRT products: long-acting and short-acting. In many cases, if you are an occasional smoker, short-acting NRT products may be enough to manage withdrawal symptoms and cravings. Short-acting NRT products include: nicotine gum, lozenges, inhaler and mouth spray. Heavy smokers may require long-acting NRT to provide a steady source of nicotine to manage withdrawal symptoms and a short-acting NRT product to manage cravings. The only long-acting NRT product currently available is the nicotine patch which is available in different strengths. The number of cigarettes you smoke per day will help determine which patch strength you should start with. Gradually, the dosage of nicotine patch and the frequency of using the short-acting NRT products are decreased until you no longer require them.

Prescription Smoking Cessation Products

Varenicline and bupropion are two prescription medications that are taken every day by mouth to increase the chance of successfully quitting. These medications do not contain nicotine – instead, they act in the brain to reduce the effects and pleasure of nicotine to lessen cravings. Bupropion is as effective as NRT for smoking cessation but varenicline is more effective than bupropion or NRT. Sometimes, combining two types of products, for example NRT and bupropion, may be needed.

E-Cigarettes & Vaping

E-cigarettes are devices that heat up a liquid into fine mist which is then inhaled or vaped. The liquid that is used for vaping usually contains flavouring agents, nicotine and other chemicals. In general, vaping is considered a safer way of inhaling nicotine than smoking because there are fewer harmful chemicals in the vaping mist than in cigarette smoke. However, there have been cases of vaping-associated lung illnesses and the long-term effects of inhaling the other chemicals found in the vaping liquid are unknown. Vaping can also increase the risk of heart attack. Although there currently is not enough evidence to recommend using e-cigarettes as a tool for smoking cessation, for individuals that cannot stop using nicotine, vaping is considered less harmful than smoking.

Resources for Smoking Cessation

There are many free resources and services that are available (specifically in Ontario) to help with you with your journey towards becoming smoke-free. Some include:

1. Your Healthcare Team

o Your primary care provider can answer questions you may have regarding smoking cessation and may offer counselling support. They can also help determine if prescription smoking cessation aids may be appropriate for you.

o Your pharmacist can answer questions you have about NRT and medications used for smoking cessation. Many also offer smoking cessation support and they may also be able to prescribe smoking cessation medications.

2. Center for Addiction and Mental Health (CAMH) https://www.nicotinedependenceclinic.com/en

o CAMH offers the Smoking Treatment for Ontario Patients (STOP) program through different health organizations in Ontario to provide counselling support and free nicotine replacement therapy

o The STOP program is currently also offered online due to COVID-19

o This program is available to Ontario residents 18 years of age and older that are currently smoking. To enrol, contact your local partnering organization (for a list, see the QuitMap below)

3. Telehealth Ontario Smoking Cessation Program (1-866-797-0000)

o Smoking Cessation Coaches can you provide 24/7 telephone support through the different stages of smoking cessation from thinking about quitting to staying smoke-free

o This service has translator services for over 100 languages

For a list of available services near you, you can visit the QuitMap from Smokershelpline.ca (https://csl.cancer.ca/smokershelpline/en)