SMOKING cessation is difficult, and it is estimated the patients who attempt to stop without professional medical help succeed approximately three to five per cent of the time.

This success rate can rise to 35-55 per cent with the use of smoking cessation clinics that provide medical and psychological support. In the primary care clinics where most of our patients are seen, the success rates are lower with some studies suggesting a success rate of 11 per cent at nine months.

This is an improvement over patients who attempt to stop smoking on their own but suggests a significant need for improvement in the primary care arena. An important point for patients to remember is that trying and failing is the norm. The Center for Disease Control in the United States suggests that patients can expect to have eight to 11 attempts before stopping successfully. A research paper in 2016 in the British Medical Journal found that for some smokers up to 30 attempts were required.

Most physicians suggest that patients attempt to stop smoking abruptly as most studies suggest that people who set a quit date and stop smoking on that day have higher success rates than those who try to gradually decrease the number of cigarettes smoked over time. We encourage patient to pick a quit date that has some meaning for example, a birthday or a wedding anniversary. It is important that this date be not too far in the future and that the smoker informs his friends and family that he will not be smoking after that date. On the quit date the patient should throw away all cigarettes and smoking related paraphernalia.

Attempts should be made to avoid the situations that had been previously associated with smoking behaviours. This could be drinking with friends in the bar or starting the day by sitting outside and smoking. The patient should attempt to avoid cigarette smoke and smokers. The use of behaviours to take the place of the cigarette can be helpful. This could include chewing gum or sucking candy or eating low calorie vegetables such as carrots or celery. Emotional and psychological support is important as well with the highest success rates being seen in patients who have access to formal programmes where professional counselling is available. Support in less formal settings can be obtained from family and friends, medical personnel in the primary care office, churches, or community organisations.

The use of nicotine replacement therapy has been shown to increase the quit rate by about 50 per cent, while Chantix and Bupropion have been shown to improve quit rates by 30-40 per cent and 20 per cent, respectively. The use of e-cigarettes is somewhat controversial. They have been shown to double the chance that a patient will stop using cigarettes but there is limited long-term data on the safety of these devices. Many physicians, however, believe that given the absence of the chemicals produced during combustion of the tobacco leaf, they are safer than regular cigarettes. Other therapies such as hypnosis and acupuncture have limited data but have been found to be helpful for some patients.

Given its impact on health the best approach is to never start to smoke cigarettes. Smoking cessation remains very challenging with relatively poor success rates, however many of our patient have achieved success and our best advice to current smokers is to keep trying.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107.