Makindo Medical Notes

🚭 Smoking itself is not a disease, but it is a leading cause of preventable morbidity and mortality. Helping motivated patients quit is one of the most effective interventions in medicine. ⚠️ Markers of severe nicotine dependence: smoking within 30 min of waking + >25 cigarettes/day.

🩸 Pathology Caused or Worsened by Smoking

• 🧬 Cancers: Lung, stomach, oral cavity, larynx, colon, bladder, oesophagus, pancreas.
• 🫀 Vascular: Malignant hypertension, subarachnoid haemorrhage (ruptured Berry aneurysm), Buerger’s disease, AAA, ↑ VTE risk (esp. on OCP), atherosclerotic PVD.
• 🍽 Gastrointestinal: Thrombosis, dyspepsia, peptic ulcer disease.
• 🌬 Pulmonary: Worsens COPD, asthma control, Goodpasture’s alveolar haemorrhage, ↑ lung cancer risk, severe varicella pneumonia.
• 🦋 Endocrine: Exacerbates thyroid eye disease in Graves’ disease.
• 🤰 Pregnancy: IUGR, perinatal morbidity & mortality.
• 🧠 Neurology: May worsen multiple sclerosis severity.

📉 Conditions Less Common / Less Severe in Smokers

• Osteoporosis
• Parkinson’s disease
• Ulcerative colitis
• COVID-19 pneumonia (controversial; not a reason to smoke)

💊 Therapies for Smoking Cessation

• 🌱 Complementary: Hypnotherapy, acupuncture (variable evidence).
• 🩹 Nicotine Replacement Therapy (NRT): Gum, inhalers, sprays, patches, lozenges. Widely available on the NHS. Avoid immediately post-MI, stroke, or in severe arrhythmias.
• 💊 Bupropion SR (Zyban): NA/DA reuptake inhibitor. Contraindicated in epilepsy, bipolar disorder, pregnancy, breastfeeding. Start 1 week pre-quit, continue 2–3 months. Can combine with patch.
• Other options (not listed above): Varenicline (Champix) – partial nicotinic agonist, effective but watch mood changes. Often 1st-line alongside NRT in UK practice.

😖 Nicotine Withdrawal

• Cravings, irritability, restlessness, anxiety.
• ↑ appetite, poor concentration.
• Most symptoms resolve by ~30 days.
• Weight gain: ~2–4 kg is common.

🩺 General Approach (UK Context)

• Stopping smoking at any age reduces risk → “never too late.”
• Encourage smoke-free homes 🚭🏠 and involve family/partners.
• NRT and cessation support available via the NHS; refer to local stop-smoking services.
• Use caution with NRT in arrhythmias/AF patients – tailor therapy.
• Follow NICE + local protocols: behavioural + pharmacological support is most effective.

📚 References

• NICE COPD Guidelines
• NICE NG92: Stop Smoking Interventions

💡 Teaching Pearl: Always ask about smoking status at every consultation – brief advice (“Very Brief Advice” model: Ask, Advise, Act) is proven to increase quit rates.