This is “Healthy Conversations,” a podcast presented by Adventist Health.

Prakash Chandran (Host):  You’ve smoked for years. You know it’s not good for you. But it’s just really hard to quit. Stopping isn’t easy but today we’ll cover why it’s so important that you try and cover some helpful tips about the most effective ways to do so. We’re going to talk about it today with Pulmonologist Dr. Ross Michel.

This is Healthy Conversations, I’m Prakash Chandran. So, Dr. Michel, I think we all know that smoking is bad for us but exactly how big of a problem is it in the United States?

Ross Michel, MD (Guest):  Yeah, thanks for asking. Tobacco use is the leading preventable cause of death in the United States. Cigarette smoking causes about one out of every five deaths in the US each year which is more than 480,000 deaths annually. Worldwide, cigarette smoking causes six million deaths per year. So, it is a huge problem. 

Host:  I can’t even believe that the number is that large. And just to get into the specifics, when you say the leading cause of death; are we talking about cancer? I’m curious as to what causes the smoking-related deaths.

Dr. Michel:  Absolutely. The number one cause of smoking-related death is lung cancer followed by cardiovascular disease like heart attacks and respiratory illnesses such as chronic obstructive pulmonary disease or COPD. There are other related cancers that can be caused by smoking like oral cancer, throat cancer, esophageal cancer, pancreatic cancer, bladder cancer and others that all contribute significantly to the death toll. 

Host:  Yeah and it’s safe to probably say that tobacco or smoking tobacco is directly related to developing lung cancer. Is that correct?

Dr. Michel:  That is an accurate statement. The relative risk of lung cancer in long-term smokers is anywhere from 10 to 30 times that of lifelong nonsmokers. The risk of lung cancer increases with both the number of cigarettes smoked per day as well as with the number of years smoked total. The age that person started smoking, the nicotine and tar contents of cigarettes used, and the use of unfiltered cigarettes are all bad risk factors in development of lung cancer in people that do smoke. 

Host:  Yeah and the crazy thing is, I have a lot of these conversations with medical professionals and every time I ask them for what the prevention mechanisms are for whatever we are talking about; almost uniformly they say stop smoking. So, it’s not even related to just the lung cancer that we’re talking about. It’s pretty much related to everything. Is that safe to say?

Dr. Michel:  I’d say that’s an accurate statement. When people smoke, they just have such a high relative risk of problems like lung cancer anywhere 10 to 30 times that of lifelong nonsmokers so, stopping smoking just has huge health benefits. 

Host:  So, let’s dig into those benefits a little bit. I’ve heard that your breathing will immediately become better within a year of you quitting smoking. But maybe talk to some of the other benefits beyond that. 

Dr. Michel:  Absolutely. In general, when a patient quits smoking, they start to breathe better and have an easier time being physically active and that can actually happen pretty quickly within a matter of weeks. Risk for heart attack drops sharply just after a year of being off cigarettes. After two to five years, the risk for stroke plummets to about the same as a nonsmoker. And within five years of quitting, the chance of cancer of the mouth, throat, esophagus and bladder gets cut in half. People can really start to see those benefits pretty quickly although another big benefit people see is to their wallets. Quitting smoking usually saves people a ton of money. 

Host:  So, let’s talk about how you stop smoking. I have so many friends that picked this habit up in high school usually for social reasons but now they are addicted and no matter how many times they’ve tried; it seems like they just can’t quit. So, I’m curious as to what measures you’ve seen work and just what’s available in general to people trying to quit.

Dr. Michel:  Well, there are a lot of things that can help people quit. The first thing is a smoker has to decide that he or she wants to quit. It’s really helpful when people recognize that they need to quit for the health and the health of those around them before they try using any medicines. Once they’ve come to that realization and they are properly motivated; medicines like Chantix, Wellbutrin, and nicotine replacement can help people stop using cigarettes. 

I usually like to have my patients set a quit date and have a plan to combat cravings, support from family members, friends, former smokers and healthcare providers can also give patients an excellent chance to become and to remain smoke-free. 

Host:  Yeah, that sounds great and just talking about some of the nicotine replacement stuff that you covered; what exactly does that look like? Is that the patch? Is there another sort of therapy that people can use?

Dr. Michel:  Nicotine replacement can come in lots of forms. Some people use a patch. I tend to use patch plus therapy, a nicotine patch plus either a nicotine gum or a Nicotrol inhaler. Nicotine replacement therapy itself really helps to relieve the symptoms of nicotine withdrawal when the smoking is stopped. Nicotine replacement can have some side effects but overall, we do feel that the benefits outweigh the risks and that nicotine replacement therapy has been shown to be a safe and effective way to get people to stop smoking. 

Host:  Speaking of nicotine replacement, or another alternative; we’ve been hearing a lot about vaping and I’d love to hear your thoughts around vaping or E-cigarettes and if that’s actually a safe alternative to smoking tobacco.

Dr. Michel:  Well the short answer to that nowadays seems like it’s no. We still don’t understand all the toxicities of vaping or E-cigarette use. But it has become clear that there are some intense, adverse effects of vaping. This year, 2019, the CDC reported over 1000 cases of suspected severe lung illnesses called evali, E-V-A-L-I or E-cigarette or vaping associated lung injury. The most common symptoms of this lung injury are fatigue, shortness of breath, fever, chest pain, weightloss. Some patients required ventilator support and there has been a case of a lung transplant associated from vaping. There have been multiple deaths from vaping. So, overall, we don’t recommend it as a safer alternative to smoking. 

Host:  Yeah, that’s really good to know because especially some of these bigger vape brands, they advertise it as a way to wean yourself off of cigarettes. They claim that it doesn’t have the carcinogens or toxins that you get from smoking an actual cigarette but as you mentioned, there are so many other side effects to vaping and we don’t even know all the details about what else is going to be coming down the pike, that it’s better to just avoid it all together. Would you say that that’s your recommendation?

Dr. Michel:  I’d say that’s absolutely right. That would be my recommendation. Most of the patients that have the lung injury from vaping was associated with THC or the active ingredient in marijuana but some of the patients were just inhaling nicotine alone. Vaping has been found to be associated with idiopathic eosinophilic pneumonia and you’re right, we really don’t know exactly what’s causing all the problems from E-cigarettes. Some people think that it’s the vitamin E or other chemicals. There are other kinds of – lots of other kinds of carcinogens or cancer causing compounds that have been found in E-cigarettes in trace levels. So, a lot of studies are ongoing, but the general consensus is we don’t recommend it as an alternative to smoking at this time. 

Host:  Yeah, that’s really good to know. So, let’s say that there are smokers listening to this and they want to get started on their journey to quit smoking. What resources are available that you would recommend to help them?

Dr. Michel:  Well thanks for asking. There are a ton of resources out there for smokers who want to quit. The California Smokers Helpline is 1-800-NOBUTTS. That’s N-O-B-U-T-T-S. It provides smoking cessation, telephone counseling free of charge to California residents. There is also a website associated with www.nobutts.org where patients can go get counseling, free self-help materials, quitting tips and links to other resources. There are also resources associated with the American Lung Association at www.lung.org. There is www.smokefree.gov which is the National Cancer Institute’s smoking cessation website. And you can even go to the American Cancer Society website at www.cancer.org. So, there are a lot of things out there, a lot of resources for folks to help them stop smoking. 

Host:  That’s awesome. It’s so great that there are so many resources out there. I’m curious as to if you have a friend or a family member that is addicted to cigarettes and they are smoking everyday and you are trying to be supportive to help them quit; what advice might he have for them?

Dr. Michel:  I think that it’s a great question. Just trying to be straightforward with your friend or family member about the risks to their health and also the risks to others around them is a good place to start. Offering them your support and letting them know that you care about them and you want them to be off cigarettes to have them live a healthier, longer life is always a good way to start. 

Host:  So, just in wrapping up here; as a pulmonologist, I imagine that you are seeing smokers at a time when things have gotten really bad. So, do you have any parting words of advice or wisdom that you can share with them that they should understand before things get to that level?

Dr. Michel:  Well we see the effects of cigarette smoke everyday in our office and it can be devastating for patients and their families. Lung cancer, COPD, oxygen use, people ending up on ventilators. We just try to spare people that misery by counseling them early on to get off cigarettes if they can and avoiding those problems down the road. 

Host:  Absolutely. Well Dr. Michel, I really appreciate your time today and your insight. That’s Pulmonologist Dr. Ross Michel. Thanks for checking out this episode of Healthy Conversations and we’d love to know what you thought of this episode. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations.  Thanks and we’ll talk next time. 

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