The Effects of Smoking on the Lungs
Aside from cancers of the ororespiratory tract, death is caused, primarily, by tobacco smokers being predisposed to chronic obstructive pulmonary disease (COPD), which is the more commonly used umbrella term for chronic bronchitis and emphysema.
COPD is characterised by poorly reversible airflow obstruction and a continuous, exaggerated inflammatory response in the lungs, which is due to the toxic, irritant chemicals of smoking [3, 4, 5]. With time, this inflammatory response causes damaging changes in the lungs, both of a structural and physiological nature. The airways constrict and narrow due to smooth muscle hypertrophy and fibrosis in the bronchioles, which in turn, leads to mucus hypersecretion and cilia dysfunction [4, 5]. The latter two changes make clearing the lungs, hence breathing, very difficult. In addition to this, the alveolar walls are destroyed rendering the lungs less elastic, leading to collapsed airways during expiration, then air trapping and lung hyperinflation [3, 4, 5].
The typical symptoms of COPD are therefore characterised as a productive cough, wheezing and breathlessness that is worse in the mornings. As life goes on, the breathlessness becomes marked and can be debilitating for patients, significantly reducing their quality of life. Patients who develop the disease severely, need home oxygen and often cannot walk ten metres without the oxygen mask.
COPD is primarily managed with lifelong inhalers. Mucolytic capsules are also necessary for some patients. As the disease progresses, long term oxygen therapy may also become a necessity.
Nicotine Replacement Therapy (NRT)
NRT can be used to reduce the withdrawal symptoms that occur when one stops smoking. The aim is to deter the person from having another cigarette, hence lessening the harmful effects of tobacco, by replacing nicotine in another form. A large scale multi-trial review  has found that NRT evidently provides a huge benefit to people who are trying to quit smoking; the rate of quitting smoking was increased by 50 – 70% when NRT was used, regardless of the situation .
There are many different forms of NRT: slow release trans-dermal patches (providing background systemic levels of nicotine), and more fast acting dosage forms such as the gum, nasal spray, oral spray, sublingual lozenges / tablets and the inhalator. Faster acting preparations are used to suppress cravings or whenever the urge to smoke occurs. It is interesting to note that no difference of effectiveness between the different dosage forms was found . However, it was found that using the slow acting patch in combination with a faster acting form was of benefit to achieve success in quitting . Behavioural support and monitoring through regular contact with healthcare professionals, however, is thought to largely contribute to overall success .
Advice on NRT Preparations
Use the following flow chart as a guide to quitting smoking. Please ask your local pharmacist / doctor for further advice on availability of preparation, pricing and personal specifications.
The British National Formulary 66 has been used as a source of information when compiling this flow chart.