12 hours after quitting: The carbon monoxide level in your blood drops to normal.
(US Surgeon General's Report, 1988, p. 202)

2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.
(US Surgeon General's Report, 1990, pp.193, 194,196, 285, 323)

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1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
(US Surgeon General's Report, 1990, pp. 285-287, 304)

1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.
(US Surgeon General's Report, 1990, p. vi)

5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
(US Surgeon General's Report, 1990, p. vi)

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10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease.
(US Surgeon General's Report, 1990, pp. vi, 131, 148, 152, 155, 164,166)

15 years after quitting: The risk of coronary heart disease is that of a non-smoker's.
(US Surgeon General's Report, 1990, p. vi)

Last Medical Review: 10/22/2008
Last Revised: 10/22/2008

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Use our calculator to see how much cigarettes cost you.

     Follow the Link to use the Calculator.....


http://www.cancer.org/docroot/PED/ped_10_CigCostCalc.asp?sitearea=PED

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What is secondhand smoke?

Secondhand smoke is also known as environmental tobacco smoke (ET or passive smoke. It is a mixture of 2 forms of smoke that comes from burning tobacco:

• sidestream smoke: smoke that comes from the end of a lighted cigarette, pipe, or cigar

• mainstream smoke: smoke that is exhaled by a smoker

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When non-smokers are exposed to secondhand smoke it is called involuntary smoking or passive smoking. Non-smokers who breathe in secondhand smoke take in nicotine and other toxic chemicals just like smokers do. The more secondhand smoke you are exposed to, the higher the level of these harmful chemicals in your body.

Why is secondhand smoke a problem?

Secondhand smoke causes cancer

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Secondhand smoke is classified as a "known human carcinogen" (cancer-causing agent) by the US Environmental Protection Agency (EPA), the US National Toxicology Program, and the International Agency for Research on Cancer (IARC), a branch of the World Health Organization.

Tobacco smoke contains over 4,000 chemical compounds. More than 60 of these are known or suspected to cause cancer.

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Secondhand smoke causes other kinds of diseases and deaths

Secondhand smoke can cause harm in many ways. In the United States alone, each year it is responsible for:

• an estimated 46,000 deaths from heart disease in non-smokers who live with smokers

• about 3,400 lung cancer deaths in non-smoking adults

• other breathing problems in non-smokers, including coughing, mucus, chest discomfort, and reduced lung function

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• 
  
• 150,000 to 300,000 lung infections (such as pneumonia and bronchitis) in children younger than 18 months of age, which result in 7,500 to 15,000 hospitalizations annually

• increases in the number and severity of asthma attacks in about 200,000 to 1 million children who have asthma

• more than 750,000 middle ear infections in children

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Pregnant women exposed to secondhand smoke are also at increased risk of having low birth weight babies.

Secondhand smoke may be linked to breast cancer

An issue that is still being studied is whether secondhand smoke may increase the risk of breast cancer. Both mainstream and secondhand smoke contain about 20 chemicals that, in high concentrations, cause breast cancer in rodents. And we know that in humans, chemicals from tobacco smoke reach breast tissue and are found in breast milk.

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Any link between secondhand smoke and breast cancer risk in human studies is still being debated. This is partly because breast cancer risk has not been shown to be increased in active smokers. One possible explanation for this is that tobacco smoke may have different effects on breast cancer risk in smokers and in those who are exposed to secondhand smoke.

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Secondhand smoke kills children and adults who don't smoke, and makes others sick (Surgeon General's report)

The 2006 US Surgeon General's report reached some important conclusions:

• Secondhand smoke causes premature death and disease in children and in adults who do not smoke.

Children exposed to secondhand smoke are at an increased risk of sudden infant death syndrome (SID, acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes breathing (respiratory) symptoms and slows lung growth in their children.

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• Secondhand smoke immediately affects the heart and blood circulation in a harmful way. Over a longer time it also causes heart disease and lung cancer.

• The scientific evidence shows that there is no safe level of exposure to secondhand smoke.

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• The only way to fully protect non-smokers from exposure to secondhand smoke indoors is to prevent all smoking in that indoor space or building. Separating smokers from non-smokers, cleaning the air, and ventilating buildings cannot keep non-smokers from being exposed to secondhand smoke.

Where is secondhand smoke a problem?

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At work

The workplace is a major source of secondhand smoke exposure for adults. Secondhand smoke meets the standard to be classified as a potential cancer-causing agent by the Occupational Safety and Health Administration (OSHA), the federal agency responsible for health and safety regulations in the workplace. The National Institute for Occupational Safety and Health (NIOSH), another federal agency, also recommends that secondhand smoke be considered a possible carcinogen in the workplace. Because there are no known safe levels, they recommend that exposures to secondhand smoke be reduced to the lowest possible levels.

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In public places

Everyone can be exposed to secondhand smoke in public places, such as restaurants, shopping centers, public transportation, schools, and daycare centers. Some businesses seem to be afraid to ban smoking, but there is no proof that going smoke-free is bad for business. Public places where children go are a special area of concern.

At home

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Children are especially sensitive to secondhand smoke. Asthma, lung infections, and ear infections are more common in children who are around smokers. Some of these problems can be serious and even life-threatening. Others may seem like small problems, but they add up quickly: think of the expenses, doctor visits, medicines, lost school time, and often lost work time for the parent who must take the child to the doctor. In the United States, 21 million, or 35% of children live in homes where residents or visitors smoke in the home on a regular basis. About 50% to 75% of children in the U.S. have detectable levels of cotinine, the breakdown product of nicotine, in their blood.

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In the car

Americans spend a great deal of time in cars, and if someone smokes there, hazardous levels of smoke can build up quickly. Again, this can be especially harmful to children. In response to this fact, the U.S. Environmental Protection Agency has a special program to encourage people to make their cars, as well as their homes, smoke-free. And some states have laws that ban smoking in the car if carrying passengers under the age of 17.

What about smoking odors?

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What can be done about secondhand smoke?

Local, state, and federal authorities can enact public policies to protect people from secondhand smoke and protect children from tobacco-caused diseases and addiction. Because there are no safe levels of secondhand smoke, it is important that any such policies be as strong as possible, and that they do not prevent action at other levels of government.

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To learn how you can become involved in helping to promote laws to reduce exposure to secondhand smoke, you can visit the American Cancer Society Cancer Action Network on the Web at www.acscan.org and see what's happening across the country. The Web site can also take you to your state's page so you can find out what is going on there. Or you can call ACS CAN at 1-888-NOW I CAN (1-888-669-4226).

Additional resources

More information from your American Cancer Society

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Guide to Quitting Smoking

What do I need to know about quitting?

The U.S. Surgeon General has said, "Smoking cessation (stopping smoking) represents the single most important step that smokers can take to enhance the length and quality of their lives."

Quitting smoking is not easy, but you can do it. To have the best chance of quitting and staying quit, you need to know what you’re up against, what your options are, and where to go for help. You'll find this information here.

Why is it so hard to quit smoking?

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Nicotine

Nicotine is a drug found naturally in tobacco. It is as addictive as heroin or cocaine. Over time, a person becomes physically and emotionally addicted to (dependent on) nicotine. Studies have shown that smokers must deal with both the physical and psychological (mental) dependence to quit and stay quit.

How nicotine gets in, where it goes, and how long it stays

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Different factors affect how long it takes the body to remove nicotine and its by-products. In most cases, regular smokers will still have nicotine or its by-products, such as cotinine, in their bodies for about 3 to 4 days after stopping.

How nicotine hooks smokers

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After a while, the smoker develops a tolerance to the drug. Tolerance means that it takes more nicotine to get the same effect that the smoker used to get from smaller amounts. This leads to an increase in smoking over time. The smoker reaches a certain nicotine level and then keeps smoking to maintain this level of nicotine.

Nicotine withdrawal symptoms can lead quitters back to smoking

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Those who have smoked regularly for a few weeks or longer, and suddenly stop using tobacco or greatly reduce the amount smoked, will have withdrawal symptoms. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later when most of the nicotine and its by-products are out of the body. Withdrawal symptoms can last for a few days to up to several weeks. They will get better every day that you stay smoke-free.

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• dizziness (which may only last 1 to 2 days after quitting)
• depression
• feelings of frustration, impatience, and anger
• anxiety
• irritability
• sleep disturbances, including having trouble falling asleep and staying asleep, and having bad dreams or even nightmares
• trouble concentrating
• restlessness or boredom
• headaches
• tiredness
• increased appetite
• weight gain
• constipation and gas
• cough, dry mouth, sore throat, and nasal drip
• chest tightness

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These symptoms can lead the smoker to start smoking cigarettes again to boost blood levels of nicotine back to a level where there are no symptoms. (For information on coping with withdrawal, see the section, "How to quit.")

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Why should I quit?

Your health

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Cancer

Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer too, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemias.

Lung diseases

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Heart attacks, strokes, and blood vessel diseases

Smokers are twice as likely to die from heart attacks as are non-smokers. And smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles. Smoking also affects the walls of the vessels that carry blood to the brain (carotid arteries), which can cause strokes. Men who smoke are more likely to develop erectile dysfunction (impotence) because of blood vessel disease.

Blindness and other problems

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Special risks to women and babies

Women have some unique risks linked to smoking. Women over 35 who smoke and use birth control pills have a higher risk of heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to miscarry (lose the baby) or have a lower birth-weight baby. And low birth-weight babies are more likely to die, or have learning and physical problems.

Years of life lost due to smoking

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Why quit now?

No matter how old you are or how long you've smoked, quitting can help you live longer and be healthier. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who keep smoking. Ex-smokers enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health, and reduced rates of bronchitis and pneumonia.

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• Quitting smoking has major and immediate health benefits for men and women of all ages. These benefits apply to people who already have smoking-related disease and those who don't.

• Ex-smokers live longer than people who keep smoking.

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• Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth-weight baby to that of women who never smoked.

• The health benefits of quitting smoking are far greater than any risks from the small weight gain (usually less than 10 pounds) or any emotional or psychological problems that may follow quitting.

When smokers quit -- What are the benefits over time?

20 minutes after quitting: Your heart rate and blood pressure drops.

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12 hours after quitting: The carbon monoxide level in your blood drops to normal.

(U.S. Surgeon General's Report, 1988, p. 202)

2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.

(U.S. Surgeon General's Report, 1990, pp. 193, 194, 196, 285, 323)

1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.

(U.S. Surgeon General's Report, 1990, pp. 285-287, 304)

1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.

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5 years after quitting: Your stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting.

(U.S. Surgeon General's Report, 1990, p. vi)

10 years after quitting: The lung cancer death rate is about half that of a person who continues smoking. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease, too.

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(U.S. Surgeon General's Report, 1990, p. vi)

Immediate rewards of quitting

Kicking the tobacco habit offers some benefits that you'll notice right away and some that will develop over time. These rewards can improve your day-to-day life a great deal:

• your breath smells better

• stained teeth get whiter

• bad smelling clothes and hair go away

• your yellow fingers and fingernails disappear

• food tastes better

• your sense of smell returns to normal

• everyday activities no longer leave you out of breath (such as climbing stairs or light housework)

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Cost

The prospect of better health is a major reason for quitting, but there are other reasons, too. Smoking is expensive. It isn't hard to figure out how much you spend on smoking: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been using tobacco and that amount will probably shock you.

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And this doesn't include other possible costs, such as higher costs for health and life insurance, and likely health care costs due to tobacco-related problems.

Social acceptance

Smoking is less socially acceptable now than ever.

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Landlords may choose not to rent to smokers since maintenance costs and insurance rates may rise when smokers live in buildings.

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Smokers may also find their prospects for dating or romantic involvement, including marriage, are largely limited to other smokers, who make up less than 20% of the adult population.

Health of others

Smoking not only harms your health but it hurts the health of those around you. Exposure to secondhand smoke (also called environmental tobacco smoke or passive smoking) includes exhaled smoke as well as smoke from burning cigarettes.

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If a mother smokes, there is a higher risk of her baby developing asthma in childhood, especially if she smoked while she was pregnant. Smoking is also linked to sudden infant death syndrome (SID and low-birth weight infants. Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis, and other lung and breathing problems than children in non-smoking families. Secondhand smoke can also cause eye irritation, headaches, nausea, and dizziness.

Setting an example

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Help is available

There are a wide range of counseling services, self-help materials, and medicines available today, so smokers have more tools than ever to help them quit smoking for good.

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Help with the mental part of addiction

Some people are able to quit on their own, without the help of others or the use of medicines. But for many smokers, it can be hard to break the social and emotional ties to smoking while getting over nicotine withdrawal symptoms at the same time. Fortunately, there are many sources of support out there -- both formal and informal.

Telephone-based help to stop smoking

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Telephone counseling is also easier to use than some other support programs. It doesn't require driving, transportation, or child care, and it's available nights and weekends.

Counselors may suggest a combination of methods including medicines, local classes, self-help brochures, and/or a network of family and friends.

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Support of family, friends, and quit programs

Many former smokers say a support network of family and friends was very important during their quit attempt. Other people who may offer support and encouragement are co-workers and your family doctor. Try to spend time with non-smokers and ex-smokers who support your efforts to quit.

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What to look for in a stop smoking program

Stop smoking programs are designed to help smokers recognize and cope with problems that come up during quitting. They also provide support and encouragement in staying quit. Studies have shown that the best programs will include either one-on-one or group counseling. There is a strong link between how often and how long counseling lasts (its intensity) and the success rate. Overall, the more intense the program, the greater the chance of success.

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• each session lasts at least 15 to 30 minutes

• there are at least 4 sessions

• the program lasts at least 2 weeks -- longer is usually better

Make sure the leader of the group has training in smoking cessation.

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Often your local American Cancer Society, American Lung Association, or your local health department will sponsor quit smoking classes, too. Call us for more information.

There are also some programs to watch out for. Not all programs are ethical. Think twice about any programs that:

• promise instant, easy success with no effort on your part

• use shots (injections) or pills, especially "secret" ingredients

• charge a very high fee -- check with the Better Business Bureau if you have doubts

• are not willing to give you references from people who have used the program

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Help with the physical part of addiction: Nicotine replacement therapy and other medicines

Nicotine replacement therapy

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How nicotine replacement works

Nicotine replacement therapy (NRT) can help with the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. Using NRT reduces a smoker's withdrawal symptoms.

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Lack of success is often related to the onset of withdrawal symptoms. And most quitters go back to smoking within the first 3 months of quitting. So don't be discouraged if you start smoking again. Just try to stop again and make your attempt more successful by adding another method or technique to help you quit. You can reduce withdrawal symptoms with NRT and reduce their impact with support techniques. This gives you a better chance of quitting and staying quit.

Getting the most from nicotine replacement

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The best time to start NRT is when you first quit. Many smokers ask if it's OK to start a program of NRT while they are still smoking. At this time the companies that make NRT products say that they should not be used if you are still smoking. There is some research being done with smokers using NRT while still smoking, but it is still too early to tell if this is dangerous to your health. The most important thing is to make sure that you are not overdosing on nicotine, which can affect your heart and blood circulation. It is safest to be under a doctor's care if you wish to try smoking and using NRT while you are tapering down your cigarette use.

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Note that NRT has not yet been proven to help people who smoke fewer than 10 cigarettes per day. You may want to talk with your doctor about a lower dose of NRT if you smoke less than half a pack per day but feel you need nicotine replacement.

When may I begin using nicotine replacement therapy?

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How do I know if I'm a light, average, or heavy smoker?

Some NRT products make their recommendations based on what kind of smoker you are. But there is no formal category in any textbook or a group that defines a light, average, or heavy smoker. In general, a light smoker is someone who smokes less than 10 cigarettes per day. Someone who smokes a pack a day or more is a heavy smoker. An average smoker falls in between.

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What are the types of nicotine replacement therapy?

The Food and Drug Administration (FDA) has approved 5 types of nicotine replacement therapy:

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The 16-hour patch works well if you are a light-to-average smoker. It is less likely to cause side effects like skin irritation, racing heartbeat, sleep problems, and headache. But it does not deliver nicotine during the night, so it may not be right for those with early morning withdrawal symptoms.

The 24-hour patch provides a steady dose of nicotine, avoiding peaks and valleys. It helps with early morning withdrawal. But there may be more side effects like disrupted sleep patterns and skin irritation.

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Depending on body size, most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5-14 mg of nicotine) for another 4 weeks. The patch should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist -- for example, on the upper arm or chest. The FDA recommends using the patch for a total of 3 to 5 months.

Side effects are related to:

• the dose of nicotine
• the brand of patch
• skin characteristics (such as the person's tendency to have a skin reaction to the patch)
• how long the patch is used
• how it is applied

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Some possible side effects of the nicotine patch include:

• skin irritation -- redness and itching
• dizziness
• racing heartbeat
• sleep problems or unusual dreams
• headache
• nausea
• vomiting
• muscle aches and stiffness

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What to do about side effects:

• Do not smoke while you are using a patch.
• Try a different brand of patch if your skin becomes irritated.
• Reduce the amount of nicotine by using a lower-dose patch.
• Sleep problems may be short-term and go away in 3 or 4 days. If not, and you're using a 24-hour patch, try switching to a 16-hour patch.
• Stop using the patch and try a different form of NRT.

Nicotine gum (nicotine polacrilex): Nicotine gum is a fast-acting form of replacement in which nicotine is taken in through the mucous membrane of the mouth. You can buy it over the counter without a prescription. It comes in 2 mg and 4 mg strengths.

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For best results, follow the instructions on the package insert. Chew the gum slowly until you note a peppery taste. Then "park" it inside your cheek, chewing it and parking it off and on for about 20 to 30 minutes. Food and drink can affect how well the nicotine is absorbed. You should avoid acidic foods and drinks such as coffee, juices, and soft drinks for at least 15 minutes before and during gum use.

If you smoke a pack or more per day, smoke within 30 minutes of waking up, or have trouble not smoking in restricted areas, you may need to start with the higher dose (4 mg). Chew no more than 20 pieces of gum in one day. Nicotine gum is usually recommended for 1 to 3 months, with the maximum being 6 months. Tapering the amount of gum chewed may help you stop using it.

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If you have sensitive skin, you may prefer the gum to the patch.

Another advantage of nicotine gum is that it allows you to control the nicotine doses. The gum can be chewed as needed or on a fixed schedule during the day. The most recent research has shown that scheduled dosing works better. A schedule of 1 to 2 pieces per hour is common. On the other hand, with an as-needed schedule, you can chew when you need it most -- when you have cravings.

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Some possible side effects of nicotine gum:

• bad taste
• throat irritation
• mouth sores
• hiccups
• nausea
• jaw discomfort
• racing heartbeat

The gum can also damage dentures and dental work.

Symptoms related to the stomach and jaw are usually caused by improper use of the gum, such as swallowing the nicotine or chewing too fast.

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Long-term dependence is one possible disadvantage of nicotine gum. In fact, research has shown that 15% to 20% of gum users who are able to quit smoking keep using the gum for a year or longer. Although the maximum recommended length of use is 6 months, continuing to use the gum is probably safer than going back to smoking. But since there is little research on the health effects of long-term nicotine gum use, most health care providers still recommend limiting its use to 6 months.

Nicotine nasal spray: The nasal spray delivers nicotine to the bloodstream as it is quickly absorbed through the nose. It is available only by prescription.

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The nasal spray relieves withdrawal symptoms very quickly and lets you control your nicotine cravings. Smokers usually like the nasal spray because it is easy to use. But the FDA warns users that since this product contains nicotine, it can allow the addiction to continue. The FDA recommends that the spray be prescribed for 3-month periods and that it not be used for longer than 6 months.

The most common side effects last about 1 to 2 weeks and can include the following:

• nasal irritation
• runny nose
• watery eyes
• sneezing
• throat irritation
• coughing

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There is also the danger of using more than is needed. If you have asthma, allergies, nasal polyps, or sinus problems, your doctor may suggest another form of NRT.

Nicotine inhalers: Inhalers are available only by prescription. The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. When you take a puff from the inhaler, the cartridge puts out a nicotine vapor. Unlike other inhalers, which deliver most of the medicine to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth. Nicotine inhalers are the FDA-approved nicotine replacement method that is most like smoking a cigarette, which some smokers find helpful.

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The recommended dose is between 6 and 16 cartridges a day, for up to 6 months.

The most common side effects, especially when first using the inhaler, include:

• coughing
• throat irritation
• upset stomach

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At this time, inhalers are the most expensive forms of NRT available. They are not the same as electronic cigarettes, which have not been proven in clinical trials to help with quitting and are not approved by the FDA. (See section, "Other nicotine and tobacco products not reviewed or approved by the FDA.")

Nicotine lozenges: Nicotine-containing lozenges as an over-the-counter aid to stop smoking are the newest form of NRT on the market. As with nicotine gum, the lozenge is available in 2 strengths: 2 mg and 4 mg. Smokers choose their dose based on how long after waking up they normally have their first cigarette.

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The lozenge manufacturer recommends using it as part of a 12-week program. The recommended dose is 1 lozenge every 1 to 2 hours for 6 weeks, then 1 lozenge every 2 to 4 hours for weeks 7 to 9, and finally, 1 lozenge every 4 to 8 hours for weeks 10 to 12. The manufacturer also recommends the following:

• Stop all smoking when you begin to use the lozenge.

• Do not eat or drink for 15 minutes before using the lozenge. (Some drinks can reduce how well the lozenge works.)

• Suck on the lozenge until it is fully dissolved, about 20 to 30 minutes. Do not bite or chew it like a hard candy, and do not swallow it. The medicine is taken in through the tissues of the mouth.

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• Do not use more than 5 lozenges in 6 hours, or more than 20 lozenges total per day.

• Stop using the lozenge after 12 weeks. If you still feel you need to use the lozenge, talk to your doctor.

• Do not use the lozenge if you keep smoking, chewing tobacco, using snuff, or use any other product containing nicotine (such as the nicotine patch or nicotine gum).

Possible side effects of the nicotine lozenge include:

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• trouble sleeping
• nausea
• hiccups
• coughing
• heartburn
• headache
• flatulence (gas)

Which type of nicotine replacement may be right for you?

There's no evidence that any one type of nicotine replacement therapy (NRT) is any better than another. When choosing which type of NRT you will use, think about which method will best fit your lifestyle and pattern of smoking. Do you want/need something to chew or occupy your hands? Or are you looking for once-a-day convenience?

 [ send green star]

Some important points to think about:

• Nicotine gums, lozenges, and inhalers are substitutes you can put into your mouth that allow you to control your dosage to help keep cravings under better control.

• Nicotine gums and lozenges are generally sugar-free, but if you are diabetic and have any doubts, check with the manufacturer.

• Nicotine nasal spray works very quickly when you need it.

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• Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler.

• Nicotine patches are convenient and only have to be put on once a day.

• Both inhalers and nasal sprays require a doctor's prescription.

• Some people may not be able to use patches, inhalers, or nasal sprays because of allergies or other conditions.

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Whatever type you use, take your NRT at the recommended dose, and for as long as it is recommended. If you use a different dose or stop taking it too soon, it can't be expected to work like it should. If you are a very heavy smoker or a very light smoker, you may want to talk with your doctor about whether your NRT dose should be changed to better suit your needs.

Combining the patch and other nicotine replacement products:

Using the nicotine patch along with shorter-acting products such as the gum, lozenge, nasal spray, or inhaler is another method of NRT. The idea is to get a steady dose of nicotine with the patch and to use one of the shorter-acting products when you have strong cravings.

 [ send green star]