Teaching with a Twist – Quitting Smoking: Why should you?

Posted on March 13, 2020   |   

This article was written by Stephanie Williams, BS, RRT

Quitting Smoking | COPD Digest

Quitting smoking. It is a subject that triggers a variety of reactions from people when you bring it up. Some people get defensive, some get argumentative, and some seem to appreciate the concern behind the question. I know this because I am one of the annoying people who will bring it up. If you have been on COPD360social a while, or if you have read other things I have posted, you might know that I am a respiratory therapist with many years of experience in caring for people in the hospital, pulmonary rehab, skilled nursing facilities, and as part of a home care team. In each of those different settings I brought up the topic of quitting smoking. And even here, on this forum, I’m doing it again.

Let’s start off by doing a little level setting. I am not going to spend time talking about the reasons you should quit – damaging your lungs, increased risk of cancer, or heart disease. If you are an adult human who has lived in proximity to the news or other media, you already know all of those things about smoking. For your own reasons, those reasons alone are not enough to motivate you to quit. So, let’s move to another level of motivation.

If you were in one of my smoking cessation classes, I would ask you why you keep trying to quit smoking. What keeps drawing you back to the notion to quit? Write that reason(s) down. Now think about why you still smoke. Think it through honestly and write it down, too. You don’t need to show these reasons to anyone – they are personal. Do you believe smoking is a habit that you can quit, or do you think it is an addiction? Several years ago, I found a simple test that can help answer that question. It is called the Fagerstrom Test and a link to it can be found here. Once you determine if you are dealing with a habit or an addiction, it can help you talk to your doctor about a plan to quit. Go ahead and take the test and score before reading on.

You are probably telling yourself that you have tried to quit many times and always end up smoking again for some reason. Believe me I understand. But here is the good news, most people have to attempt quitting several times before they are successful quitters. I would suggest that we change the way we think about those previous attempts at quitting. Instead of looking at those as failed attempts, look at them as figuring out what didn’t work for you. Maybe you just need another recipe to quit smoking for good, or maybe you are leaving a key ingredient out of the recipe you have used. You may think you used the right ingredients but missing an ingredient or skipping a step may make all the difference.

Here is my example:

My grandmother made THE BEST layered cakes in the world. No kidding – they were ah-mazing. And throughout my childhood, I would stand next to her in the kitchen while she sifted and measured and stirred the glorious cake batter. She would make these cakes for our family reunions or special occasions and most of the time they were devoured before other available desserts.

One year, she asked me if I would like to make the cakes for a family special occasion. Do you know how amazing that honor was? I was so excited to be the one to make the cake in place of my grandmother. I wanted so much to make her proud.

Well, there I stood in my kitchen – sifting and measuring and stirring, and knowing I was doing everything just like my grandmother would do. I even went and bought the same brand of flour just so I wouldn’t be taking any chances. The batter was poured into the pans and into the oven they went. So far so good . . . until it came time to turn the cakes out of their pans. I grew very nervous when it became obvious that the cakes were not coming out of those pans in one piece.

I did the only thing I knew to do. I called my grandmother. She was so patient as we went through each ingredient and I assured her that I had followed the recipe to the letter. Then she asked me the million-dollar question – had I floured the pans? Ohhhh, no. I had missed a step. I had missed a pretty important step and it completely changed the outcome.

This story is the basis for how I ran my smoking cessation classes. What if all those other times you tried to quit you were just following the wrong recipe, or you had a recipe that almost worked? What if you were just missing the right tool or combination of tools to make you successful? If you are addicted to nicotine, that is a medical problem that can require a medical intervention, so talk to your health care professional about tools they can prescribe to help you be successful, including medications, as well as over-the-counter nicotine replacement therapies like gum or lozenges. They can be extremely helpful when the urge strikes to light up.

Next, keep these points in mind as you plan to quit:

  1. Set a quit date and stick to it. Smoke your last cigarette the night before and start off fresh and smoke-free the next morning.
  2. Nicotine cravings are real, but not rational. Have you ever seen a toddler in a store pitching a fit for something they want? This is how your brain will work during cravings. Your brain will effectively be your toddler and you will have to firmly tell it ‘no’ when it pitches a fit for a cigarette. Like the parent in the store, you do not have to give in to the toddler tantrum. Let that image come to mind when you have a craving.
  3. For most people, these nicotine cravings will be at their peak around day three. After that, your brain begins to get the picture that the tantrums are not working, and it isn’t going to get what it wants.
  4. On average, a nicotine craving will last about 10 minutes. What can you do for that 10 minutes that would get you out of that situation, change your frame of mind, and keep you from smoking? Make a phone call, check the mail, go get a glass of water, eat a piece of sugar free candy, check in to COPD360social – do something to ignore that toddler brain.
  5. Find a buddy who is a non-smoker, or a never smoker, and ask them if they can be a lifeline for you. I would tell my classes to call me if they had a very strong urge to smoke that they couldn’t seem to get through. I told them that if they called me and could convince me that it was a good idea for them to go ahead and smoke, that I would come to their house and smoke a cigarette with them. As of the writing of this post, I have never had to do that – I have never been convinced. Sometimes, just talking it through can take the urge away.

Now the Twist!

Celebrity name game!

Have you heard of Six Degrees of Kevin Bacon? There is a theory that every actor in Hollywood is only separated from Kevin Bacon by six working relationships. This is a fun game and can make you think of actors or movies you haven’t thought of in a long time.

For instance, I might say Jeff Daniels. As a group, we would try to connect the relationships back to Kevin Bacon.

Here is an example:

Jeff Daniels

  • Jeff Daniels to Keanu Reeves in Speed
  • Keanu Reeves and Charlize Theron in Sweet November
  • Charlize Theron and Kevin Bacon in Trapped

And there we have it – Jeff Daniels is 3 degrees of separation from Kevin Bacon.

So here we go…

We will start with a fairly easy one. Our actor is Ben Affleck. How can we connect the dots?

Ben Affleck to Matt Damon in Good Will Hunting

Your turn!!


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  • JFC
    For me it was just a decision one morning getting ready to go to work and I just said that's it, I'm done and off I went. The only time it bothered me was all day long. At the times I would be driving and light up at this intersection gas station McDonalds and the golf course on the way into work. Once there, no problems since you can' smoke anywhere on the hospital grounds. On the way home, same thing thought about this is where I'd light up etc., etc. all the way home and so forth until I just didn't think about it any more and began to just fugedaboudit.
    I worked in surgery as a Certified Perfusionist and in tandem with the Anesthesiologist, monitor the patients physiological status as relates to the blood chemistry, pressures, volume and Ph as the case called for; repair insitu or external, transplant, or implant devices, stents etc.
    One would think I, knowing all of the dangers and being involved w pts whose lungs, even externally, revealed damage due to tobacco would not smoke.
    I wrote a paper for our Training department to hand out to the people who would be going thru the smoking cessation classes as a view of the mechanics of how the lungs work. This was reviewed by several departments and it was decided they would incorporate this into the course work in the future. Below are the first few paragraphs.

    Original Equipment Lungs
    Under Attack
    Every breath you take is a challenge to accommodate the demands of established chemistry and body mechanics. Between 17 and 22 times each minute and more often in moments of heavy exertion, the diaphragm, a horizontal wall of muscle above your abdomen, contracts and pulls the bottom of your lungs downward. At the same time the intercostal muscles woven between your ribs strains to move the upper section of your lungs upward and outward. This stretching causes the once very elastic spongy tissue of your lungs to expand, which drops the pressure of the gasses inside. Yet nature abhors even a partial vacuum, so air rushes in through your nasal passages and mouth and raises the pressure inside your lungs once more.

    A few seconds later, your diaphragm and intercostal muscles somewhat relax; the accumulation of nicotine, tar and over 400 other chemicals have inflicted their toll on the musculature of the body and relaxation is slower and never complete, even in sleep, your lungs contract slower as well, and still the air pressure inside goes up to ever decreasing levels. The body’s’ upper torso has assumed a more barrel shape. This is the body’s’ way of attempting to compensate for the loss of lung volume. This normal higher pressure inspired in the lungs causes’ air to rush out through the nose and mouth. In the course of an average day, you will repeat this cycle more than 31,000 times, taking in and pushing out more than 4,100 gallons of air. Combine an approximate decreased efficiency of approximately 65%; now consider that when you must move quickly or exert more energy, your body can not provide the efficiency you have always counted upon. Walking at a normal rate will cause you to stop every 50-60 ft. to try to catch your breath
    This external respiration is only the most obvious of the three steps of breathing. In the next process, internal respiration, incoming air is funneled through a deteriorating elaborate, branching network of lung passages and filtered down into more than 230 million microscopic sacs, or alveoli, each one of which is surrounded by daily decreasing equally minute blood vessels, or capillaries. Here, oxygen is harvested from air breathed in, or “inspired,” a moment earlier and passed through the walls of both alveoli and capillaries, then attached to red blood cells to be carried throughout the body. This exchange is reduced now to 55% of its original capacity and the respiratory rate increases, the muscles begin to strain and weaken and the body tells the brain: STOP and recover.
    At the same time, carbon dioxide (CO2) is passed back from the capillaries to the alveoli, to be expelled when we breathe out, or “expire.” This exchange, prior to the exposure to the tobacco smoke was 100% efficient. It has now been reduced to just over 48% capacity and 41% efficiency. The lungs are straining, the heart is becoming overtaxed and the muscles are never completely satisfied. The system is constantly “short” on life sustaining O2.
    Finally there is cellular respiration, as a reduced volume of oxygen rich blood travels from the lungs to all living tissue in the body, where the exchange process that took place within the lungs is repeated at the cellular level, and the oxygen generated blood is traded for CO2. The exchange is now being stretched to the extreme levels of efficiency. The brain and cardiac muscles will demand their “fair share” of the much needed oxygen to continue their vital operation but the other parts of the anatomy require adequate O2 to accomplish their tasks as well. The volume is just not there anymore.

    The air we breathe in is more like the gas we push out of our lungs than you might think. Incoming air contains about 20% oxygen, with less than 1% CO2 and water vapor; the rest is nitrogen, trace gasses and particulate matter. The air we exhale is still about 16% oxygen but now contains around 4% CO2 and 6% water vapor. This high oxygen content explains why the life-saving technique of mouth-to-mouth resuscitation actually works, rather than suffocating the person in distress. Now you know this little tidbit.
    Specialized cells called chemoreceptors constantly monitor oxygen and carbon dioxide levels in the blood, then signal the brain to speedup or slow down the respiration rate. Our breathing is so efficient that we usually make use of only one-fifth of our lungs’ capacity to process air. Just smoking one pack of even low-tar nicotine per day for 10 years decreases O2 exchange by 10%. This is barely noticeable. Consider the difference for the body that has had 20 years of one pack per day exposure. This exchange rate is now down 27%. This is approximately a 150% increase in just double the time. Now consider an exposure of 30 years and 40 years. These are just one pack a day exposure rates. Try 1.5 to 2 full packs per day and you can begin to see why the body is just incapable of providing the energy required to just do the basic movements with out over exertion A final wonder: air that enters our body through our mouth or nostrils was heated or cooled to within three degrees or so of body temperature by the time it reached the lungs, regardless of how hot or cold it was when first inspired, a second or less earlier years before the tobacco and associated gasses took their toll. The air is now just warmed to about half of what it once was because the cilia structures in our nasal, pharyngeal, terminal bronchioles; whose function is to filter, warm, and moisten air and conduct it into the lungs, and thoracic structures have decreased never again to be replaced.

    • Thanks for sharing this - sometimes it is good to step back and just look objectively at what happens when someone smokes. For some people, they have to approach it from a very logical, data driven perspective. I am sure there will be people who benefit here from what you wrote :) Thanks again!
  • Matt Damon and Julia Roberts in Ocean's Eleven
  • Julia Roberts - Kevin Bacon in Flatliners 1990

  • How about Harrison Ford? How can we connect him?
  • This is one I may have to have a lot of help on this one: Scarlett Johansson :)
  • So... now I have a craving for bacon!!! :-)
  • This game requires to much thinking for me-------I think
  • How about Nicholas Cage?
    • Nicolas Cage - Olympia Dukas in Moonstruck
    • Olympia Dukakis & Kevin Bacon in PICTURE PERFECT
    • You and I could clean up in a bar version of this game, JeanO53. LOL!
    • LOL!! :-)
  • I am just registering as a new member here. Hello ! Dr Muthu here. The content of such articles and the respones are an amazing service to the fraternity . Very inspiring. One of the most important overlooked skill that we as physicians need to practice and display is "Talking or marketing skills". We have to work on it and use communication skills so effectively when helping our client with habits like smoking or other unhealthy addictive lifestyle choices. I am learning a lot from here as i spend more time reading thru the works of Ms. Stephanie williams and the likes. I got recently board certified by the American College of Lifestyle Medicine and that has immensely helped me with Motivational interviewing skills and use of tools like 5As. Kudos! Keep it up!

    Muthu Integrative and Lifestyle Pulmonary