Cigarette smoking has been prevalent in society for several years. Over time, some smokers have shifted from traditional cigarettes to electronic cigarettes (e-cigarettes). This trend is particularly concerning, as a significant number of smokers begin at a young age. According to the 2022 National Health and Morbidity Survey, 6.2% of school-going adolescents (Form 1 to Form 5) were found to smoke cigarettes, while 14.9% were using e-cigarettes and vapes.
Detrimental effects of smoking
Smoking poses a significant threat to health. Smoking-related diseases, such as cancer, heart disease, and chronic respiratory conditions, are major causes of approximately 20,000 deaths annually in Malaysia. The belief that e-cigarettes are less harmful has contributed to their increased use. However, scientific studies have shown that e-cigarettes can be more harmful than beneficial. In 2019, a new illness called e-cigarette or vaping product-associated lung injury (EVALI) was identified, which causes lung inflammation and can lead to fatalities.
Even brief exposure to second-hand smoke is detrimental to health, as it raises the risk of heart disease, lung cancer, and other life-threatening conditions. Second-hand smoke, or passive smoke, is the combination of smoke exhaled by smokers and the smoke emitted from the burning tip of a cigarette. Children and other vulnerable populations are particularly at risk.
The negative impacts of smoking on both smokers and those around them highlight the importance of collective action to prevent smoking initiation, especially among youth, while also ensuring accessible and effective support for those who want to quit.
How to break free from smoking?
Nicotine is the main addictive substance in smoking products. Nicotine Replacement Therapy (NRT) products help people quit smoking by delivering controlled amounts of nicotine, which reduces cravings and withdrawal symptoms, gradually lessening dependence on smoking.
The Ministry of Health (MOH) reclassified NRT products, such as gum and patches, from the ‘Group C poison’ category under the First Schedule of the Poisons Act 1952 to the non-poison classification. With this change, these products have become more accessible as over-the-counter products in pharmacies throughout Malaysia.
NRT products available in the market
NRT products should be used appropriately to ensure their effectiveness and minimize any possible unwanted effects.
- Nicotine gum
Nicotine gum should be used for up to 12 weeks, with a maximum of 24 pieces per day. Smokers should chew the gum slowly until a peppery or mint taste or tingling sensation develops. Then hold the gum between the cheek and gum to allow for nicotine absorption. Continue to chew for about 30 minutes or until the taste fades. It is important to avoid eating or drinking anything other than plain water for 15 minutes before or while chewing the gum, as this can affect the absorption of nicotine. Common side effects of nicotine gum may include mouth soreness, hiccups, dyspepsia, and jaw aches, which are usually mild and temporary
- Nicotine lozenge
Nicotine lozenge comes in two strengths; with 2 mg lozenges are for individuals who smoke fewer than 20 cigarettes a day and 4 mg for those who smoke more. It can be used for up to 24 weeks. To ensure effective absorption, the lozenge should not be chewed or swallowed, and smokers should avoid eating or drinking while it is in the mouth. Its possible side effects include nausea, vomiting, dry mouth, and discomfort in the mouth.
- Nicotine patch
Nicotine patches are applied once daily to the skin and provide a steady release of nicotine throughout the day to help reduce cravings and dependence. The patch should be placed on a clean, dry, and hairless area such as the upper arm, hip, back, or chest. Users may experience local skin reactions, which are usually mild and self-limiting but may occasionally worsen. To prevent skin irritation, it is advisable to rotate application sites with each new patch and avoid using the same spot for a week.
- Nicotine mouth sprays
Nicotine mouth sprays provide rapid craving relief by delivering nicotine through the lining of the mouth, offering a fast-acting solution for individuals trying to manage nicotine urges. One or two sprays can be used whenever cravings arise or during moments when one would usually smoke. To prevent excessive nicotine consumption, it is advised not to exceed four sprays per hour.
Let’s breathe easy
Before starting any NRT product, it is best to talk to a doctor or pharmacist. They can check for any health issues and help to choose the right type and dose of NRT based on the smoking habits. Combining a long-acting product with a fast-acting one often works better for controlling cravings. Healthcare professionals such as doctors and pharmacists may also provide guidance on how to use NRT correctly, monitor the progress, manage side effects, and adjust the plan if needed.
Smoking cessation support programmes are widely accessible at MOH healthcare facilities, where dedicated services are available to assist individuals who wish to stop smoking. Similar services are also offered through the mQuit programme at selected private healthcare facilities. The support can help to boost the chances of quitting cigarette smoking for good.
In short, while quitting smoking is not easy, it is certainly possible. With the right support, effective treatment, and guidance from healthcare professionals, smokers can overcome nicotine addiction. Using NRT and staying committed to healthier habits can make a big difference in achieving long-term success. Let us all breathe easy through quitting smoking.
If there are any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8 a.m. to 5 p.m., except on public holidays.
This article was prepared by Panisha a/p Nagaratnam (Pharmacist) from Klinik Kesihatan Buloh Kasap, Pejabat Kesihatan Daerah Segamat for Bahagian Amalan dan Perkembangan Farmasi (BAPF), KKM x The Malaysian Medical Gazette Series. It is hoped that this collaboration will help propagate information regarding medication to the general public.