08 May

COPD: Overview of Definitions, Epidemiology, and Factors Influencing Its Development: Nicotine

It is now recognized that nicotine is an addicting psychoactive drug. It is capable of inducing euphoria, an effect that depends both on the absolute level and the rate of rise in the concentration of nicotine at specific receptors in the brain. It is for this reason that smoking, which delivers large doses of nicotine directly into the arterial circulation, is a preferred route of self-administration. Current concepts suggest that the addicting potential of a psychoactive drug depends on its peak effects while its withdrawal syndrome depends, at least in part, on reduction in blood levels below a certain threshold. This has led to the concept of nicotine replacement therapy. The strategy is to administer nicotine by a route that is capable of at least partially ameliorating nicotine withdrawal symptoms, allowing the addicted individual to deal with the behavioral aspects associated with smoking without suffering the physiologic consequences of withdrawal. After dealing with the behavioral aspects, an addicted smoker can then taper the nicotine. Currently available forms of nicotine replacement appear to sustain blood levels approximately half that of the IV2 pack per day smoker and partially ameliorate, but do not eliminate, withdrawal symptoms. Importantly, nicotine replacement can increase quit rates, perhaps by a factor of two. Even so, most programs used to date achieve only 30 to 40% quit rates These quit rates, moreover, are generally reported from smoking cessation clinics or smoking cessation studies where the population is likely to be highly selected for individuals wishing to quit. Smokers seen routinely in physicians’ offices generally have much lower quit rates, although both nicotine replacement and behavioral interventions can be effective in this setting as well. As newer strategies to aid smokers in quitting become developed, their implementation is likely to have an important impact on the prevalence of COPD, although the impact will likely be delayed due to the prolonged natural history of the condition. buy zyrtec online

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